Managing pain during mediastinal chest tube removal

Abstract

Objective: To compare four analgesic regimens used in preparing patients for chest tube removal.

Design: Prospective, randomized, controlled multiple-group comparison.

Setting: Mid-atlantic university affiliated tertiary medical center.

Patients: 80 adult patients who underwent heart surgery and who had two mediastinal chest tubes.

Outcome measures: Subject's pain intensity rating on a 0 to 100 mm visual analog scale and subject's description of sensations blindly rated by six nurses.

Intervention: Before chest tube removal, subjects were medicated with either: (1) intravenous morphine sulfate (morphine), (2) intravenous morphine and subfascial angiocatheter lidocaine hydrochloride (lidocaine), (3) intravenous morphine and subfascial angiocatheter normal saline solution, or (4) subfascial angiocatheter lidocaine.

Results: Mean pain rating scores for groups 1, 2, 3, and 4 were 43.7 40.9, 36.4, and 38.1, respectively. Analysis of variance showed no significant difference between scores (p = 0.8948). The percentage of comments rated as "not bad at all" or "not bad" for groups 1, 2, 3, and 4 were 56%, 83%, 47% and 75%, respectively. Chi-square analysis showed a significant difference between ratings (p < 0.01).

Conclusions: Blind ratings of subjects' descriptions of sensations suggest subfascial lidocaine may be useful in reducing discomfort during chest tube removal.