Intrapleural therapy for the prevention of recurrent spontaneous pneumothorax-A Randomized Comparative Evaluation of Bleomycin Pleurodesis & Autologous Blood Pleurodesis Mudassir A. Khan, M. Akbar Bhat, A. Majeed, Naveed Khan, Faheem, Hilal, Saima N, Asif M. BACKGROUND: Pneumothorax is free air in pleural space i.e. between visceral and parietal pleura. Among various treatment options for recurrent pneumothorax, one is chemical pleurodesis; intended to achieve a symphysis between parietal and visceral pleura, in order to prevent accumulation of air (pneumothorax) in the pleural space. OBJECTIVE: Our objectives in this study were to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in primary spontaneous recurrent pneumothorax and to compare the efficiency, side effects, cost and complications of autologous blood pleurodesis vis a vis bleomycin pleurodesis. STUDY DESIGN: It was a prospective randomized comparative evaluation of autologous blood & bleomycin pleurodesis involving patients with persistent air leak resulting due to primary spontaneous recurrent pneumothorax. We followed the patients for a period of 1-22 months with average follow up of 11.766 months. METHODS: The study entitled, “Intrapleural therapy for the prevention of recurrent spontaneous pneumothorax-A Randomized Comparative Evaluation of Bleomycin Pleurodesis & Autologous Blood Pleurodesis” was carried out in the department of CVTS, SKIMS Srinagar Kashmir from May 2010 to Oct 2012. Total of thirty (30) patients with primary spontaneous recurrent pneumothorax were included in the study; 16 patients in Study Group (receiving autologous blood) & 14 patients in Control Group (receiving bleomycin). On an average 54.7ml (1ml/kg body weight) of peripheral venous blood taken from the patient's arm vein was immediately injected into the pleural cavity via the chest tube & chest tube was clamped for 1-2hrs. In bleomycin pleurodesis at 15 min after instillation of 20 ml of lidocaine 1%, about 55.7 units (1 iu/kg body wt.) of bleomycin in 100 ml of normal saline were instilled into the pleural cavity via the chest tube and the tube clamped for 1-2hrs. RESULTS: One (6.3%) patient in the Study group had failure of cessation of air leak after blood patch pleurodesis. Hence the success rate of cessation of air leak in Control group was 100% while as it is 93.7% in Study group (p-value=0.178, insignificant). In Study group 3(18.8%) patients had post-procedure pain but none had fever; while as in Control group 13(92.9%) patients had post-procedure pain & 6(42.9%) patients had fever. None of the patients from Study as well as Control groups had post-procedure empyema, tension pneumothorax, anaphylaxis, chest tube clogging or progressive respiratory failure. Per patient average cost of the procedure in Study group was Rs 53.13, while the average cost of procedure per patient in Control group was Rs1925.00 (p-value ≤0.0001). After 1-22 months (average 11.76) follow up, in Study group 3(20%) out of 15 patients had recurrence, and also in Control group 3(21.4%) out of 14 patients had recurrence of pneumothorax.( p-value (0.44) insignificant). CONCLUSION: The effectiveness of blood pleurodesis in cessation of air leak is approaching to that of bleomycin pleurodesis with similar recurrence rates in both groups. However the incidence of immediate post-procedure pain and fever is much higher in patients of bleomycin pleurodesis. Also compared to bleomycin, the autologous blood pleurodesis is very much cost effective. Our limited experience indicates that pleurodesis with self-donated blood is an easy-to-perform, painless, convenient, rapid and inexpensive procedure that is moderately effective in the short and medium term.