Puntillo K A
Department of Physiological Nursing, University of California, San Francisco 94143-0610, USA.
Am J Crit Care. 1996 Mar;5(2):102-8.
Moderate to severe pain associated with the removal of pleural chest tubes is poorly controlled with opioids. New methods are needed to manage the pain associated with this procedure.
To compare the effects of interpleural injections of 0.25% bupivacaine without epinephrine to those of normal saline on chest tube removal pain in cardiothoracic surgery patients.
A randomized, double-blind, placebo-controlled trial was used, with a repeated measures design. Pain intensity and distress were measured before, immediately after, and 1 hour after chest tube removal. Pain sensations and affect were evaluated immediately after chest tube removal. The experimental group (n = 21) received bupivacaine and the control group (n = 20) received normal saline.
In both groups pain intensity and distress scores were significantly higher at the time of chest tube removal than immediately before or 1 hour after. No significant differences in pain intensity, distress, sensation, or affect scores were found between the two treatment groups. The 13 patients who received intramuscular ketorolac an average of 3.5 hours before the procedure, independent of the study design, had significantly lower pain intensity scores at the time of chest tube removal than the 26 who did not.
These data demonstrate that chest tube removal pain is of moderate to severe intensity and that pleural chest tube injections of bupivacaine were not effective in decreasing chest tube removal pain. However, the decrease in pain associated with the administration of ketorolac warrants future study.
与拔除胸腔引流管相关的中重度疼痛，使用阿片类药物难以有效控制。需要新的方法来处理与该操作相关的疼痛。
比较在心胸外科手术患者中，胸膜腔内注射不含肾上腺素的0.25%布比卡因与注射生理盐水对拔除胸腔引流管时疼痛的影响。
采用随机、双盲、安慰剂对照试验，并采用重复测量设计。在拔除胸腔引流管前、拔除后即刻以及拔除后1小时测量疼痛强度和痛苦程度。在拔除胸腔引流管后即刻评估疼痛感觉和情感反应。实验组（n = 21）接受布比卡因，对照组（n = 20）接受生理盐水。
两组在拔除胸腔引流管时的疼痛强度和痛苦程度评分均显著高于拔除前即刻或拔除后1小时。两个治疗组在疼痛强度、痛苦程度、感觉或情感反应评分方面未发现显著差异。与研究设计无关，在操作前平均3.5小时接受肌肉注射酮咯酸的13例患者，在拔除胸腔引流管时的疼痛强度评分显著低于未接受注射的26例患者。
这些数据表明，拔除胸腔引流管时的疼痛为中重度，胸膜腔内注射布比卡因对减轻拔除胸腔引流管时的疼痛无效。然而，与酮咯酸给药相关的疼痛减轻值得未来进一步研究。
