Objective Postoperative Pain Assessment Using Incentive Spirometry Values: A Prospective Observational Study

Abstract

Aim: Determine if incentive spirometry (IS) values correlate with postoperative pain control. Design: Prospective observational study. Setting & participants: A total of 100 patients undergoing major abdominal procedures at the University of North Carolina Medical Center. Interventions: Patients studied as a single cohort. All patients received thoracic epidural analgesia preoperatively. Outcome: Preoperative and daily postoperative numeric pain scores, subjective pain description and IS values were collected for all patients. Results: There was a strong correlation with IS values relative to baseline for both the numeric pain scores (p < 0.0001), postoperative day (p < 0.0001) and the subjective pain score (p < 0.0007). Conclusion: IS values are an objective surrogate data point for pain control after surgery, particularly when followed over time and compared with a preoperative baseline value.

Lay abstract

Our goal was to determine if an incentive spirometer (a device used while in the hospital to help with recovery by expanding the lungs and decreasing the risk of lung collapse, pneumonia and other lung issues) could be used to better evaluate pain control after major surgery. We followed 100 patients having major abdominal surgery at a large academic medical center over several months. All patients had an epidural placed before surgery to help control their pain after surgery. For the first few days after surgery, these patients were followed closely and evaluated for pain control and their incentive spirometry values. We found that a patient’s performance with their incentive spirometer was helpful in determining how their pain was doing. Patients with good pain control were able to use their incentive spirometer easily while patients with less effective pain control had difficulty taking deep breaths needed for incentive spirometry. We believe, incentive spirometry is a tool that can be used by other health providers in the future to help evaluate pain after abdominal surgery.

Tweetable abstract

Incentive spirometry values are an objective surrogate data point for pain control after surgery, particularly when followed over time and compared with a preoperative baseline value. @UNC_Anesthesia @EnhanceRecover @LKolarczyk_MD @kimhjUNC #postoppaincontrol #useyourincentivespirometer.

Keywords::

• acute pain
• analgesia
• incentive spirometry
• IS
• numeric pain rating scale
• NPRS
• postoperative
• thoracic epidural

Author contributions

MJ Hallman helped with designing the study, collecting data, organizing data, data analysis, drafting, reviewing and editing the manuscript. N Dorinsky helped with collecting data, direct patient care, reviewing and editing the manuscript. Y Wang and Q Li helped with statistical analysis, reviewing and editing the manuscript. R Isaak, L Kolarczyk and HJ Kim helped with designing the study, reviewing and editing the manuscript. AJ Lobonc helped with designing the study, data analysis, data collection, direct patient care, drafting, reviewing and editing the manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors of this manuscript have obtained appropriate institutional review board approval from the University of North Carolina (in this case exemption was given) and have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations.