The optimal size and insertion technique of chest tubes for managing traumatic pneumothorax remains unclear. While large-bore chest tubes with blunt dissection for insertion have traditionally been used, smaller pigtail catheters and small-bore chest tubes inserted under Seldinger technique are being increasingly considered due to their less invasive nature and potential for reduced patient discomfort. Methods: This study was conducted using PRISMA guidelines. 4,486 papers were identified through database searches. 93 had full text review and 10 studies were included. Key comparisons were made between 14-Fr pigtail catheters, 20-22 Fr small-bore chest tubes, 28-36 Fr large-bore chest tubes and insertion technique.. Outcomes assessed included tube-site pain, effectiveness in pneumothorax resolution, tube-related complications, and need for additional interventions. Results: Smaller tubes and Seldinger technique were associated with significantly lower tube-site pain compared to large-bore tubes. They showed comparable efficacy with regards to drainage and complication rates. Pain scores were lower with small tubes, and duration of hospital stays were often shorter. In cases of stable trauma, small-bore and pigtail catheters were effective and associated with fewer complications such as unresolved pneumothorax or need for additional drains. Conclusions: Small-bore chest tubes, pigtail catheters and Seldinger technique are viable alternatives to large-bore chest tubes for managing traumatic pneumothorax, with reduced tube-site pain and comparable clinical outcomes. While the success rate of smaller tubes is generally comparable, there is a need for further prospective studies to confirm their role and optimize their use in various clinical scenarios