The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study

Pain Manag Nurs. 2010 Sep;11(3):186-96. doi: 10.1016/j.pmn.2009.09.002. Epub 2010 May 31.


The aim of this study was to investigate the effect of cold application on pain and anxiety during chest tube removal (CTR) in patients who had undergone cardiac surgery. A single-blinded randomized design was used in this study. Ninety patients aged 18-74 years, hospitalized in the intensive care unit (ICU), who had a chest tube for a duration of at least 24 hours were used for this convenience sample. The application of cold, placebo, or control therapies was randomized into three different groups. Sixty minutes before CTR was scheduled, an ICU nurse administered 10mg/kg paracetamol intravenously to all study subjects. Cold and warm packs covered with gauze dressing were applied to the area surrounding the chest tubes for 20 minutes. Pain intensity, pain quality and situational anxiety for CTR were measured. Variance analysis and the latent growth model were used in the analysis of the data. Patients in the cold group had significantly lower pain intensity than the placebo group. The perception of pain intensity measured by visual analog scores of patients in the cold group showed the least variation. There was no statistically significant difference in McGill Melzack Pain Questionnaire scores or in change of anxiety level between the three groups. The application of cold prolonged the length of time until analgesics were needed after CTR. Results showed that cold application reduced patients' intensity of pain due to CTR but did not affect anxiety levels or the type of pain. Cold application is recommended as a pain-relieving technique during CTR.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / therapeutic use*
  • Adult
  • Aged
  • Analgesics, Non-Narcotic / therapeutic use*
  • Analysis of Variance
  • Anxiety / diagnosis
  • Anxiety / etiology
  • Anxiety / prevention & control*
  • Chest Tubes / adverse effects*
  • Clinical Nursing Research
  • Combined Modality Therapy
  • Cryotherapy / methods*
  • Cryotherapy / nursing
  • Device Removal / adverse effects
  • Hot Temperature / therapeutic use
  • Humans
  • Middle Aged
  • Pain / diagnosis
  • Pain / etiology
  • Pain / prevention & control*
  • Pain Measurement
  • Severity of Illness Index
  • Single-Blind Method
  • Treatment Outcome
  • Turkey


  • Analgesics, Non-Narcotic
  • Acetaminophen