A Comparative Study between Transcutaneous Electrical Nerve Stimulation and Fentanyl to Relieve Shoulder Pain during Laparoscopic Gynecologic Surgery under Spinal Anesthesia: A Randomized Clinical Trail

Abstract

Background Traditionally, laparoscopic procedures have been performed under general anesthesia. Spinal anesthesia is an effective alternative to general anesthesia. However, one of the intraoperative complications of performing laparoscopic surgery under spinal anesthesia is shoulder pain. This study aimed to compare the effect of transcutaneous electrical nerve stimulation (TENS) with fentanyl on pain relief in patients who underwent gynecologic laparoscopy under spinal anesthesia. Methods We conducted a prospective randomized clinical trial from May 2016 to March 2017. A sample of patients who underwent gynecological laparoscopy under spinal anesthesia was recruited. If they had shoulder pain, they randomly received either transcutaneous electrical nerve stimulation (TENS) or 50 mg of fentanyl. Pain intensity was measured using the single item visual analogue scale (VAS-10 cm) immediately before and 5, 10, 20, and 30 minutes after treatment. Also, the effect of higher doses of analgesia on pain relief was analyzed. Results In all, 80 patients (40 patients in each group) were entered into the study. The mean pain intensity score was 9.02 ± 1.32 in the TENS group and 8.95 ± 1.33 in the fentanyl group at baseline (P = 0.80). Repeated measures analysis of variance indicated that there was no significant difference on overall pain scores between the two treatment groups adjusted for age, BMI, total analgesia used, and baseline pain score (F (1, 74) = 1.44, P = 0.23). The use of analgesic drugs in the TENS group was significantly higher than the fentanyl group (P = 0.01). In addition, we found that nine patients (22.5%) complained of nausea/vomiting in the TENS group compared to thirteen patients (32.5%) in the fentanyl group (P = 0.31). Conclusions The findings indicated that TENS was not superior to fentanyl for pain relief in laparoscopic surgery. It seems that the correct use of TENS parameters might merit further investigation. This trial is registered with: IRCT2016031216765N3.

A randomized clinical trial on the effect of a lidocaine patch on shoulder pain relief in laparoscopic cholecystectomy

“…For example, pretreatment using a trigger point injection or an EMLA cream on the shoulder significantly reduced the incidence and severity of shoulder pain after laparoscopy 14 . Moreover, transcutaneous electrical nerve stimulation on the shoulder alleviated shoulder pain during laparoscopy 24 . Based on these studies, we hypothesized that the application of a lidocaine patch to the shoulder could also reduce referred shoulder pain after laparoscopic surgery.…”

Laparoscopic surgery for benign adnexal conditions under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach

“…Pain scores differences in the three groups assessed after surgery and the time of discharge were not statistically significant [26]. A recent series evaluated 80 women submitted to gynaecological laparoscopic surgery under LRA, randomized to receive transcutaneous electrical nerve stimulation or intravenous Fentanyl to decrease intraoperative shoulder pain [27]; no differences in pain relief were found.…”

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“…Traditionally, general anesthesia (GA) with controlled ventilation is accepted as the safest technique for laparoscopic procedures, and various myths and dogmas discouraged the use of regional anesthesia, whereas the no anesthetic technique has been proved to be clinically superior to another ( 1 ) . Possible adverse effects due to pneumoperitoneum or the Trendelenburg position are among the main concerns regarding neuroaxial anesthetic techniques ( 2 ) .…”