Intraoperative placement of a purse-string suture around the drain exit site reduces pain associated with subdural drain removal

Abstract

BackgroundUse of surgical skin staples to close the subdural drain exit site after drain removal is often associated with pain. This prospective study compared the degree of pain between staple closure and a technique in which a purse-string suture is placed around the exit site the time of the operation in consecutive patients who underwent one-stage surgery for bilateral chronic subdural hematoma. MethodsIn each patient, on one side, a purse-string suture that was later manually ligated immediately after drain removal was placed around the drain exit site during the operation. On the other side, the drain exit site was closed using staples immediately after drain removal. Pain scores were compared according to method of drain exit site closure. ResultsTwenty-two patients were included for analysis. The mean Numerical Rating Scale score was significantly lower in the suture group than in the staple group (3.7 ± 2.2 vs. 7.3 ± 2.1; p < 0.001). The mean Verbal Rating Scale score was also significantly lower in the suture group (2.2 ± 0.8 vs. 3.8 ± 0.9; p < 0.001). ConclusionPain related to subdural drain removal can be reduced by use of a purse-string suture that is placed around the drain exit site during surgery and subsequently manually ligated immediately after drain removal.