Friday August 25, 2006
Pain management during chest tube removal !


It is important to know that chest tube removal is a painful procedure and pain could be moderate to severe in intensity. Most of the discomfort of chest tube removal relates to the initial movement of the tube.

Patient should receive some kind of analgesic prior to chest tube removal. Per one survey only 16% of nurses indicated that a prescription for pain medication was routinely available before chest tube removal 1. One study advocate administration of analgesic 20 minutes prior of removal of chest tube with either choice of morphine or ketorolac 2. Unfortunately, chest tube removal are poorly controlled with opioids and low dose morphine doesn't help much and morphine upto 4 mg may be required 2. In cases where narcotics are of concern, ketorolac is found to be a good choice. Intrapleural administration of bupivicaine did not show any benefit 3.

One interesting study was done few years ago, where EMLA (topical lidocaine 2.5% and prilocaine 2.5%) cream applied 3 hours prior to chest drain removal was more effective than IV morphine. EMLA cream can give analgesia to a depth of 5mm 4.



References: click to get article/abstract

1. Chest tube removal practices in critical care units in the United States. - Am J Crit Care. 1995 Nov;4(6):419-24.

2. Appropriately Timed Analgesics Control Pain Due to Chest Tube Removal - American Journal of Critical Care. 2004;13: 292-302

3. Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial - Am J Crit Care.1996 Mar;5(2):102-8.

4. Topical Lidocaine - Prilocaine Cream (EMLA) for thoracostomy tube removal. Anesth Analg 1999;88:1107-8.