Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Puntillo
K A
KA
Department of Physiological Nursing, University of California, San Francisco 94143-0610, USA.
D000368:Aged; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002045:Bupivacaine; D006348:Cardiac Surgical Procedures; D015505:Chest Tubes; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020910:Ketorolac; D008297:Male; D009020:Morphine; D015999:Multivariate Analysis; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011182:Postoperative Care; D013903:Thoracic Surgery; D014046:Tolmetin / Q000031:analogs & derivatives
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D014046:Tolmetin; D002045:Bupivacaine; D020910:Ketorolac