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J Thorac Cardiovasc Surg 2007;133:1124
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Modern drainage techniques include not only smaller drains for pain reduction

Helmut Mair, MD, Ingo Kaczmarek, MD, Sabine Daebritz, MD

Cardiac Surgery, University of Munich, Munich, Germany

To the Editor:

In a prospective, randomized, controlled trial, Roberts and colleagues1Go recently demonstrated that the performance of small-bore Blake drains (19F) (Ethicon Inc, Somerville, NJ) is not inferior to that of standard Portex drains (28F) (Portex, Inc, Hythe, Kent, UK) after cardiac surgery. The study provides important evidence on the efficacy of modern drainage techniques. However, we have some comments.

The authors compared 199 patients undergoing first-time cardiac procedures; 90 patients received Blake drains, and 109 patients received standard Portex drains. We are not convinced that the influence of complex valve procedures, which are more frequent in the Blake group, is not statistically relevant. Furthermore, we believe that a homogenous patient group might demonstrate the advantage of silastic Blake drains and allow extrapolation to other patient groups.

Akowuah and colleagues2Go demonstrated less pain with Blake drains, but, as mentioned by Roberts and colleagues,1Go with only a small patient group (70 patients with 35 in each group). Therefore, it is a pity that the authors did not assess pain with a visual analog scale score, which is easy to perform.

Finally, the authors somehow misquoted our correspondence on the article by Barnard and colleagues:3Go We do not believe that "... the only way to reduce patient discomfort is to use smaller and softer drains." In fact, we stated that a modern drainage technique is a fundamental part in pain reduction while removing drains after thoracic and cardiac surgery. Of course, analgesia, special removal maneuvers, and so forth have value, as demonstrated in various studies.4Go In our unit, 10F to 19F Blake drains are used in all patients (1800 patients/year). Our observations are consistent with the literature: The Blake drain system is as effective as conventional drains with no increased risk of retained blood in the chest or tamponade and significantly less pain for the patient. We therefore advocate the use of Blake drains in patients undergoing thoracic or cardiac surgery as well.

References

  1. Roberts N, Boehm M, Bates M, Braidley PC, Cooper GJ, Spyt TJ. Two-center prospective randomized controlled trial of Blake versus Portex drains after cardiac surgery. J Thorac Cardiovasc Surg 2006;132:1042-1046.[Abstract/Free Full Text]
  2. Akowuah E, Ho E, George R, Brennan K, Tennant S, Braidley P, et al. Less pain with flexible fluted silicone chest drains than with conventional rigid chest tubes after cardiac surgery. J Thorac Cardiovasc Surg 2002;124:1027-1028.[Free Full Text]
  3. Barnard J, Thompson J, Dunning J. Can any intervention effectively reduce the pain associated with chest drain removal?. Interact CardioVasc Thorac Surg 2004;3:229-232.[Abstract/Free Full Text]
  4. Singh M, Gopinath R. Topical analgesia for chest tube removal in cardiac patients. J Cardiothorac Vasc Anesth 2005;19:719-722.[Medline]

Related Article

Reply to the Editor
Neil Roberts and Tom J. Spyt
J. Thorac. Cardiovasc. Surg. 2007 133: 1124-1125. [Extract] [Full Text] [PDF]



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This Article
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