Kathleen Puntillo1, S Jill Ley. 1. School of Nursing, University of California, San Francisco, San Francisco, Calif, USA.
Abstract
BACKGROUND:Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain. OBJECTIVE: To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients. METHODS: Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time. RESULTS:Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered. CONCLUSIONS: If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.
RCT Entities:
BACKGROUND:Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain. OBJECTIVE: To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients. METHODS: Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time. RESULTS:Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered. CONCLUSIONS: If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.
Authors: Kathleen A Puntillo; Adeline Max; Jean-Francois Timsit; Stephane Ruckly; Gerald Chanques; Gemma Robleda; Ferran Roche-Campo; Jordi Mancebo; Jigeeshu V Divatia; Marcio Soares; Daniela C Ionescu; Ioana M Grintescu; Salvatore Maurizio Maggiore; Katerina Rusinova; Radoslaw Owczuk; Ingrid Egerod; Elizabeth D E Papathanassoglou; Maria Kyranou; Gavin M Joynt; Gaston Burghi; Ross C Freebairn; Kwok M Ho; Anne Kaarlola; Rik T Gerritsen; Jozef Kesecioglu; Miroslav M S Sulaj; Michelle Norrenberg; Dominique D Benoit; Myriam S G Seha; Akram Hennein; Fernando J Pereira; Julie S Benbenishty; Fekri Abroug; Andrew Aquilina; Julia R C Monte; Youzhong An; Elie Azoulay Journal: Intensive Care Med Date: 2018-08-21 Impact factor: 17.440
Authors: Valdecy Ferreira de Oliveira Pinheiro; José Madson Vidal da Costa; Marcelo Matos Cascudo; Ênio de Oliveira Pinheiro; Maria Angela Ferreira Fernandes; Ivonete Batista de Araujo Journal: Rev Lat Am Enfermagem Date: 2015 Nov-Dec
Authors: Min Soo Kim; Sumin Shin; Hong Kwan Kim; Yong Soo Choi; Jhingook Kim; Jae Ill Zo; Young Mog Shim; Jong Ho Cho Journal: Korean J Thorac Cardiovasc Surg Date: 2018-08-05
Authors: Kathleen Puntillo; Judith Eve Nelson; David Weissman; Randall Curtis; Stefanie Weiss; Jennifer Frontera; Michelle Gabriel; Ross Hays; Dana Lustbader; Anne Mosenthal; Colleen Mulkerin; Daniel Ray; Rick Bassett; Renee Boss; Karen Brasel; Margaret Campbell Journal: Intensive Care Med Date: 2013-11-26 Impact factor: 17.440