Managing pain during mediastinal chest tube removal.
OBJECTIVE
To compare four analgesic regimens used in preparing patients for chest tube removal.


METHODS
Prospective, randomized, controlled multiple-group comparison.


METHODS
Mid-atlantic university affiliated tertiary medical center.


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


METHODS
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.


METHODS
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.
Carson
M M
MM
University of Virginia Health Sciences Center, Charlottesville.
Barton
D M
DM
Morrison
C C
CC
Tribble
C G
CG
D000368:Aged; D000698:Analgesia / Q000451:nursing; D006348:Cardiac Surgical Procedures; D015505:Chest Tubes / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D011182:Postoperative Care; D011446:Prospective Studies
D009020:Morphine; D008012:Lidocaine