Position to Prevent Pleural Irritation (PPPI) for Pain and Sleep

Clinical Trial Aim: The study was conducted to investigate the effect of the Position given to Prevent Pleural Irritation (PPPI) due to chest tube on pain level and sleep quality in patients undergoing thoracic surgery.

Does the Position to Prevent Pleural Irritation (PPPI) reduce participants' pain levels due to pleural irritation? Does the Position to Prevent Pleural Irritation (PPPI) improve participants' sleep quality? Researchers were compare the effectiveness of the Position to Prevent Pleural Irritation (PPPI) in reducing pain from pleural irritation and improving sleep quality with routine clinical care.

Participants received the in-bed position and the Position to Prevent Pleural Irritation (PPPI) applied by the researcher in routine care before their first night's sleep in the clinic after thoracotomy. At the same time, participants' pain was be assessed with a pain scale, and their sleep quality was be assessed with a PolySomnioGraph (PSG) and sleep scale.

The participants in the study group were positioned in bed the Position to Prevent Pleural Irritation (PPPI) in order to minimize pleural irritation caused by the contact of the chest tube with the pleura during sleep. Routine care was applied by the researcher in the clinic's prosedure for the participants in the control group.

Position to Prevent Pleural Irritation (PPPI)

1. The participants were informed before the surgery and consent was obtained. The positioning and sleep measurement method were explained. Sleeping scale was filled out for information about the sleep routine before hospitalization.
2. When the participants were admitted to the thoracic surgery clinic, information about positioning and sleep measurement was given by the researcher.
3. The researcher questioned and evaluated the patient's pain before bedtime, and routine analgesic were applied.
4. It was checked that the participant's bed was in working order for the Position to Prevent Pleural Irritation (PPPI), and the positions that could be given with the bed's remote control were explained to the participant.
5. The position and working order of the chest drainage system and drainage tube were checked.
6. The participant was given an upright or dorsal recumbent position with the head of the bed at 30-45 degrees, according to participant's preference. Pillows were placed under the head, under the shoulder where the tube was located, and under the arms, according to the participant's preference. In order to keep the abdominal muscles relaxed, femur and knee flexion was provided.
7. PolySomnioGraph (PSG) was placed on the participant for sleep measurement. The participant's satisfaction about the position was questioned. The room lights were turned off, and noise-causing factors were removed.
8. In the morning, the PolySomnnioGraph (PSG) connections were removed from the participant and pain was questioned and rated again.

Eligibility Criteria:
Inclusion Criteria:

* being in the 18-70 age group (adult age group accepted for pain perception and sleep)
* being operated on by the same surgical team
* having a posterolateral thoracotomy technique
* having the same anesthesia and analgesia protocol
* being transferred from the intensive care unit to the clinic at the 48th hour after thoracotomy
* having a single chest tube inserted (placed under the 1-2nd intercostal space of the thoracotomy incision, in the mid-axillary line)
* having a rigid drainage tube with a diameter of 28-32 Fr
* having a chest tube inserted for the first time.

Exclusion Criteria:

* rib fracture
* pneumonectomy and decortication
* previous thoracic surgery and radiotheraphy
* having a diagnosis of a major neurological problem (as it may affect pain perception and sleep)
* having a diagnosed sleep problem
* a diagnosis of substance or alcohol dependency requiring treatment
* any musculoskeletal problem that prevents positioning in bed