The Effectiveness of Hand Massage on the Pain of Cardiac Surgery Critically Ill

The Effectiveness of Hand Massage on the Pain of Cardiac Surgery Critically Ill- A Randomized Controlled Trial

Postoperative pain is a common phenomenon in the intensive care unit (ICU) despite the multitude of efforts dedicated to promote its effective relief. Mounting evidence shows that cardiac surgery ICU patients experience moderate to severe pain reaching proportions as high as 74% despite the use of analgesics. The highest pain intensity is experienced in the first 24 hours post surgery when patients are still in the ICU, and represents a strong predictor for the presence and severity of persistent postoperative pain. To maximize pain relief, massage has been suggested in the recent clinical practice guidelines of the Society of Critical-Care Medicine as a complementary non-pharmacological therapy in the ICU given its opioid-sparing and analgesia-enhancing potential. Some randomized controlled trials showed promising pain relief effects of massage when administered to cardiac surgery patients in acute care units, however, its effects on pain relief while patients are still in the ICU and when pain severity is highest remain unknown.

This study aims to compare the effect of three 20-minute hand massage administrations within 24 hours postop on the pain intensity (primary outcome), pain unpleasantness, pain interference, muscle tension, anxiety and vital signs (blood pressure, heart and respiratory rates) of adult intensive care unit (ICU) patients post cardiac surgery versus hand holding (i.e., simple touch) and standard care. Other objectives are to describe the location and quality of pain of cardiac surgery ICU patients.

Hypothesis:

Patients receiving 3 hand massages within 24 hours postop will have lower pain intensity, unpleasantness and interference, muscle tension, anxiety and vital signs compared to patients receiving hand holding and to those in the standard care group.

Inclusion Criteria:

• able to speak French or English
• elective cardiac surgery requiring sternal incision (e.g., coronary artery bypass graft, valve replacement)
• able to answer questions and self-report symptoms

Exclusion Criteria:

• previous cardiac surgery
• diagnostic of cognitive or psychiatric disorder
• pulmonary artery pressure >50 mmHg
• right ventricular failure
• systolic left ventricular dysfunction (ejection fraction 35% or less)
• body mass index > 30
• prolonged bleeding from the chest drainage tubes (i.e., >200 ml/h)
• having mechanical blood pressure support (e.g., intra-aortic balloon pump)
• receiving cardiac pacing with complete control of HR
• peripheral intravenous line in the hands
• suppurating/infective/inflammatory skin condition of the hands
• hypersensitivity to touch.