title: Chest tube insertion: a prospective evaluation of pain management.
abstract: OBJECTIVE
  To evaluate pain associated with chest tube insertion in a group of patients with malignant pleural effusions.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Acute care cancer center in an academic institution.
  
  
  METHODS
  Fifty-two patients with symptomatic malignant pleural effusions. Twenty-six evaluated by conventional approach to chest tube insertion (group 1), 26 evaluated after institution of a new chest tube protocol (group 2).
  
  
  METHODS
  A new protocol was designed to improve pain control during chest tube insertion. The protocol included improved housestaff and nursing education, premedication, proper insertion techniques, and more liberal and precise delivery of local anesthetic.
  
  
  METHODS
  Both groups were evaluated by a verbal self-report scale (1-10) to assess pain and anxiety.
  
  
  RESULTS
  The mean pain rating in group 1 was 6.2 (+/-0.76) compared with 3.7 (+/-5.6) in group 2 (p < 0.01). In group 1, pain or anxiety was 9 or 10 in 12 of 26 on a scale of 1 to 10, compared with 2 of 26 in group 2 (p < 0.001). Anxiety rating was 4.5 (+/-0.72) in group 1 compared with 1.5 (+/-0.54) in group 2 (p < 0.01).
  
  
  CONCLUSIONS
  Chest tube insertion was associated with an unacceptably high level of pain and anxiety in our hospital. A new protocol, including housestaff education and changes in nursing policies, technical aspects, local anesthetic dose and delivery, and pre-medication, allowed us to approach the goal of a painless chest tube insertion.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer enter, New York, New York, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Luketich
authors.forename: M
authors.initials: M
authors.lastname: Kiss
authors.forename: J
authors.initials: J
authors.lastname: Hershey
authors.forename: G K
authors.initials: GK
authors.lastname: Urso
authors.forename: J
authors.initials: J
authors.lastname: Wilson
authors.forename: M
authors.initials: M
authors.lastname: Bookbinder
authors.forename: R
authors.initials: R
authors.lastname: Ginsberg
mesh_terms: D001007:Anxiety / Q000523:psychology; D015505:Chest Tubes; D006801:Humans; D007440:Intubation / Q000009:adverse effects*; D010146:Pain / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement; D010166:Palliative Care / Q000592:standards*; D016066:Pleural Effusion, Malignant / Q000628:therapy; D011446:Prospective Studies; D012649:Self Concept