Despite the major advances in analgesic techniques, pain relief on 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, non-randomized, open-label, interventional trial, to investigate whether the BFC maneuver relieves cough-related pain after abdominal surgery, and examine the efficacy of this maneuver in relation to patient characteristics and surgical factors.

Participants were patients who underwent gastroenterological 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) 1–7, on coughing with and without the BFC maneuver using the Prince Henry pain scale.

We 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<.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<.0001).

The BFC maneuver relieves cough-related pain after abdominal surgery and may help prevent of postoperative pulmonary complications.