Simple Compression Maneuver Curbs Pain on Coughing After Abdominal Surgery

By Megan Brooks

August 04, 2021

NEW YORK (Reuters Health) - A bilateral flank compression maneuver can reduce pain on coughing after abdominal surgery, say clinicians in Japan who developed it.

In a report in the Journal of the American College of Surgeons, they note that "despite the major advances in analgesic techniques, pain relief on coughing after abdominal surgery remains challenging. Cough-related pain causes postoperative respiratory complications by impairing sputum clearance; nevertheless, an effective technique to abolish it is not yet available."

Dr. Hayato Shimoyama and colleagues at Kyorin University School of Medicine in Tokyo devised the bilateral flank compression (BFC) maneuver, in which the flanks are compressed medially using both hands.

They tested it in 514 patients who underwent gastroenterological surgery (excluding open inguinal hernia repair) at their center.

Up until postop day 7, most patients had pain on coughing without the BFC maneuver, despite standard pain control measures.

In contrast, on each of the first seven postop days, use of the BFC maneuver significantly relieved cough-related pain. The maneuver was most effective on the first postop day.

The analgesic effect of the BFC maneuver was evident in all subgroups relating to patient characteristics and surgical factors and was effective with vertical, horizontal and laparoscopic incisions.

The BFC maneuver was performed by trained nurses. In the postoperative setting, it can be performed by nurses or by patients themselves, Dr. Shimoyama and colleagues say in their paper.

"Initially, patients and some nurses were reluctant to perform forceful compression; however, they soon realized that forceful compressions are well tolerated and more efficacious," they report.

In an email to Reuters Health, Dr. Shimoyama said this study shows that the BFC maneuver "reduces pain on coughing after abdominal surgery and it is not difficult to implement and teach the maneuver to the patients."

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: Journal of the American College of Surgery, online July 12, 2021.