The duration of mediastinal chest tube drainage is not associated with postoperative pain or opioid consumption after cardiac surgery

Abstract

Objectives. Mediastinal chest tubes are considered to be a significant factor causing postoperative pain after cardiac surgery. The aim of the study was to ascertain whether the duration of mediastinal drainage is associated with postoperative pain and opioid consumption. Design. A total of 468 consecutive patients undergoing cardiac surgery at the Tampere University Hospital between December 2015 and August 2016 were retrospectively analyzed. The first 252 patients were treated according to short and the following 216 patients according to extended drainage protocol, in which the mediastinal chest tubes were habitually removed on the first and second postoperative day, respectively. The oxycodone hydrochloride consumption, as well as daily mean pain scores assessed by numeric/visual rating scales, were compared between the groups. Results. The mean daily pain scores and cumulative opioid consumption were similar in both groups. Patients with reduced ejection fraction, diabetes, and peripheral vascular disease reported lower initial pain scores. The median cumulative oxycodone hydrochloride consumption did not differ according to the drainage protocol but was higher in males, smokers, and after aortic surgery. In contrast, patients with advanced age, hypertension, and peripheral vascular disease had lower consumption. In multivariable analysis, male sex and aortic surgery were associated with higher and advanced age with lower opioid use. Conclusions. The length of mediastinal chest tube drainage is not associated with the amount of postoperative pain or need for opioids after cardiac surgery. Male sex and aortic surgery were associated with higher and advanced age with lower overall opioid consumption.

Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices

“…72 With respect to pain and opioid analgesia, Kalli and colleagues recently reported that the amount of postoperative pain or need for opioids was not affected by shorter chest tube duration after cardiac surgery. 73 These results associated with removal are preliminary, and their findings remain to be confirmed. An ongoing, single-center, prospective RCT (NCT04487262) is currently evaluating the timing of chest tube removal in adult cardiac surgery patients, comparing early postoperative pain, consumption of analgesic drugs, incidence of infection, and early postoperative respiratory function on postoperative day 0 and day 1 in 1,300 consecutive patients undergoing elective open heart surgery.…”

“…With respect to pain and opioid analgesia, Kalli and colleagues recently reported that the amount of postoperative pain or need for opioids was not affected by shorter chest tube duration after cardiac surgery. 73…”

“…74 Patient-reported outcomes (PROs) are increasingly important in contemporary cardiac surgery. These include pain, 66,73,75 sleep, mobility, and quality of life, and they will play an important role in shared decision making and practice. The rise of novel biosensors will assist in better understanding these PROs.…”