The effect on perception of pain sensation, distress and incentive spirometry performance when cholecystectomy patients are mobilized at onset, peak or post peak of opioid (meperidine) action

There has been little study of ways to decrease pain generated by painful postoperative exercise. The purpose of this study was to determine the effect of performing painful activities at various times of analgesic action on pain sensation, pain distress and inspiratory capacity of one day postoperative cholecystectomy patients. In addition, the relationship of inspiratory capacity to pain sensation and distress was explored. The theoretical framework for this study was based on Melzack and Wall's Revised Gate Control Theory of Pain. This experimental study used a randomized balanced incomplete block design in which the subjects served as their own control. Subjects ranged in age from 25 to 59 years and were free of chronic disease, pain syndromes, chemical abuse and psychiatric disorders. Twelve subjects were randomly assigned to two out of three possible combinations: ambulation at 15, 60, or 110 minutes after receiving an intramuscular injection of meperidine. These times represented the predicted onset, peak and post peak of analgesic action. After ambulation, subjects scored a visual analogue scale measuring pain sensation and a rating scale measuring level of distress, and then performed 5 maximal inspirations using a Volurex incentive spirometer. An analysis of variance found no significant difference in pain sensation, distress or inspiratory capacity when subjects were ambulated at different times after meperidine injection. Overall, moderate but variable levels of pain sensation and distress were reported. Decreases in postoperative inspiratory capacity ranged from 40 to 90% of the preoperative baseline. The relationship between inspiratory capacity and pain sensation scores was non significant but a strong trend was noted. When the change in inspiratory capacity between two ambulation times was correlated with the change in pain sensation, a significant negative correlation was found. The relationship between inspiratory capacity and distress was non significant. Additional correlations were performed among selected variables related to sample characteristics. A negative correlation between age and pain sensation was the only significant ancillary finding. The findings were discussed in relation to theoretical expectations, other research studies, and methodological problems inherent in the study. Implications of the findings for nursing practice, education and theory were suggested. Recommendations for future research were made.Applied Science, Faculty ofNursing, School ofGraduat