Systemic versus local analgesia for chest drain removal in post cardiac surgery patients: The taming of a beast

Background: Among the most emotionally distressing experiences in cardiac surgery is the removal of mediastinal drains. The study compared between two commonly used methods for pain control during the procedure of chest drain removal. We either used systemic administration of IV morphine or local infiltration of Bupivacaine as a mode of analgesia. Our goal was to provide effective analgesia and patient comfort, while keeping high standards of patient safety.Methods: A prospective, randomized, single blinded observational study conducted in a single institution; Cardio-thoracic surgery Academy, Ain –Shams University, Cairo, Egypt. 70 Patients, with valvular heart lesions needing elective surgical intervention in the form of valve replacement/repair were enrolled in the study. On the day after surgery, when the mediastinal drains were no longer surgically needed, patients were randomized to one of two groups. In the first group (Morphine group, n = 35), patients received an IV bolus of 0.1 mg/kg morphine over a period of 2 min. The second group (Bupivacaine group, n = 35), received 0.5% bupivacaine as subcutaneous infiltration around the sites of drain insertion, using a standardized technique. Drains were removed 20 min later. All the patients had their blood pressure, heart rate and the pain score on a Visual Analog Scale (VAS) assessed 20 min before starting the procedure (baseline values), and were assessed one more time, 5 min after completion of the procedure (drain removal values).Results: The median difference within the bupivacaine group between baseline and drain removal VAS scores was 19.94 ± 2.36 mm and 9.52 ± 2.41 mm respectively (this showed to be highly significant, P < 0.001).Median VAS scores difference between the bupivacaine and morphine groups on drain removal were 9.52 ± 2.41 mm and 18.93 ± 2.96 mm respectively (this showed to be highly significant, P < 0.001).Conclusions: There was a significant difference with regards to patients’ pain control between both groups. Concerning pain scores (VAS) reduction at post procedural point, a local subcutaneous infiltration of 0.5% bupivacaine is a superior analgesic modality