Effects of midline laparotomy on cough strength: a prospective study measuring cough pressure
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- dc.contributor.author Aguilera, Lluís G.
- dc.contributor.author Gallart Gallego, Lluís
- dc.contributor.author Ramos, Isabel
- dc.contributor.author Duran Jordà, Xavier, 1974-
- dc.contributor.author Escolano Villén, Fernando
- dc.date.accessioned 2024-10-24T06:55:31Z
- dc.date.available 2024-10-24T06:55:31Z
- dc.date.issued 2023
- dc.description.abstract Background: Laparotomy is assumed to decrease cough strength due to three factors: abdominal muscle trauma, postoperative pain, and diaphragmatic dysfunction. However, the effect of trauma from laparotomy itself on strength (net of the other two factors) has not been measured to our knowledge. The aim of this study was to measure the effect of laparotomy on cough strength after first measuring the effect of epidural analgesia. Methods: In 11 patients scheduled for open midline laparotomy, cough pressure (PCOUGH), a proxy for strength, was measured with a rectal balloon at three moments: before the procedure, at baseline; before surgery, under epidural bupivacaine to T6; and postoperatively, under epidural bupivacaine to the same analgesic level (T6). Continuous variables were compared using the Wilcoxon signed-rank test. The repeatability of PCOUGH measurements was confirmed with the intraclass correlation coefficient (ICC). Pain on coughing, hand grip strength, and the Ramsay and modified Bromage scores were also recorded. Results: Median (interquartile range) PCOUGH decreased from a baseline of 103 (89-137) to 71 (56-116) cmH<inf>2</inf>O under presurgical epidural bupivacaine (P=0.003). Postoperative PCOUGH remained unchanged at 76 (46-85) cmH<inf>2</inf>O under epidural analgesia (P=0.131). The ICCs indicated excellent repeatability of the PCOUGH measurements (P<0.001). Pain on coughing was 0 to 1 in all subjects. Hand grip strength and the Ramsay and Bromage scores were unchanged. Conclusions: Although thoracic epidural bupivacaine reduces cough strength as measured by PCOUGH, midline laparotomy does not further reduce strength in the presence of adequate epidural analgesia.
- dc.format.mimetype application/pdf
- dc.identifier.citation Aguilera LG, Gallart L, Ramos I, Duran X, Escolano F. Effects of midline laparotomy on cough strength: a prospective study measuring cough pressure. Minerva Anestesiol. 2023 Dec;89(12):1092-8. DOI: 10.23736/S0375-9393.23.17519-5
- dc.identifier.doi http://dx.doi.org/10.23736/S0375-9393.23.17519-5
- dc.identifier.issn 0375-9393
- dc.identifier.uri http://hdl.handle.net/10230/68336
- dc.language.iso eng
- dc.publisher Edizioni Minerva Medica
- dc.relation.ispartof Minerva Anestesiol. 2023 Dec;89(12):1092-8
- dc.rights Copyright © 2023 THE AUTHORS. This is an open access article distributed under the terms of the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/) which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
- dc.subject.keyword Bupivacaine
- dc.subject.keyword Analgesia, epidural
- dc.subject.keyword Laparotomy
- dc.subject.keyword Cough
- dc.subject.keyword Pain, postoperative
- dc.subject.keyword Respiratory muscles
- dc.title Effects of midline laparotomy on cough strength: a prospective study measuring cough pressure
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion