Effectiveness of Treatment versus Non Treatment in Post Surgical Recovery Period after Major Operative Procedures

Dr. S.K. Dwivedi¹* Dr. Ajit S. Rajput², Kiran Patel³and Adile S.L.⁴

¹Assistant Professor and H.O.D. Physiology, Govt. Medical College, Jagdalpur

²Associate Professor, Physiology, G.R. Medical College, Gwalior

³Associate Professor, Physiology, NSCB Medical College, Jabalpur

⁴Dean, Govt. Medical College, Jagdalpur (Bastar)

*Corresponding Author E-mail:

ABSTRACT:

Objective: Does treatment (chest physiotherapy) as an intervention have any beneficial effect in post surgical recovery period after major surgical operations?

Material and method: Data was collected from ninety cases of 18 to 60 years of age of both sexes, who underwent major abdominal surgery in NSCB Medical College, Jabalpur. Variables: Duration of surgery, length of incision, Naso Gastric tube duration and dose of analgesia in mg.

Findings and interpretation: On analysis of the recorded data it was found that in treatment group only 14 percent was the attack rate in comparison to their non treatment 60 percent counterparts which was statistically significant

Conclusion and Recommendation: Hence physiotherapy found beneficial than no physiotherapy. Authors recommended in developing countries like India routine prophylactic Balloon type of chest physiotherapy can be used as an aid in preventing post pulmonary complications.

KEYWORDS: Treatment in form of Chest Physiotherapy, Non treatment.

INTRODUCTION:

Since 1954, when Thoren (1) reported that chest physiotherapy reduced the incidence of pulmonary complications after cholesystectomy, there has been an acceptance that patients undergoing abdominal surgery benefitted from some form of prophylactic physiotherapy. The nature of this physiotherapy varied according to the prevailing attitude of about the path physiology of atelactsis. There are several methods of chest physiotherapy.

By taking in to consideration the above points and as per recommendations of the World Health Organization (W.H.O.) study group in 1957, that in order to get a comprehensive picture of any disease or health problem, more and more such studies have to be done, Garg Narenra K.(2) and Garg Narenra K. and Sharma A.B.(3), the authors have under taken inspiratory based maneuver (incentive spirometer), expiratory based maneuver (balloon chest exercise) as a treatment as an intervention have any beneficial effect in post surgical recovery period after major surgical operations in comparison to controlled as no treatment group?.

MATERIALS AND METHOD:

This study was organized in NSCB Medical College and Hospital, Jabalpur (M.P.) between May 2006 and 2007. Over all 98 cases (38, 45 and 15 put on incentive spirometry, Balloon Spirometer and as controlled group respectively) of 18 to 60 years of age and belong to both sexes, who were undergoing major abdominal surgery, taken as sample.

Table – I. Quantitative Assessment of chest complication between treatment (B.S. and I.S.) and No treatment i.e. control group

Group	Complication	No-complication	Total	Attack Rate in percentage
Control	09	06	15	60.00
I.S.	05	33	38	13.2
B.S.	07	38	45	15.5

Table – II. Quantitative Assessment of chest complication between treatment i.e. chest physiotherapy and No treatment group i.e. no chest physiotherapy

Group	Complication	No-complication	Total	Attack Rate in percentage
No treatment	09	06	15	60.00
Treatment	12	71	83	13.2
Total	21	77	98	P=0.0001

The subjects selected for study had no history of COPD or any other respiratory system involvement which could influence pulmonary functions. The outcome of the surgery was assessed by any type of post operative pulmonary complications. Chest radiograph was used as measure.

Consistent with collapse/consolidation.

Unexplained temperature > 38⁰C

+ Positive CXR/ Positive sputum (C/ST)

When a patient produces discolored sputum sample were sent for the culture.

Pulmonary emboli and pulmonary edema neither were nor regarded as pulmonary complications for the purpose of this study.

Physical examination was used as a secondary outcome measure if it was not possible to separate chest radiograph findings.

OBSERVATIONS AND DISCUSSION:

On analysis of the collected data it was found that mean duration of surgery was 2.26 and 2.27 hour in balloon and incentive group respectively while incision length was 13.87 and 13.80 cm. respectively. Regarding nasogastric tube duration was concerned it was 126.71 and 127.32 hours respectively in balloon and incentive spirometry.

