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Chest drain removal pain and its management: a literature review
Elizabeth A Bruce1, Richard F Howard, Linda S Franck
1Great Ormond Street Hospital for Children NHS Trust, London, UK. L.Bruce@ich.ucl.ac.uk
Insights
Chest drain removal causes significant pain, with current analgesia often inadequate. Further research into multimodal pain management strategies is crucial for improving patient comfort.
Area of Science:
- Pain Management
- Thoracic Surgery
- Evidence-Based Medicine
Background:
- Chest drain removal is a painful procedure, especially for pediatric patients.
- Limited research exists on the pain experienced and the effectiveness of analgesia for this intervention.
Purpose of the Study:
- Critically analyze published research on chest drain removal pain and its management.
- Summarize findings from descriptive and non-pharmacological intervention studies.
- Critique analgesic efficacy studies in depth.
Main Methods:
- Systematic review of 14 studies (5 descriptive, 3 non-pharmacological, 6 RCTs).
- Included studies evaluated morphine, local anesthetics, and Entonox.
- Limited inclusion of pediatric-specific studies.
Main Results:
- Most studies reported moderate to severe pain during chest drain removal.
- Even with morphine or local anesthetics, pain relief was often insufficient.
- Significant design limitations and poor reporting were noted in many studies.
Conclusions:
- Current analgesic protocols for chest drain removal are unsatisfactory.
- Morphine alone is insufficient for adequate pain relief.
- Non-steroidal anti-inflammatory drugs, local anesthetics, and inhalation agents show potential for improved analgesia.
Aims And Objectives:
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.
Relevance To Clinical Practice:
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.
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