Conference Coverage

Biofeedback Breathing Reduces 24-Hour Pain After Cholecystectomy in RCT

Ashton L. Stahl

Key Highlights

  • Among 196 trial completers, biofeedback reduced 24-hour postoperative pain compared with controls (adjusted mean difference, −0.53; P = .003).
  • Preoperative anxiety scores were significantly lower with biofeedback (adjusted mean difference, −6.67; P < .001).
  • Rescue analgesic consumption during the first 24 hours was 33% lower in the biofeedback group.
  • The intervention used portable-device cues to guide breathing at 6 breaths per minute before and after surgery.

Biofeedback-guided breathing reduced pain intensity 24 hours after elective laparoscopic cholecystectomy in a prospective randomized controlled trial. Participants receiving the intervention also reported lower preoperative anxiety and used less rescue analgesia during the first postoperative day than controls.

The findings, from investigators at Seoul National University Bundang Hospital in Seongnam, Republic of Korea, are scheduled for presentation on October 19 at the ANESTHESIOLOGY Annual Meeting 2026 in San Diego. Investigators evaluated heart rate variability biofeedback as a nonpharmacologic approach that may enhance parasympathetic activity and reduce anxiety.

Adults scheduled for elective laparoscopic cholecystectomy were randomized to biofeedback or control groups. The biofeedback group used a portable device providing real-time visual and auditory cues to pace breathing at 6 breaths per minute. Sessions occurred at least 3 times daily from the day before surgery through the day after surgery, with an additional session in the preoperative waiting area.

The primary outcome was pain intensity at 24 hours, measured using a visual analog scale. Secondary outcomes included preoperative anxiety, pain intensity and fentanyl consumption in the postanesthesia care unit, and total analgesic consumption during the first 24 hours, converted to morphine milligram equivalents (MME). Analyses were adjusted for age and sex. We conducted exploratory mediation analyses to examine potential pathways underlying the biofeedback effect.

Study Findings

Of 212 enrolled patients, 196 completed the trial (98 per group). At 24 hours post-surgery, pain scores were significantly lower with biofeedback than in controls: the adjusted mean difference was −0.53 (95% CI, −0.88 to −0.18; P = .003).

Preoperative anxiety was also significantly lower in the biofeedback group, with an adjusted mean difference of −6.67 (95% CI, −9.04 to −4.31; P < .001). Rescue analgesic consumption during the first 24 hours was 3.84 MME with biofeedback versus 5.79 MME with control, a reported 33% reduction (P = .039).

Clinical Implications

According to the investigators, biofeedback may be a useful adjunct to multimodal perioperative care. They concluded that its effect appeared to shift from anxiety-mediated analgesia immediately after surgery to a potential direct analgesic effect later.

Expert Commentary

“Preoperative biofeedback reduced postoperative pain 24 hours after laparoscopic cholecystectomy,” the researchers concluded.

Reference

Jang H, Koo YH, Park JW, Ryu JH, Koo BW. The effect of respiratory exercise with preoperative biofeedback on postoperative pain. Abstract scheduled for presentation at: ANESTHESIOLOGY 2026; October 16–20, 2026; San Diego, CA. Abstract A1845.