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Randomized Controlled Trial
. 2008 Sep;126(5):269-73.
doi: 10.1590/s1516-31802008000500005.

Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial

Roberta Munhoz Manzano  1 , Celso Ricardo Fernandes de Carvalho, Beatriz Mangueira Saraiva-Romanholo, Joaquim Edson Vieira
Affiliations
Randomized Controlled Trial

Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial

Roberta Munhoz Manzano et al. Sao Paulo Med J. 2008 Sep.

Abstract
in English, Portuguese

Context and objective: Abdominal surgical procedures increase pulmonary complication risks. The aim of this study was to evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective upper abdominal surgery.

Design and setting: This randomized clinical trial was performed in the post-anesthesia care unit of a public university hospital.

Methods: Thirty-one adults were randomly assigned to control (n = 16) and chest physiotherapy (n = 15) groups. Spirometry, pulse oximetry and anamneses were performed preoperatively and on the second postoperative day. A visual pain scale was applied on the second postoperative day, before and after chest physiotherapy. The chest physiotherapy group received treatment at the post-anesthesia care unit, while the controls did not. Surgery duration, length of hospital stay and postoperative pulmonary complications were gathered from patients' medical records.

Results: The control and chest physiotherapy groups presented decreased spirometry values after surgery but without any difference between them (forced vital capacity from 83.5 +/- 17.1% to 62.7 +/- 16.9% and from 95.7 +/- 18.9% to 79.0 +/- 26.9%, respectively). In contrast, the chest physiotherapy group presented improved oxygen-hemoglobin saturation after chest physiotherapy during the immediate postoperative period (p < 0.03) that did not last until the second postoperative day. The medical record data were similar between groups.

Conclusions: Chest physiotherapy during the immediate postoperative period following upper abdominal surgery was effective for improving oxygen-hemoglobin saturation without increased abdominal pain. Breathing exercises could be adopted at post-anesthesia care units with benefits for patients.

CONTEXTO E OBJETIVO:: Cirurgias abdominais podem aumentar o risco de complicações pulmonares. O objetivo foi avaliar a eficácia da fisioterapia respiratória precoce no pós-operatório imediato em pacientes submetidos a cirurgia abdominal alta.

TIPO DE ESTUDO E LOCAL:: O estudo foi do tipo ensaio clínico aleatório, realizado na sala de recuperação pós-anestésica de um hospital público universitário.

MÉTODO:: 31 adultos foram selecionados aleatoriamente em dois grupos, controle (n = 16) e grupo de fisioterapia respiratória (n = 15). Espirometria, oximetria de pulso e anamnese foram realizadas no pré-operatório e no segundo dia pós-operatório. A escala visual analógica foi aplicada no segundo dia pós-operatório e antes e depois da fisioterapia respiratória. O grupo da fisioterapia respiratória recebeu fisioterapia na sala de recuperação pós-anestésica e o grupo controle, não. Tempo cirúrgico, tempo de internação e as complicações pulmonares pós-operatórias foram analisados nos prontuários dos pacientes.

RESULTADOS:: Os grupos apresentaram uma diminuição dos valores espirométricos após a cirurgia, porém, não houve diferença entre eles (capacidade vital forçada, CVF 83.5 ± 17.1% versus 62.7 ± 16.9% grupo controle pré versus pós-operatório e 95.7 ± 18.9% versus 79.0 ± 26.9% grupo fisioterapia). Em contraste, o grupo da fisioterapia respiratória apresentou uma melhora na saturação de oxi-hemoglobina após a fisioterapia no pós-operatório imediato (p < 0,03), mas esta não se manteve até o segundo dia pós-operatório.

CONCLUSÕES:: A fisioterapia respiratória é efetiva na melhora da saturação de oxi-hemoglobina em pacientes observados na sala de recuperação pós-anestésica em cirurgia abdominal alta, e não provoca dor durante os exercícios.

NÚMERO DE REGISTRO DE ENSAIO CLÍNICO:: NCT00596778

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Conflict of interest statement

Conflict of interest: Not declared

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