• Hayato Shimoyama, Masanori Sugiyama, Yutaka Suzuki, Koji Teruya, Atsuko Ohki, Tomokazu Kishiki, Hirohisa Takeuchi, Yoshihiro Sakamoto, Eiji Sunami, and Nobutsugu Abe.
• Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan. Electronic address: hayatos@ks.kyorin-u.ac.jp.
• J. Am. Coll. Surg. 2021 Sep 1; 233 (3): 459-466.e6.

BackgroundDespite the major advances in analgesic techniques, pain relief in 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. We devised the bilateral flank compression (BFC) maneuver, in which the flanks are compressed medially using both hands. We conducted a prospective, single-center, single arm, nonrandomized, open-label, interventional trial, to investigate whether the BFC maneuver relieves cough-related pain after abdominal surgery and examined the efficacy of this maneuver in relation to patient characteristics and surgical factors.Study DesignParticipants were patients who underwent gastroenterologic surgery (except for open inguinal hernia repair) at the Department of Surgery, Kyorin University School of Medicine. We evaluated postoperative pain, from postoperative days (PODs) 1 to 7, on coughing, with and without the BFC maneuver, using the Prince Henry pain scale.ResultsWe finally analyzed 514 patients. On each of the first 7 PODs, the BFC maneuver significantly relieved cough-related pain, especially on POD1; (the mean pain scores [standard deviation] with and without the BFC maneuver were 0.98 [1.030] vs 1.63 [1.112] points, p < 0.0001). On each POD, more patients were free of cough-related pain with than without the BFC maneuver, with the most marked difference on POD7 (52.0% [208/400] vs 16.8% [67/400], p < 0.0001).ConclusionsThe BFC maneuver relieves cough-related pain after abdominal surgery and may help prevent of postoperative pulmonary complications.Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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