Hi-TENS combined with PCA-morphine as post caesarean pain relief

Binder, Pauline; Gustafsson, Annica; Uvnäs‐Moberg, Kerstin; Nissen, Eva

doi:10.1016/j.midw.2010.05.002

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…We found several studies that reported similar patterns of postoperative analgesic requirement using PCA. [23,24] A slightly shorter (6 hours) period of the greatest demand for opioid analgesia has been reported, [23,25] but that result was not subject to statistical analysis. We did not find any other study that analyzed PCA use according to the method of hour-by-hour bolus counting that we used in the present study.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

et al. 2016

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Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage.This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain.Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9–51.6).The requirement for postoperative analgesics is greatest during the first 12 hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative analgesia and decreases opioid consumption during the period of the highest analgesic demand after CS, without an increase in maternal or neonatal side effects. We recommend using intrathecal fentanyl for CS in medical centers not using morphine or other opioids intrathecally at present.

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Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

et al. 2016

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“…Seventeen trials used distal acupoint stimulation [20–22, 27–29, 34, 35, 40–42, 44–49] and 17 trials used peri-incisional stimulation [23–25, 30–33, 36–39, 43, 50–54], and one trial combined distal and peri-incisional stimulation [26].…”

Section: Resultsmentioning

confidence: 99%

“…Two out of 17 studies compared different frequencies of stimulation [45, 47], and 1/17 compared EA with manual acupuncture [21]. In the 17 peri-incisional stimulation studies, 11 compared with sham [24, 30, 32, 33, 36–38, 43, 50, 51, 54], three compared with non-active stimulation [23, 25, 52], and three compared with both [31, 39, 53]. In addition, one study compared different intensities of stimulation [30], and one compared different frequencies of stimulation [32].…”

Section: Resultsmentioning

confidence: 99%

Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice

Zhu

Zou

et al. 2019

BMC Complement Altern Med

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Background Acute postoperative pain remains a major clinical problem that affects patient recovery. Distal acupoint and peri-incisional stimulation are both used for relieving acute postoperative pain in hospital. Our objective was to assess and compare the effects of distal and peri-incisional stimulation on postoperative pain in open abdominal surgery. Methods MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Chinese databases CNKI and Wanfangdata were searched to identify eligible randomized controlled trials. Intensity of postoperative pain, opioid consumption and related data were extracted and analyzed using a random effects model. Risk of bias was assessed. Subgroup analyses were conducted when data were enough. Results Thirty-five trials were included, in which 17 trials studied distal stimulation, another 17 trials studied peri-incisional stimulation and one studied the combination of the two approaches. No studies that directly compared the two approaches were identified. Subgroup analysis showed that both distal and peri-incisional stimulation significantly alleviated postoperative resting and movement pain from 4 h to 48 h after surgery by 6 to 25 mm on a 100 mm visual analogue scale. Peri-incisional stimulation showed a better reduction in postoperative opioid consumption. No studies compared the effects of the combined peri-incisional and distal stimulation with either mode alone. Overall the quality of evidence was moderate due to a lack of blinding in some studies, and unclear risk of allocation concealment. Conclusion Both distal and peri-incisional modes of stimulation were effective in reducing postoperative pain. Whether a combined peri-incisional stimulation and distal acupuncture has superior results requires further studies.

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“…TENS has added advantage of being non-invasive and having no side effects. 18,19 TENS is a widely used modality for pain relief in physiotherapy and there are variations in its parameters having various effects. It activates complex neuronal network to reduce pain by activating descending inhibitory systems in the central nervous systems to reduce hyperalgesia.…”

Section: Discussionmentioning

confidence: 99%

Effect of acupuncture TENS versus conventional TENS on post cesarean section incision pain

Mehendale¹,

Revadkar²

2018

Int J Reprod Contracept Obstet Gynecol

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Background: There is evidence regarding beneficial use of Transcutaneous Electrical Nerve Stimulation (TENS) on post Lower Segment Caesarean Section (LSCS) incision pain. However, efficacy of different types of TENS following C section pain has not yet been explored adequately.Methods: 96 women who had recently undergone LSCS were included for the study. The subjects were in the age group of 20 to 40 years (25.84±3.96); having pain intensity 4 or more on Numerical Pain Rating Scale (NPRS). They were divided into three groups by random allocation method; namely Group A: Acupuncture (Low/Motor) TENS, Group B: Conventional (High/Sensory) TENS and Group C: Control group. Group A and B received specific type of TENS twice a day for 15 minutes. Control group C did not receive any TENS intervention. All subjects received standard post-operative medications and physiotherapy. Pain intensity was recorded on NPRS pre and post intervention.Results: Both Acupuncture TENS and Conventional TENS significantly decreased post-operative pain intensity as compared to control group (p value <0.0001).Conclusions: Both, acupuncture and conventional TENS are equally effective in reducing post LSCS incision pain at a strong and non-painful intensity.

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Hi-TENS combined with PCA-morphine as post caesarean pain relief

Cited by 15 publications

References 36 publications

Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice

Effect of acupuncture TENS versus conventional TENS on post cesarean section incision pain

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