CHEST TUBE INSERTION - A PROSPECTIVE EVALUATION OF PAIN MANAGEMENT

Objective: To evaluate pain associated with chest tube insertion in a group of patients with malignant pleural effusions. Design: Prospectiv e case series. Setting: Acute care cancer center in an academic instit ution. Patients: Fifty-two patients with symptomatic malignant pleural effusions. Twenty-six evaluated by conventional approach to chest tub e insertion (group 1), 26 evaluated after institution of a new chest t ube protocol (group 2). Interventions: A new protocol was designed to improve pain control during chest tube insertion. The protocol include d improved housestaff and nursing education, premedication, proper ins ertion techniques, and more liberal and precise delivery of local anes thetic. Outcome Measures: Both groups were evaluated by a verbal self- report scale (1-10) to assess pain and anxiety. Results: The mean pain rating in group 1 was 6.2 (+/-0.76) compared with 3.7 (+/-5.6) in gro up 2 (p < 0.01). In group 1, pain or anxiety was 9 or 10 in 12 of 26 o n a scale of 1 to 10, compared with 2 of 26 in group 2 (p < 0.001), An xiety rating was 4.5 (+/-0.72) in group 1 compared with 1.5 (+/-0.54) in group 2 (p < 0.01). Conclusions: Chest tube insertion was associate d with an unacceptably high level of pain and anxiety in our hospital. A new protocol, including housestaff education and changes in nursing policies, technical aspects, local anesthetic dose and delivery, and premedication, allowed us to approach the goal of a painless chest tub e insertion.