A New Breathing Technique for Pain Management in Patients With Thoracic Trauma: A Randomised Trial

Pain management following thoracic trauma is important for optimal patient outcomes. One nostril inspiration (ONI) encourages slow inspiration through one nostril to minimise inspirational flow, avoiding rapid breathing movements which induce pain.

To investigate the effects of ONI, added to standard physiotherapy management, on patients' reported pain levels, and on functional status, exercise capacity, pulmonary complications, adverse events, and hospital length of stay (LOS).

A single-centre randomised trial was conducted. Adults with confirmed thoracic trauma, spontaneous breathing, and able to cooperate were recruited using consecutive sampling. Participants in two trauma wards received either standard physiotherapy or experimental care (standard physiotherapy plus ONI). A computer-generated randomisation list was used to determine ward allocation for standard (SC) and experimental care (EC). Allocation was 1:1. EC participants performed sets of 10 ONI breaths every second waking hour and when experiencing pain. Training was recorded in a diary. Outcomes were assessed on days 1-5 of admission. Descriptive and inferential analyses were performed.

Participants (n = 150; median age 31 (IQR 26-39) years; 92.7% male) had mostly sustained penetrating thoracic trauma from physical assault (82.7%). Most participants had intercostal drains in place. Both groups received a median of four physiotherapy sessions. EC participants performed ONI breathing at a median frequency of 2.8 (IQR: 2.1-3.6) times/day; 45% adhered to ≥ 75% of prescribed sessions. Pain decreased in both groups. On day 5, EC reported significantly lower pain (p = 0.01, moderate effect size d = 0.72). Participants practicing ONI ≥ 3 times/day had less pain on day 3 than those with lower adherence (p = 0.05). Secondary outcomes showed a slightly longer mean LOS for EC (5.0 vs. 4.5 days, p = 0.008). No between-group differences were found for pulmonary complications, functional or exercise capacity, or adverse events. All participants were discharged home.

Education on repeated slow deep breathing exercise taught to patients with thoracic injury reduced pain, with ONI being one method of slow deep breathing. Those who adhered closely to the protocol had reduced pain from the third day of hospitalisation. ONI is a feasible and safe adjunct to standard physiotherapy that empowers patients to manage their respiratory pain.

The study was registered with the Pan African Clinical Trials Registry (PACTR202201706227234).