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Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial
  1. Shin-nosuke Watanabe1,
  2. Kazuhiro Imai1,
  3. Tetsu Kimura2,
  4. Yoshitaro Saito1,
  5. Shinogu Takashima1,
  6. Ikuo Matsuzaki1,
  7. Nobuyasu Kurihara1,
  8. Maiko Atari1,
  9. Tsubasa Matsuo1,
  10. Hidenobu Iwai1,
  11. Yusuke Sato1,
  12. Satoru Motoyama1,
  13. Kyoko Nomura3,
  14. Toshiaki Nishikawa2 and
  15. Yoshihiro Minamiya1
  1. 1Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
  2. 2Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
  3. 3Public Health, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
  1. Correspondence to Dr Kazuhiro Imai, Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita 010-8543, Japan; i-karo{at}


Background and objectives Pain 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.

Methods This 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.

Results Visual 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).

Conclusion Analgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS.

Trial registration number UMIN000013824.

  • acute pain
  • pain measurement
  • postoperative pain

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  • Contributors SW collected and analyzed the data. KI analyzed the data and wrote the paper. TK, YS, ST, IM, NK, MA, TM, HI, YS, and SM helped to collect the data. KN suggested the statistical analysis. TN and YM designed and supervised the research. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Written informed consent was obtained from each patient before enrollment.

  • Ethics approval The study was carried out in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines. The protocol was approved by the institutional review boards at Akita University Hospital (approval number/ID 1122).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.