Effectiveness of Cold Application in Relieving Pain of Chest Drain Removal among Patients with Open Cardiac Surgeries: A Systematic Review and Meta-Analysis

Background: The process of chest drain removal exposes patients to immense pain, widely recognised as “the worst” experience for patients. Contradictions prevail among researchers regarding pain management during chest drain removal (CDR). Numerous alternative therapies, such as cold application, music relaxation, and aromatherapy, have been attempted to alleviate pain, as pharmacological agents frequently incur significant adverse effects. Objective: The objective of this systematic review and meta-analysis was to investigate the effectiveness of cold application to relieve the pain of chest drain removal among open cardiac surgical patients. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was utilised to carry out this study. A sensitive search strategy was conducted in PubMed, CINAHL, PsycINFO, Ovid, Medline and Google Scholar for relevant literature. All studies were Randomised Clinical Trials (RCTs), published between 2002 and 2023 in the English language. The pooled estimate of mean differences, reported with a 95% confidence interval of pain assessment, immediately after CDR (Time 2) and 20 to 20 minutes after CDR (Time 3), were used to analyse pain intensity. Time 1 was not included in the analysis as it was baseline data before intervention. Results: 10 RCTs satisfied the eligibility criteria, involving 620 participants. The majority of the participants were men. The pooled effect demonstrated that the intervention group experienced statistically significant lower pain (Time 2) immediately after CDR (1.93, 95%CI: 0.68,2.11, p˂0.01) and 10 to 20 minutes after (Time 3) CDR (0.95,95%CI:0.36,1.54) than the Control group. Conclusion: The review concluded that the cold application is an effective therapy to decrease pain due to chest drain removal among patients who underwent open cardiac surgery.