You should not underestimate the anxiety and pain that chest drain insertion causes, even with the use of local anaesthesia. Strongly consider the use of intravenous benzodiazepines and/or opiates to pre-emptively relieve distress [4].

Avoid nitrous oxide/oxygen mixtures (e.g. Entonox®) since these will expand any pneumothorax, with potential dramatic clinical consequence.

Learning bite

Explain the procedure to the patient and obtain written consent where practical. Strongly consider the use of pre-emptive intravenous benzodiazepines and/or opiates.