At 1^st recording for balloon and incentive-

(a)FVC, FEV1, PEF at (n1+n2-2) df=81. Calculated – t value is 0.04, 0.96 and 1.24. At 81 df highest obtainable value of “t” at 5% level of significance is 1.96 as found to reference “t” test. “t” value calculated is lower thus p>0.05 difference observed has no significance. Such a difference can occur due to chance.

(b) FEV1/FVC and MVV has “t” value 2.69 and 3.75 respectively. Table value for 81 df is at 1.96 at 5% level. Calculated value more than table value. 0<0.05 significant at 5% level. Thus the probability of occurring 2.69 and 3.75 is much higher than highest 1.96 obtained by chance.

At 2^ndrecording for balloon and incentive-

(a). FVC calculated value t=1.86 which is lower than 81 degree of freedom reference value 1.96. P>0.05. So difference observed is statistically in significant.

(b). FEV1, PEF, FEV1/FVC and MVV calculated t value are much higher than table value 1.96 at 5% level. P<0.05. So this value is highly significant.

A t 3^rd recording for balloon and incentive-

(a). FEV1 calculated t value is 1.81 which is lower than 81 degree of freedom reference value p>0.05. So difference observed is statistically insignificant.

(b). FVC, PEF, FEV1/FVC and MVV calculated t value are much higher than table value 1.96 at 5% level. P<0.05. Hence this value is highly significant.

For balloon group complication rate was 15.6 percent and for incentive group it was only 13.2 percent in comparison to 60.00 in control group (Table-1). This shows that treatment group has less complication in comparison to non treatment group. On statistical analysis it has been noted that the difference between two treatments was not found significant at 5% level.

(Table-II) shows that in treatment group only 14 percent attack rate in comparison their 60 percent counterparts, At one degree of freedom c² value correspond to probability 0.05 is 3.84 calculated value is 15.12 which is much higher than table value (p=0.0001). Hence physiotherapy proved statistically beneficial to no physiotherapy.

Thoran (1) found in his study that patients under elective surgery who received chest physiotherapy have only 12% complications in comparison to 30% in non treatment group. Moran et al (4) concluded that % of chest complication was lower in treatment than no treatment group. Celli B, Rodriguez G, Snider G,: (5) Controlled trial of intermittent positive pressure breathing, incentive spirometry and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am. Rev Respir. Dis. (1984) 130:12-15

CONCLUSIONS:

A lung function varies in different recordings.

Most lung function parameter in different recording much more in incentive group in comparison to their counterpart balloon group.

Hence authors reached to the conclusion that balloon physiotherapy is as effective as that of incentive in prevention of complication.

On the basis of the present study authors recommend balloon therapy which is also cheaper in comparison to incentive as a routine for all patients before major abdominal surgery particularly high risk patients and those with morbid obesity irrespective of age for prevention of chest complications.

REFERENCES:

1. Thoren L. Postoperative pulmonary complications: Acta Chir. Scand. (1954) : 107 :193

2. Garg Narendra K.: Evaluation of the impact of emesis and emesis plus purgation Therapy; Research J Pharmacology and Pharmacodynamics:2 (2) March-April;2010:201-202.

3. Garg Narendra K and Sharma A.B. : Epidemiological profile of patients attending a tertiary care hospital, Muktsar, Punjab (India); Research J Pharmacology and Pharmacodynamics:3 (6) November-December;2011:311-317

4. Morran CG, Finlay IG, Mathison M, Mckay AJ, Wilson N, Mcardle CS. Randomized controlled trial of physiotherapy for postoperative pulmonary complications: BR. J Anesth. 1983:55:1113-17

5. Celli B, Rodriguez G, Snider G,: A controlled trial of intermittent positive pressure breathing , incentive spirometry and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am. Rev Respir. Dis. (1984) 130:12-15

Received on 08.08.2014 Modified on 15.09.2014

Res. J. Pharmacology & P’dynamics. 7(1): Jan.-Mar. 2015; Page 35-37

DOI: 10.5958/2321-5836.2015.00008.7