Pneumothorax Medication

Updated: May 09, 2022
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Medication Summary

A tension pneumothorax requires treatment with rapidity. However, anesthetics and analgesics should be used if the patient is not in distress. The goals of pharmacotherapy are to reduce morbidity and to prevent complications. In addition to the medications discussed in this section, talc may be used as a sclerosing agent for pleurodesis by mixing 2-5 g in 250 mL of sterile isotonic sodium chloride solution to form a slurry or poudrage. Note that acute respiratory distress syndrome (ARDS) has been reported after use of talc as a pleural sclerosing agent, but this is considered a rare complication.


Local Anesthetics

Class Summary

Local anesthetic agents are used for analgesia for thoracentesis and chest tube placement.

Lidocaine hydrochloride (Xylocaine, LidaMantle, Anestacon)

Lidocaine hydrochloride is a local anesthetic that may be absorbed following topical administration to mucous membranes. Its rate and extent of absorption depends on the specific site of application, duration of exposure, concentration, and total dosage. This drug acts by decreasing the permeability to sodium ions in neuronal membranes, resulting in the inhibition of depolarization, and blocking the transmission of nerve impulses. Adverse effects with the use of lidocaine hydrochloride as a local anesthetic include allergic reactions.


Opiate Analgesics

Class Summary

Opiate analgesic agents are used for pain control, which is essential to good patient care, ensures patient comfort, and promotes pulmonary toilet. Most analgesics have sedating properties, which are beneficial for patients with painful skin lesions. These drugs are important in the initial placement of thoracostomy tubes and for controlling pain after the procedure.

Fentanyl citrate (Sublimaze)

The onset of analgesia with fentanyl citrate is immediate with intravenous (IV) administration, and the duration of analgesia is 30-60 minutes. However, the respiratory depressant effect may last longer than analgesia. The dose should be individualized, and vital signs should be monitored in routinely.

Morphine (Astramorph, Infumorph 200, MS Contin, Oramorph SR)

Morphine is the drug of choice for analgesia because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

In adults, the initial dose is given intravenously and titrated for effect. Recommended doses begin at 0.1 mg/kg, but practically the regimen is 1-2 mg IV. The dose may be repeated at frequent intervals until analgesia is reached, and then the interval is lengthened. For most adults, the usual upper limit during the acute event is 10-15 mg over the first 4 hours. Morphine IV, delivered via patient-controlled analgesia machines, is set to get 1-2 mg on demand every 6 minutes, with a 4-hour lockout of 30 mg. Conversion to oral narcotics is accomplished as soon as possible.

In neonates, the dose is 0.05-0.2 mg/kg IV/IM/SC as needed; in children, the dose is 0.1-0.2 mg/kg IV/IM/SC q2-4h as needed. As in adults, the IV doses vary and the drug should be titrated for the desired effect.



Class Summary

Benzodiazepines are used for conscious sedation. These agents are useful for premedication before pleurodesis/sclerotherapy or placement of a thoracostomy tube.


Benzodiazepine used for sedation component of conscious sedation protocol. Onset of action occurs within 1-5 min. Half-life of 1-4 h. Prolonged with liver cirrhosis, congestive heart failure, obesity, and old age.

Lorazepam (Ativan)

Lorazepam is a sedative hypnotic with a short onset of effects and a relatively long half-life. This drug acts by increasing the action of gamma aminobutyric acid (GABA), a major inhibitory neurotransmitter in the brain. However, lorazepam may depress all levels of the central nervous system (CNS), including the limbic and reticular formations.

The initial adult dose is 2 mg total or 0.044 mg/kg IV, whichever is smaller. Alternatively, administer 0.05 mg/kg IV, not to exceed 4 mg/dose.

In children, the dose is 0.05-0.1 mg/kg IV slowly over 2-5 minutes; a slow 0.5 mg/kg IV dose may be repeated.



Class Summary

In patients with repeated pneumothoraces who are not good candidates for surgery, pleurodesis (or sclerotherapy) may be necessary. Two major sclerosing agents that can be used are talc and doxycycline. Prophylactic antibiotics are not recommended for the placement of chest tubes in nontraumatic causes.

Doxycycline (Vibramycin, Vibra-Tabs, Doryx)

Doxycycline is broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Cefazolin (Kefzol)

Cefazolin is a first-generation cephalosporin. According to the Eastern Association for the Surgery of Trauma (EAST) Practice guidelines, a first-generation cephalosporin should be administered for no longer than 24 hours after tube thoracostomy.