Cold application for pain and anxiety reduction following chest tube removal : A systematic review and meta-analysis

Abstract

Background and Objective: Data on the effects of cold application on reducing pain and anxiety after chest tube removal (CTR) are inconsistent. This study aimed to conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after CTR.Methods: We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System, and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomized controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration’s tool was used to assess the risk of bias, and Review Manager 5.4 was used to conduct the meta-analysis.Results: Ten RCTs with 623 participants were included in the meta-analysis. The use of cold application could effectively reduce immediate pain and had persistent effects on pain after CTR. There were significant effects of cold application on reducing anxiety. The meta-regression showed that a drop in skin temperature to the 13°C target of cold application was significantly more effective for the immediate reduction in pain intensity compared with receiving up to 20 minutes target of cold application.Conclusion: Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. In particular, skin temperature drops to the 13°C target of cold application were effective for immediate reduction of pain intensity following CTR.