Cold Therapy and Respiratory Relaxation Exercise on Pain and Anxiety Related to Chest Tube Removal

Abstract

Background: Current strategies to control pain and anxiety of chest tube removal are not efficacious. The aim of this study is to determine the effects of cold therapy and respiratory relaxation exercise on pain and anxiety of chest tube removal. Materials and Methods: A parallel single-blind clinical trial study was conducted in Imam Khomeini Hospital, Iran, on 120 patients. Participants were randomized into 4 groups of 30. Numeric Rating Scale was used to assess pain and anxiety. One-way ANOVA test and Fisher's exact test were used to analyze demographic data. The Kruskal–Wallis test was used to compare the severity of pain and anxiety between groups; the Friedman and Mann–Whitney test were used to compare the severity of pain and anxiety within groups with a significance level of 0.05. Results: Pain intensity was weak before chest tube removal and there was no significant difference in basal pain. Pain immediately after chest tube removal was significantly higher than other times in each group (χ 2 = 57.16, χ 2 = 63.70, χ2 = 46.49, χ 2 = 59.04, df = 3, p < 0.001). There was no significant difference in pain score immediately (p = 0.052) and 15 min (p = 0.329) after Echest tube removal in experimental groups compared to the control group. No significant difference was found between control and experimental groups in anxiety score immediately (p = 0.995) and 15 min (p = 0.976) before chest tube removal. Conclusions: Mentioned methods were not effective in reducing pain and anxiety. It is suggested to investigate effects of different methods of removing chest tubes and applying cold with a larger sample size.

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

“…The results of the meta-analysis show that cold application can effectively reduce immediate pain intensity after CTR. This result is similar to those from the two studies conducted by Sajad et al [20] and Ertug and Ulker [24], respectively. In addition to pain relief after CTR, cold application was also reported to reduce pain before arterial puncture and intramuscular injection, but few studies have been reported [25,26].…”

“…Among the studies, 5 studies (50%) were rated as having a low risk of bias for random sequence generation because they were randomly employed using random number generators, random number tables, block randomization, eight-member block randomization, or computer programs [7,8,[19][20][21], and 5 studies were rated as having an unclear risk of random sequence generation [3,4,[22][23][24]. One study was rated as having an unclear risk of concealment because the author did not provide a detailed explanation [8], and 9 studies (90%) were rated as having high risks of allocation concealment [3,4,7,[19][20][21][22][23][24].…”

“…Two studies were rated as having unclear risks of blinding of participants or researchers [8,23], and 8 studies (80%) were rated as having high risks of blinding of participants or researchers [3,4,7,[19][20][21][22]24]. Because cold application is a nonpharmacologic therapy, it is di cult to blind both participants and researchers.…”

“…Because cold application is a nonpharmacologic therapy, it is di cult to blind both participants and researchers. Two studies were rated as low-risk for the blinding of the outcome assessments [8,19], and 8 studies (80%) were rated as high-risk for the blinding of the outcome assessments [3,4,7,[20][21][22][23][24]. All studies (100%) were rated as low-risk for incomplete outcome data, selective reporting, and other biases.…”

“…Five intervention studies used cold application [8,[20][21][22]24], and 5 intervention studies used cold application plus a standard drug treatment [3,4,7,19,23]. The intervention durations varied from 10 minutes to 20 minutes [3,4,8,11,[20][21][22][23], and 2 studies showed that cold application applied to the skin dropped the skin temperature to 13.6°C before CTR [7,24]. The cold application was applied to the area surrounding the chest tube with 9-inch[8], 7-cm[24], 5-cm [23], and 6-inch [22] diameters.…”