title: Effect of effort pain after upper abdominal surgery on two independent measures of respiratory function.
abstract: OBJECTIVE
  To determine how effort pain interacts with changing pulmonary function after upper abdominal incisions.
  
  
  METHODS
  Prospective, case-controlled study.
  
  
  METHODS
  Academic teaching hospital.
  
  
  METHODS
  34 ASA physical status I, II, and III patients recovering from elective, major incisional, upper abdominal surgery.
  
  
  METHODS
  Manometry (maximal inspiratory and expiratory pressure) and spirometry (forced vital capacity, forced expiratory volume during the first second, peak expiratory flow) for three postoperative days. Pain scores (Visual Analog Pain Scale; VAS) at rest and after the manometric or spirometric efforts.
  
  
  RESULTS
  Effort pain during either manometry or spirometry was greater than pain at rest on the first postoperative day. Maximal respiratory pressure concomitantly recovered with pain during daily efforts (slopes: -0.429 and -0.278% max/mm VAS; P < 0.05). Spirometric measurements showed minimal improvement.
  
  
  CONCLUSIONS
  The direct relationship between resolution of pain with effort and direct measures of respiratory muscle effort using manometry, but not those obtained less directly by spirometry, suggests that assessing interactions between pain and effort requires a direct, quantifiable measure of effort.
authors.affiliation: Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA. wkimball@partners.org <wkimball@partners.org>
authors.forename: William R
authors.initials: WR
authors.lastname: Kimball
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Carwood
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: McKenna
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Peters
authors.forename: Jane C
authors.initials: JC
authors.lastname: Ballantyne
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005540:Forced Expiratory Flow Rates / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D005082:Physical Exertion / Q000502:physiology*; D012129:Respiratory Function Tests; D013147:Spirometry; D014797:Vital Capacity / Q000502:physiology