Effect of Superficial Cooling on Pain Associated with Chest Tube Removal after Thoracotomy

Abstract

Removal of chest tube is considered to be very painful procedure that has been poorly controlled. Cold application, as a non-pharmacological intervention has been used successfully in many pain control situations. However, its application to control pain associated with chest tube removal has not been intensively studied. Objectives: The resent study aims at identifying the effect of superficial cooling on pain associated with chest tube removal after thoracotomy. Design: A quasi experimental research design was applied. Setting: This study was conducted in the Intensive Care Unit of Open Heart Surgery [OHS] at Mansoura Main University Hospital. Sample: Fifty adult patients of both sexes admitted to OHS intensive care unit after thoracotomy and having at least one chest tube in the immediate postoperative period. Method: Before removal of the chest tube, superficial cooling was applied for 20 minutes around the tube port only to 25 patients [the intervention group], the rest of patients formed the control group. Three tools were used: the “Chamber-Price modified pain rating scale” to assess patient conditions and the physiological and behavioral parameters of patients’ pain, the “standardized linear scale for pain assessment” to measure both pain intensity and pain distress and the “modified McGill pain questionnaire-short from” to measure the sensory and affective pain descriptors. Data were collected 4 times: before superficial cooling, before, immediately after, and 10 minutes after chest tube removal. Results: Data revealed that patients suffered from a mild to moderate pain due to chest tube removal. The pain intensity scores and the pain distress scores decreased significantly after superficial cooling application. A significant increasing trend in these score was found among the control group. This suggests an analgesic effect of superficial cooling. Sensory descriptors were more used than the affective ones to describe pain. Conclusion: It can be concluded that superficial cooling can be an efficient non-pharmacologic intervention used by nurses to reduce pain associated with chest tube removal. Recommendations: Regular assessment of pain quality and intensity among ICU patients undergoing painful procedures and integration of pharmacologic and non-pharmacologic interventions for pain reduction are strongly recommended.