Evaluation of the role of transcutaneous electrical nerve stimulation for postoperative pain relief in laparoscopic cholecystectomy: a prospective comparative study
Tóm tắt
Postoperative pain after laparoscopic cholecystectomy still remains a fairly common challenge for the anesthesiologist. Commonly used drugs such as NSAIDs and opioids have their own side effects requiring a need to substantially evaluate the use of non-pharmacological methods like TENS as adjuvants to conventional methods of pain control. We studied the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain in laparoscopic cholecystectomy. The primary objective was to compare postoperative analgesia between TENS and placebo groups using visual analog scale (VAS). The secondary objectives were to compare the requirement and dosage of rescue analgesia, hemodynamic parameters (blood pressure and heart rate), and incidence of nausea and emesis between placebo and TENS groups. A total of 64 patients of age group 18 years to 60 years of either gender posted for elective laparoscopic cholecystectomy were randomly allocated into two groups using a computer-generated sequence of random numbers: Group P (n= 32): placebo TENS and Group A (n= 32): active TENS. Statistical analysis was performed by the SPSS program for Windows, version 17.0 (SPSS, Chicago, Illinois). Unpaired t test, Mann-Whitney U test, chi-square test, and Fisher’s exact test were used for statistical analysis. The two groups were statistically similar in terms of age, gender, and weight. The VAS scores were significantly lower in patients in the active TENS group for up to 2 h after surgery, and the total weighted dose of diclofenac consumed over 8 h in the active TENS group was significantly lower as compared to the placebo TENS group. Patients who received TENS showed significantly less rise in blood pressure and heart rate and remained hemodynamically stable. Total episodes of nausea and emesis though less in the active TENS group were statistically insignificant. We conclude that TENS is an effective adjuvant non-pharmacologic modality for postoperative pain relief after laparoscopic cholecystectomy.
Tài liệu tham khảo
Benedetti F, Amanzio H, Casadio C, Cavallo A, Cianci R, Giobbe R et al (1997) Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac surg 63:773–776
Bisgaard T, Kehlet H, Rosenberg J (2001) Pain and convalescence after laparoscopic cholecystectomy. Ann R Coll Surg Engl 167:84–96
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 90:261–9
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg 136:917–921
Bjordal JM, Johnson MI, Ljunggreen AE (2003) Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A metaanalysis with assessment of optimal treatment parameters for postoperative pain. Eur J Pain 7:181–188
Chandra A, Banavaliker JN, Das PK, Hasti S (2010) Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain. Indian Journal of Anaesthesia 54(2):116
Eidy M, Fazel MR, Janzamini M, Razaei MH, Moravveji AR (2016) Preemptive analgesic effects of transcutaneous electrical nerve stimulation (TENS) on postoperative pain: a randomized, double blind, placebo-controlled trial. Iran Red Crescent Med 18:14–26
Hamza MA, White PF, Ahmed HE, Ghoname EA (1991) Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anaesthesiology 91:1232–1238
Javid PJ, Brooks DC (2004) Cholecystectomy. In: Johnson LR (ed) Encyclopedia of Gastroenterology, 1st edn. San Diego, Elesevier, p 317
Kara B, Baskurt F, Acar S, Karadibak D, Ciftci L, Erbayraktar S et al (2011) The Effect of TENS on pain, function, depression, and analgesic consumption in the early postoperative period with spinal surgery patients. Turkish Neurosurgery 21:618–624
Lau H, Brooks DC (2001) Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy. Arch Surg 136:1150–3
Lee IO, Kim SH, Kong MH et al (2001) Pain after laparoscopic cholecystectomy: the effect and timing of incisional and intraperitoneal bupivacaine. Can J Anaesth 48:545–550
Mannheimer JS, Lampe GN (1984) Clinical transcutaneous electrical nerve stimulation. Philadelphia, PA
Melzack R, Wall P (1965) Pain mechanisms: a new theory. Science 150:971–979
O’Hanlon DM, Colbert S, Ragheb J et al (2002) Intraperitoneal pethidine versus intramuscular pethidine for relief of pain after laparoscopic cholecystectomy: randomized trial. World J Surg 26:1432–6
Oncel M, Sencan S, Yildiz H, Kurt N (2002) Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures. Eur J Cardiothorac surg 22(1):7–13
Rushton DN (2002) Electrical stimulation in the treatment of pain. Ann Disabil Rehabil 24:407–415
Silva MB, de Melo PR, de Oliveira NML et al (2012) Analgesic effect of transcutaneous electrical nerve stimulation after laparoscopic cholecystectomy. Am J Phys Med Rehabil 91(8):652–657
Sjolund BH, Eriksson MBE (1976) Electro-acupuncture and endogenous morphine. Lancet 2:1085
White PF (1995) Management of postoperative pain and emesis. Can J Anaesth 42:1053–5
Wills VL, Hunt DR (2000) Pain after laparoscopic cholecystectomy. Br J Surg 87:273–84
Za´rate E, Mingus M, White PF, et al (2001) The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 92:628–35