Dimensions of procedural pain and its analgesic management in critically ill surgical patients

BACKGROUND AND PURPOSE: Many critically ill patients undergo endotracheal suctioning and chest tube removal procedures, yet little documentation of associated pain exists. Therefore, a study was conducted to (1) compare the magnitude and dimensions of pain associated with endotracheal suctioning and chest tube removal in intubated and nonintubated patients and (2) correlate preprocedural analgesic administration and pain magnitude. METHODS: Multiple dimensions of pain (ie, intensity, extent, sensation, and affect) were measured after postoperative cardiovascular surgery patients underwent endotracheal suctioning (N = 45) or chest tube removal (N = 35). Preprocedural analgesics and intubation status during pain assessments were noted. RESULTS: Patients reported lower pain intensity with endotracheal suctioning (mean, 4.9 on a 0-10 numerical rating scale) than with chest tube removal (mean, 6.6). Pain extent, sensation, and affect scores were relatively low for endotracheal suctioning and chest tube removal. Similar words such as "tender," "sharp," and "heavy" were used to describe both procedures; however, more patients described their response to chest tube removal as "fearful." Intubated patients had different pain experiences than extubated patients. Patients received little analgesic premedication, and correlations were low and nonsignificant between amount of medication received and pain magnitude. CONCLUSIONS: Patients were able to communicate extensive information about procedural pain, even when intubated. Endotracheal suctioning and chest tube removal were both painful; yet, there was little preparatory analgesic management of the pain. Research is needed to investigate a variety of pharmacological and nonpharmacological interventions for pain related to endotracheal suctioning and chest tube removal.

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