title: Chest drain removal pain and its management: a literature review.
abstract: OBJECTIVE
  The purpose of this review was to analyse critically the published research on chest drain removal pain and its management. The findings of descriptive and non-pharmacological intervention studies were summarized and studies of analgesic efficacy were critiqued in depth.
  
  
  BACKGROUND
  The removal of a chest drain is a painful and frightening experience, particularly for children. However, there is limited research regarding the amount of pain experienced or effectiveness of analgesia for this procedure.
  
  
  RESULTS
  Fourteen studies were reviewed, including five descriptive studies; three studies of non-pharmacological interventions; and six randomized controlled trials of morphine, local anaesthetics and Entonox. The search revealed only two paediatric studies. Many of the studies had design limitations or were poorly reported. The majority of studies indicated that patients experienced moderate to severe pain during chest drain removal, even when morphine or local anaesthetics were given.
  
  
  CONCLUSIONS
  Morphine alone does not provide satisfactory analgesia for chest drain removal pain. Non-steroidal anti-inflammatory drugs, local anaesthetics and inhalation agents may have a role to play in providing more effective analgesia for this procedure.
  
  
  CONCLUSIONS
  Analgesic protocols for the management of painful procedures such as chest drain removal are unsatisfactory and practice in this area should be revised. More research is needed to determine the efficacy of drugs other than morphine, particularly Entonox and to investigate multi-modal techniques of management further.
authors.affiliation: Great Ormond Street Hospital for Children NHS Trust, London, UK. L.Bruce@ich.ucl.ac.uk
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bruce
authors.forename: Richard F
authors.initials: RF
authors.lastname: Howard
authors.forename: Linda S
authors.initials: LS
authors.lastname: Franck
mesh_terms: D000328:Adult; D000367:Age Factors; D000698:Analgesia / Q000379:methods* / Q000451:nursing / Q000592:standards; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019162:Anesthetics, Combined / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015505:Chest Tubes / Q000009:adverse effects*; D002648:Child; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D006801:Humans; D009020:Morphine / Q000627:therapeutic use; D009609:Nitrous Oxide / Q000627:therapeutic use; D010100:Oxygen / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D012107:Research Design; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; C001147:Entonox; D009020:Morphine; D009609:Nitrous Oxide; D010100:Oxygen