COMPARISON OF TWO ANALGESIA TECHNIQUES FOR PAIN MANAGEMENT DURING CHEST TUBE REMOVAL AFTER CARDIAC SURGERY

BACKGROUND: This study aims to compare of two analgesia techniques for pain management during chest tube removal (CTR) after cardiac surgery. Two groups were compared in terms of pain, sedation levels, and hemodynamic response removal of chest tube. METHODS: The study was designed as a prospective, randomized, double-blinded study. Forty patients who underwent coronary artery bypass graft (CABG) surgery were enrolled. In postoperative period intravenous fentanyl 1 mu g/kg was given five minutes prior to chest tube removal (CTR). Each patient was explained about CTR procedure and VAS scoring charts. The patients were randomized into two groups as study group (Group S) and control group (Group C). All patients received either adrenaline free xylocaine 2% infiltration (Group S), 6 ml around each of three chest tube (2 mediastinal + 1 pleural) or normal saline 0.9% (Group C) in double blind manner. Severity of pain was recorded by asking Visual analogue scale (VAS) from the patients. Faces rating scale (FRS), Behavioral rating scale (BRS) and Ramsay sedation score (RSS) along with hemodynamic data were also recorded, blinding to group at four time intervals; at baseline (T base), 2min (T2m,) 5min (T5m) 10min (T10m) and 20 min (T20m.) after CTR. RESULTS: The demographic characteristics of the patients in both groups were similar. Before chest tubes removal (CTR), all the scores of pain intensity (VAS), pain distress (FRS, BRS) and sedation levels (RSS) were comparable, but they differ significantly at T2, T5, and T10. However, these scores were comparable at T20. Patients remained alert and comfortable after 20 CTR regardless of which group they were assigned. CONCLUSION: Intravenous fentanyl 1 mu g/kg along with local infiltration of 2% xylocaine can substantially reduce pain and better regime than Intravenous fentanyl 1 mu g/kg alone during chest tube removal in post-coronary artery bypass graft surgery patients. Both techniques are equally safe in terms of sedation and post procedural complications.