Combined Effects of Reflexology Massage and Respiratory Relaxation on Pain Following Chest Tube Removal in Heart Surgery Patients

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Date 2025 Jan 10

PMID 39794820

Authors

Zainab Bahramian

Majid Kazemi

Reza Vazirinejad

Hadi Hasani

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023.

Methods: This was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used.

Results: The participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008).

Conclusion: The results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients' average pain.

References

Shateri Amiri Z, Khajedaluee M, Rezaii A, Dadgarmoghaddam M . The risk of cardiovascular events based on the Framingham criteria in Adults Living in Mashhad (Iran). Electron Physician. 2018; 10(8):7164-7173. PMC: 6122869. DOI: 10.19082/7164. View

Friesner S, Curry D, Moddeman G . Comparison of two pain-management strategies during chest tube removal: relaxation exercise with opioids and opioids alone. Heart Lung. 2006; 35(4):269-76. DOI: 10.1016/j.hrtlng.2005.10.005. View

Jankowski J, Floege J, Fliser D, Bohm M, Marx N . Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation. 2021; 143(11):1157-1172. PMC: 7969169. DOI: 10.1161/CIRCULATIONAHA.120.050686. View

Goktuna G, Dagcan N, Arslan G . The Effect of Hand Reflexology Massage on Pain and Anxiety After Coronary Artery Bypass Graft Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial. J Cardiovasc Nurs. 2023; 40(2):E57-E64. DOI: 10.1097/JCN.0000000000001033. View

Ernst E . Is reflexology an effective intervention? A systematic review of randomised controlled trials. Med J Aust. 2009; 191(5):263-6. DOI: 10.5694/j.1326-5377.2009.tb02780.x. View

Townsend N, Kazakiewicz D, Wright F, Timmis A, Huculeci R, Torbica A . Epidemiology of cardiovascular disease in Europe. Nat Rev Cardiol. 2021; 19(2):133-143. DOI: 10.1038/s41569-021-00607-3. View

Miura N, Akitsuki Y, Sekiguchi A, Kawashima R . Activity in the primary somatosensory cortex induced by reflexological stimulation is unaffected by pseudo-information: a functional magnetic resonance imaging study. BMC Complement Altern Med. 2013; 13:114. PMC: 3668141. DOI: 10.1186/1472-6882-13-114. View

Kesik G, Ozdemir L, Mungan Ozturk S . The Effects of Relaxation Techniques on Pain, Fatigue, and Kinesiophobia in Multiple Sclerosis Patients: A 3-Arm Randomized Trial. J Neurosci Nurs. 2022; 54(2):86-91. DOI: 10.1097/JNN.0000000000000620. View

Gorji H, Nesami B, Ayyasi M, Ghafari R, Yazdani J . Comparison of Ice Packs Application and Relaxation Therapy in Pain Reduction during Chest Tube Removal Following Cardiac Surgery. N Am J Med Sci. 2014; 6(1):19-24. PMC: 3938868. DOI: 10.4103/1947-2714.125857. View

10.

Ertug N, Ulker S . The effect of cold application on pain due to chest tube removal. J Clin Nurs. 2011; 21(5-6):784-90. DOI: 10.1111/j.1365-2702.2011.03955.x. View

11.

Shiina K . Commentary: The Historical Roots of Visual Analog Scale in Psychology as Revealed by Reference Publication Year Spectroscopy. Front Hum Neurosci. 2021; 15:711691. PMC: 8320287. DOI: 10.3389/fnhum.2021.711691. View

12.

Aktas Y, Karabulut N . The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal. Complement Ther Clin Pract. 2019; 34:179-184. DOI: 10.1016/j.ctcp.2018.12.001. View

13.

Bell R, Ovadia P, Abdullah F, Spector S, Rabinovici R . Chest tube removal: end-inspiration or end-expiration?. J Trauma. 2001; 50(4):674-7. DOI: 10.1097/00005373-200104000-00013. View

14.

Sarrafzadegan N, Mohammmadifard N . Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med. 2019; 22(4):204-210. View

15.

Zare Z, Shahsavari H, Moeini M . Effects of therapeutic touch on the vital signs of patients before coronary artery bypass graft surgery. Iran J Nurs Midwifery Res. 2011; 15(1):37-42. PMC: 3093033. View

16.

Stephenson N, Dalton J, Carlson J . The effect of foot reflexology on pain in patients with metastatic cancer. Appl Nurs Res. 2003; 16(4):284-6. DOI: 10.1016/j.apnr.2003.08.003. View

17.

Chen Y, Huang X, Chien C, Cheng J . The Effectiveness of Diaphragmatic Breathing Relaxation Training for Reducing Anxiety. Perspect Psychiatr Care. 2016; 53(4):329-336. DOI: 10.1111/ppc.12184. View

18.

Pedersen H, Skliarova T, Attkisson C, Lara-Cabrera M, Havnen A . Measuring patient satisfaction with four items: validity of the client satisfaction questionnaire 4 in an outpatient population. BMC Psychiatry. 2023; 23(1):808. PMC: 10630992. DOI: 10.1186/s12888-023-05310-w. View

19.

Mueller X, Tinguely F, Tevaearai H, Ravussin P, Stumpe F, von Segesser L . Impact of duration of chest tube drainage on pain after cardiac surgery. Eur J Cardiothorac Surg. 2000; 18(5):570-4. DOI: 10.1016/s1010-7940(00)00515-7. View

20.

Johns C, Blake D, Sinclair A . Can reflexology maintain or improve the well-being of people with Parkinson's Disease?. Complement Ther Clin Pract. 2010; 16(2):96-100. DOI: 10.1016/j.ctcp.2009.10.003. View