Effectiveness of non-pharmacological interventions for pain reduction following chest tube removal: A systematic review and network meta-analysis

Objective: This study aimed to determine the most effective non-pharmacological intervention for pain relief following chest tube removal in adult patients. Methods: We performed a systematic review with network meta-analysis, searching electronic databases for randomized controlled trials up to January 20, 2024. Compared to control or placebo groups, the trials included adult patients receiving non-pharmacological interventions, such as cold therapy, relaxation exercises, music therapy, transcutaneous electrical nerve stimulation, or aromatherapy. Data analysis utilized a random-effects model, reporting standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment ranking was determined through surface under the cumulative ranking analysis and forest plots. Results: Sixteen studies enrolling 1,342 patients were included, with moderate to high heterogeneity. Cold therapy and relaxation exercises effectively reduced pain after chest tube removal, with SMD of −1.84 (95 % CI: −2.81 to −0.87) and −2.04 (95 % CI: −3.43 to −0.65), respectively, from baseline to immediately post-removal. From baseline to ten to twenty minutes after removal, both therapies continued to show significant pain reduction, with SMD of −1.96 (95 % CI: −3.14 to −0.77) for cold therapy and −2.01 (95 % CI: −3.75 to −0.28) for relaxation exercises. Sensitivity analysis supported these findings, and cold therapy's efficacy appeared unaffected by obesity. However, publication bias, possibly due to small study samples, was noted. Conclusions: Cold therapy and relaxation exercises proved most effective for reducing pain immediately and up to ten to twenty minutes after chest tube removal. Given their cost-effectiveness, lack of side effects, and ease of use, we recommend relaxation exercises as a practical alternative to cold therapy. Nonetheless, further studies are needed to comprehensively assess non-pharmacological options for managing chest tube removal pain. Implications for clinical practice: Incorporate cold therapy and relaxation exercises into post-chest tube removal pain management to improve patient comfort and minimize reliance on pharmacological interventions.