Effect of Motivational Spirometry on Severity of Shoulder Pain after Laparoscopic Cholecystectomy and Its Association with Body Mass Index: A Randomized Clinical Trial

Obesity as a risk factor puts patients at risk for postoperative complications. Shoulder pain is one of the early post-laparoscopic cholecystectomy symptoms related to CO2, which remains in the abdomen. Motivational spirometry is a novel technique used in management of shoulder pain after LC. This research aimed to evaluate the effect of motivational spirometry on severity of shoulder pain after LC considering body mass index (BMI).

A randomized clinical trial was performed in 84 patients who were candidate for LC. They were randomly divided into a control group and an intervention group. Demographic characteristics and body mass index were recorded. Patients in intervention group used motivational spirometry (10 deep breaths in sitting or semi-sitting positions) in full consciousness every 2 hr after surgery. In both groups, intensity of shoulder pain was measured at 4, 8, 12, 24, and 48 hours after surgery using Numerical Rating Scale (NRS).

Among the intervention group, 28.9% had a BMI higher than 25. Kruskal-Wallis test showed significant differences in pain intensity between patient in the intervention group with different BMI at 4, 8, 12, and 24 hours after surgery (P<0.05).

In this study, motivational spirometry reduced intensity of shoulder pain in patients following LC, however, some patients with high BMI had more sever and long-lasting pain, because obesity impede proper deep and effective inhalation and exhalation in these patients.