Managing pain during mediastinal chest tube removal.

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.