Combined Acupressure Effects on Post-Thoracotomy Pain and Lung Volume

The Effects of Acupressure Combination on Post-Thoracotomy Pain and Lung Volume During Rest, Breathing-Coughing Exercises: A Randomized Controlled Study

Pain is a subjective, sensory and emotionally unpleasant experience resulting from real or hidden injuries in tissues. The pain experience is a subjective and unique experience in physiological and psychological terms and is the first negative sensory experience of the patient after the surgical procedure. Thoracotomy is an invasive surgical incision that causes severe postoperative pain due to the negative effect on the ribs, muscles and peripheral nerves. During thoracic surgery, anatomical lung resection is performed through posterolateral thoracotomy. Surgical incision during thoracotomy surgery is the most severe cause of postoperative pain. Epidural analgesia, peripheral nerve block and systematic treatment methods are used in post-thoracotomy pain management. Opioid use is frequently preferred in post-thoracotomy pain management. Although thoracotomy pain can mostly be controlled with opioid analgesics, excessive use of opioids may lead to respiratory suppression, constipation, suppression of cough, nausea, vomiting and many other possible side effects. Ineffective postoperative pain management may lead to postoperative complications such as increased cardiac workload, prolonged pulmonary rehabilitation and delayed wound healing. The use of holistic non-drug pain relief methods is vital in reducing the need for opioid analgesics and the risk of possible side effects in early postoperative pain management.

Many non-drug applications such as music therapy, transcutaneous electrical nerve stimulation, cryotherapy, acupuncture, electroacupuncture are used in pain management after thoracic surgery and to reduce analgesic use. Acupuncture is an application that provides the balance of energy flow (Qi) on meridians with thin needles placed at certain points of the body, which has been widely applied in China for more than 4000 years. Factors such as trauma and surgical incision disrupt the energy flow between meridians and cause problems in organ groups where meridians are effective. Acupuncture is accepted as an application that helps to balance this energy flow. Acupressure application, which is included in nursing practices, is a holistic non-pharmaceutical application based on acupuncture. Acupressure is a holistic treatment method that includes manual and noninvasive methods that provide stimulation to acupuncture points with pressure instead of needle stimulation. The point where acupressure will be applied is selected among the acupuncture points on the relevant meridian according to the problem existing in the individual. In acupressure application, pressure can be applied to a single point or more than one point consecutively.In acupressure application, it is reported that pressure can be applied to a single point, as well as stimulating multiple points consecutively will increase the desired effect. As the preferred acupuncture key points on the meridians, points on the hand, finger, wrist, palm, elbow, knee, and feet are often preferred. Acupressure tactilely reduces the sensation of pain by stimulating Aβ nerve fibres; increases the pain threshold by supporting the release of endogenous opioids; regulates the transmission of pain signals by secreting serotonin and norepinephrine, which are neurotransmitters responsible for the regulation of pain. In a randomised controlled study, the efficacy of acupressure in the treatment of postoperative pain in patients undergoing thoracoscopic surgery was examined. The participants in the experimental group were acupressured three times a day for two days at LI11, LU7, LU9, LU5, LU1, LU2, TE5, TE6, PC4, PC6 and LI4 acupressure points. In the control group, routine treatment of the clinic was applied and acupressure was not applied. After acupressure application, the pain score of the experimental group was found to be lower compared to the control group (p < 0.001). Similarly, it is reported in the literature that the use of acupressure is one of the best options for the relief of postoperative pain. It is also reported in the literature that acupressure can effectively improve lung function, dyspnoea and quality of life of patients with pneumonia.

Non-drug applications planned for the expected pain in the early postthoracotomy period are important in terms of reducing respiratory complications, improving the quality of pain management and supporting patients. When the literature is examined, there is no study examining the effect of acupressure on pain and lung volume during deep breathing and cough exercises, which have an important role in maintaining and improving lung volume after thoracotomy.

Inclusion Criteria:

• Underwent thoracotomy
• Undergoing thoracic surgery for the first time
• Classified as ASA (American Society of Anesthesiology) physical status I, II and III
• Presence of a drain upon admission to the intensive care unit
• Conscious, oriented, and cooperative
• Provided verbal and written informed consent after receiving information about the study

Exclusion Criteria:

• Intubated
• Persistent anxiety before the surgery
• Diagnosed with panic disorder
• Chemotherapy within the last 6 months
• Diagnosed psychiatric illness or mental health problems
• Presence of edema
• Intraoperative or postoperative complications
• Non-Turkish speaking, or presence of hearing or visual impairment
• Body mass index (BMI) greater than 30
• Participation in another clinical trial during the study period