The use of ice for pain associated with chest tube removal

Every year more than 300,000 patients undergo cardiothoracic surgery, requiring placement of at least one chest tube. Removal of these chest tubes has been described as one of the worst intensive care unit experiences for these patients. Pain associated with chest tube removal (CTR) has been poorly controlled in many surgical patients. The purpose of this experimental study was to ascertain if the application of ice would decrease pain before, during, and after chest tube removal. Fifty postcardiac surgery patients were randomly assigned to two groups. The experimental group received ice therapy before CTR, whereas control subjects received a placebo. Pain intensity and pain distress were measured on a 0-10 numeric rating scale, and pain quality was measured using the McGill Pain Questionnaire-Short Form (MPQ-SF). Differences in pain intensity and pain distress between the experimental and control groups were not significant. A significant change in pain over time was noted in both groups, with pain intensity and distress being most severe during actual chest tube removal. Additionally, patients who received preprocedural pain medication did not differ in their levels of pain intensity or distress. Both groups used all the quality descriptors on the MPQ-SF for the sensory and affective components of pain, with cramping and gnawing as the most frequently chosen words. Continued research with larger samples is encouraged to further evaluate ice and other interventions that can be used to manage pain associated with CTR.