Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial

• Published in: Regional anesthesia and pain medicine Vol. 45; no. 1; pp. 16 - 21
• Main Authors: Watanabe, Shin-nosuke, Imai, Kazuhiro, Kimura, Tetsu, Saito, Yoshitaro, Takashima, Shinogu, Matsuzaki, Ikuo, Kurihara, Nobuyasu, Atari, Maiko, Matsuo, Tsubasa, Iwai, Hidenobu, Sato, Yusuke, Motoyama, Satoru, Nomura, Kyoko, Nishikawa, Toshiaki, Minamiya, Yoshihiro
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.01.2020; Copyright by American Society of Regional Anesthesia and Pain Medicine; BMJ Publishing Group LTD
• Subjects: acute pain; Analgesics; Cancer therapies; Catheters; Chest tubes; Clinical trials; Epidural; General anesthesia; Lung cancer; Narcotics; Nervous system; Nonsteroidal anti-inflammatory drugs; Original article; Ostomy; Pain; pain measurement; Patients; postoperative pain; Postoperative period; Regional anesthesia; Thoracic surgery; United Kingdom > UK; Japan; acute pain; pain measurement; postoperative pain
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2019-100760

Background and objectivesPain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved patient outcomes, chest tube removal could be distressful experience for many patients. The aim of this trial was to test whether the addition of lidocaine cream would have a significant impact on the pain treatment during chest tube removal from patients who had undergone VATS for lung cancer.MethodsThis clinical trial was a double-blind randomized study. Forty patients with histologically confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled. All patients had standard perioperative care. Patients were randomly assigned to receive either epidural anesthesia plus placebo cream (placebo, Group P) or epidural anesthesia plus 7% lidocaine cream cutaneously around the chest tube insertion site and on the skin over the tube’s course 20 min (Group L) before chest drain removal.ResultsVisual analog scale (VAS) scores were higher in Group P (median 5, IQR, 3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured using a PainVision system were also higher in Group P (median 296.7, IQR, 216.9–563.5) than Group L (median 41.2, IQR, 11.8–97.0). VAS scores and the pain intensity associated with chest drain removal were significantly lower in Group L than Group P (p=0.0002 vs p<0.0001).ConclusionAnalgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS.Trial registration numberUMIN000013824.