title: The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.
abstract: OBJECTIVE
  Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables.
  
  
  METHODS
  Retrospective study of 468 patients who underwent upper abdominal or thoracic surgery using postoperative thoracic epidural analgesia between June 1, 2009, and August 31, 2013, at a single tertiary academic center. The association between incentive spirometry performance and pain was assessed as the primary outcome. Other independent predictors of incentive spirometry performance were also identified.
  
  
  RESULTS
  Postoperative incentive spirometry performance was found to be inversely proportional to pain score, which correlated significantly stronger with deep breathing pain compared with pain at rest (-0.33 vs -0.14 on postoperative day 1; -0.23 vs -0.12 on postoperative day 2). Pain with deep breathing was independently associated with poorer incentive spirometry performance in the multivariable linear regression model (P < 0.0001), as was increasing age, female sex, thoracic surgery, and higher American Society of Anesthesiologists (ASA) physical status score.
  
  
  CONCLUSIONS
  The present study suggests that pain with deep breathing is more indicative of thoracic epidural efficacy than is pain at rest. Furthermore, incentive spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.
authors.affiliation: From the Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: David J
authors.initials: DJ
authors.lastname: Harris
authors.forename: Paul E
authors.initials: PE
authors.lastname: Hilliard
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Jewell
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
mesh_terms: D000005:Abdomen / Q000601:surgery; D015360:Analgesia, Epidural; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology*; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D013147:Spirometry / Q000706:statistics & numerical data; D013908:Thoracotomy; D016896:Treatment Outcome