Topical analgesia for chest tube removal in cardiac patients

OBJECTIVES: The aim of this study was to evaluate the efficacy of topical valdecoxib as an analgesic during chest tube removal in postcardiac surgical patients. DESIGN: A prospective, randomized, double-blind, placebo-controlled study. SETTING: The study was performed in the cardiac intensive care unit. PARTICIPANTS: Fifty-three patients undergoing elective cardiac surgery were randomized to receive either topical valdecoxib or liquid paraffin on the chest tube exit sites. INTERVENTION: Topical valdecoxib was applied to 1 of the 2 chest tube sites (mediastinal or pericardial) in a randomized manner before drain removal. Liquid paraffin was used as the control on the other tube site. The patient and observer were blinded to the drug and control. MEASUREMENTS AND MAIN RESULTS: Pain was assessed by using the visual analog scale. The heart rate and systolic blood pressure were recorded at each stage by the blinded observer. Statistical analysis of the obtained data was undertaken using the nonparametric Mann-Whitney U test. The median pain scores before, during, and after tube removal in the control group were 2, 5, and 4, respectively. The valdecoxib group had corresponding scores of 1, 2, and 2. The pain scores were significantly lower in the valdecoxib group. No differences were seen in the heart rate and systolic blood pressure between the 2 groups. No adverse effects were noted. CONCLUSIONS: Topical valdecoxib is a safe and effective topical analgesic for chest tube removal in cardiac patients.