<p>Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial</p>

Abstract

BackgroundTranscutaneous electrical nerve stimulation (TENS) is a noninvasive modality which may be used to reduce acute postoperative pain. Intense perioperative pain within the first few days after hip fracture surgery is common and is related to negative consequences such as restricted and delayed ambulation.ObjectiveThe objective of the present study was to examine the effect of incorporating TENS treatment on pain intensity, and mobility, with standard rehabilitation care during the acute post-operative phase following Gamma-nail surgical fixation of extracapsular hip fractures.Materials and methodsForty-one patients were randomly assigned to a supplement of 30 mins of active TENS or sham TENS. The standard rehabilitation care included five daily 30 mins physical therapy treatments beginning 24 hrs after surgery. Outcome measures were: pain intensity at rest, at night and during ambulation (assessed with the Numeric Rating Scale; Functional Ambulation Classification instrument; time to complete five sit-to-stand tests; and two-minute walk test). Data were analyzed with Wilcoxon score rank tests. Significance was set at p≤0.05.ResultsSignificantly greater pain reduction during walking was noted in the active TENS group compared to sham TENS group (differences between the fifth and the second days: 2.55±1.37 vs 1.06± 1.11, respectively; p=0.0011). Additionally, advantage of active TENS was demonstrated in greater increase in walking distance on the fifth day and higher level of mobility compared to the sham TENS group. No additional effects of active TENS were noted on pain intensity at rest and at night and on five times sit-to-stand performance.ConclusionAddition of TENS to the standard care of elderly patients in the early days following Gamma nail surgical fixation of extracapsular hip fracture is recommended for pain management while walking and functional gait recovery. The effect of TENS on long-term functional outcomes should be explored in future studies.Trial registrationThe trial was registered at the ISRCTN registry: ID ISRCTN32476360.

Efficacy of Transcutaneous Electrical Nerve Stimulation for Postoperative Pain, Pulmonary Function, and Opioid Consumption Following Cardiothoracic Procedures: A Systematic Review

“…Postoperative TENS has been proposed to minimize the need for opioid and nonopioid analgesics (5) in many types of procedures (6–12). The efficacy of TENS demonstrated in this meta‐analysis support the findings of Sbruzzi et al and reinforces the benefits of TENS in postoperative care.…”

“…TENS can be used as an effective adjunct for managing postsurgical pain and to minimize the need for opioid and nonopioid analgesics as part of a multimodal approach to pain (5). TENS has been shown to be effective in noncardiothoracic procedures, and has been implemented following abdominal, hip, knee and shoulder surgeries, amputations, and oocyte retrievals (6–12). Excessive use of narcotics to control pain following such procedures can lead to side effects such as respiratory depression, sedation, nausea, vomiting, and pruritus.…”

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

“…Additional improvements in the active TENS group were a greater increase in walking distance on the fifth postoperative day and a higher level of mobility compared to the sham TENS group. The authors concluded that adding TENS to the standard care of elderly patients in the early postoperative period following surgical fixation of extracapsular hip fracture with a Gamma nail could be recommended for pain management during walking and functional gait recovery [ 126 ].…”

Orthogeriatric Care: Reviewing Improvements in Outcomes

“…Additional improvements in the active TENS group were a greater increase in walking distance on the fifth postoperative day and a higher level of mobility compared to the sham TENS group. The authors concluded that adding TENS to the standard care of elderly patients in the early postoperative period following surgical fixation of extracapsular hip fracture with a Gamma nail could be recommended for pain management during walking and functional gait recovery [125].…”