Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy?

Abstract

A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of transcutaneous electrical nerve stimulation (TENS) is effective in reducing post-thoracotomy pain. Of the 74 papers found with a report search, nine prospective randomized controlled trials (RCT), among which three were double-blind, presented the best evidence to answer the clinical question. All investigated the effect of TENS as an adjunct therapy for relieving acute post-thoracotomy pain in patients undergoing thoracic surgery. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that a vast majority - seven of the nine retrieved studies - were in favor of TENS as an adjuvant to narcotic analgesics for improving outcome after thoracic surgery. Indeed, the interest and benefit has been shown not only in the treatment of acute post-thoracotomy pain (pain scores and narcotic requirements were consistently lower in the TENS group as opposed to the Placebo-TENS group), but also when used together with narcotic analgesics to reduce the duration of recovery room stay and to increase chest physical tolerance (better coughing attempts during chest physiotherapy) with positive effects on pulmonary ventilator function [forced expiratory volume in 1 s (FEV(1)) and/or forced vital capacity (FVC)]. Specifically, the TENS treatment was shown to be ineffective when used alone in severe post-thoracotomy pain (i.e. posterolateral thoracotomy incision), but useful as an adjunct to other medications in moderate post-thoracotomy pain (i.e. muscle sparing thoracotomy incision) and very effective as the sole pain-control treatment in patients experiencing mild post-thoracotomy pain (i.e. video-assisted thoracoscopy incision). Hence, current evidence shows TENS associated with postoperative medications to be safe and effective in alleviating postoperative pain and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome after thoracic surgery.

The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy

“…The number (proportion) of patients reporting severe posterior neck pain (NRS ≥ 7) at any time point was two (4%) in the TENS group compared with six (12%) in the control group, but this did not reach statistical significance. Our results support the findings of other studies that TENS is useful to treat mild to moderate postoperative pain [16].…”

Transcutaneous Electrical Nerve Stimulation: Current Status of Evidence

“…The first meta-analysis on TENS was conducted in 2003 and found that TENS reduced post-operative consumption of analgesic medication to a greater extent than placebo when TENS was administered using appropriate technique [5]. More recent systematic reviews confirm the efficacy of TENS for post-thoracotomy and post-sternotomy pain [8,9]. The most recent Cochrane review on TENS on acute pain in adults included 19 RCTs (1346 participants) of procedural (cervical laser treatment, venepuncture, screening flexible sigmoidoscopy) and non-procedural pain (postpartum uterine contractions and rib fractures) [10].…”

Postoperative Pulmonary Rehabilitation in Thoracic Surgery

“…Akut torakotomi ağrısında epidural anesteziye ek olarak uygulanan TENS'in, ağrı şiddetini azalttığı, hastaların sistolik kan basınçlarını düşüre-rek hemodinamik stabilitelerini sağladığı bulunmuştur (57). Akciğer rezeksiyonunda posterolateral torakotomi sonrası TENS'in orta ve hafif ağrıda etkili, şiddetli ağrıda etkisiz olduğu saptanmıştır (58). Posterolateral torakotomi hastalarında TENS'in, plasebo TENS veya hasta kontrollü analjezi uygulamalarına göre istirahatte ve öksürme sırasında ağrı şiddetini, analjezik kullanı-mını azalttığı ve hastaların solunum fonksiyonlarında gelişmeler meydana getirdiği kanıtlanmıştır (56,59).…”

“…İlgili araştırmalara göre TENS; toraks cerrahisi sonrası akut ve kronik posterolateral torakotomi ağrısını azaltarak, PR programlarına hastanın aktif katılımını sağlayan, medikal bakımın uygulanmasını kolaylaştı-ran, diğer analjeziklerle kullanıldığında hastaların hastaneden kalış sürelerini azaltan, solunum fonksiyonlarına indirekt pozitif etkisi nedeniyle etkili öksürmeye katkıda bulunan, hastanın fiziksel fonksiyonel düzeyini geliştiren, kısaca cerrahi kazançlarını artıran ve iyileş-meyi hızlandıran, emniyetli ve etkili bir uygulama olarak kabul edilmektedir (58,59).…”