Effectiveness of Ice-Cold Application for Pain Relief During Chest Tube Removal in Postoperative Cardiothoracic Patients

Introduction: Chest tube removal (CTR) is a painful procedure after cardiothoracic surgery. Non-pharmacological measures that are inexpensive and easy to administer may complement routine analgesia. This study evaluated the effectiveness of local ice-cold application on pain associated with CTR.
Methods: A quantitative experimental pretest–posttest control-group study was conducted among 60 postoperative cardiothoracic patients in the cardiothoracic vascular surgery intensive care unit of a 600-bed tertiary/superspecialty cardiothoracic hospital in Western Maharashtra. Participants were randomly allocated by lottery to an ice-cold application group (n=30) or control group (n=30). Both groups received routine analgesia. In the intervention group, two ice packs (17 × 8 cm), wrapped in sterile gauze, were placed around the chest-tube insertion site for 15 min before removal. Pain was assessed before, immediately after, and 15 min after CTR using the Numeric Pain Rating Scale (NPRS) and Modified Comfort Scale. Between-group comparisons used the Mann–Whitney test; within-group comparisons used the Wilcoxon signed-rank test.
Results: Immediately after CTR, mean NPRS was 4.77 ± 1.135 in the intervention group versus 7.10 ± 0.995 in controls (Z=5.81, p<0.0001). At 15 min, mean NPRS was 3.13 ± 0.973 versus 3.97 ± 1.217 (Z=2.58, p=0.01). Modified Comfort Scale scores immediately after CTR were 10.63 ± 1.650 versus 14.40 ± 1.610 (Z=5.92, p<0.0001); at 15 min the difference was not significant (8.17 ± 1.821 vs 8.43 ± 1.716; Z=0.73, p=0.47). Within the intervention group, pain decreased significantly from baseline to both post-CTR assessments (p<0.0001). No adverse incident was reported.
Conclusion: A 15-min local ice-cold application before CTR was associated with lower immediate pain and lower NPRS at 15 min after removal. It may be considered as a simple adjunct to routine

Chest tube drainage is routinely used after cardiothoracic surgery to evacuate air, blood and fluid and to support

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