Transcutaneous electrical nerve stimulation does not augment combined spinal epidural labour analgesia

Abstract

Purpose: The spinal portion of the combined spinal epidural technique (CSE) provides dramatic but limited labour analgesia. Transcutaneous Electrical Nerve Stimulation (TENS) has been noted to modulate pain, 1 in part by the frequency of stimulation chosen. 2 Because nerve action potentials are blocked by local anesthestics in a frequency dependent manner, 3 we speculated that a TENS unit could increase the quality and duration of the spinal portion of a CSE.Methods: Forty parturients in active spontaneous labour, with a singleton, vertex, term fetus, requesting analgesia were enrolled in a randomized, double blind fashion to receive a standardized CSE with either an active or inactive TENS unit. Prior to CSE placement, TENS intensity thresholds were determined with electrodes placed on the paraspinus muscles at T 10 -L 1 , and S 2-4 ; TENS settings for mode, cycle, and pulse width were standardized. Data were collected at timed intervals on pain (VAS), sensory level (pinprick), motor blockade (Bromage), cervical dilatation, and duration of analgesia, and at delivery on fetal and neonatal outcome. Results:The duration of the spinal portion of the CSE did not differ between groups (TENS off 91.1 ± 33 [mean ± SD] vs TENS on 83.1 ± 28 min, P=.42). Kaplan-Meier survival analysis and Mantel-Cox log rank analysis showed no difference between the two treatments (P=.28). Analgesia was comparable throughout the first hour of spinal analgesia. Conclusion:In healthy labouring parturients, the application of a TENS unit did not alter the quality or duration of labour analgesia provided by the spinal portion of CSE analgesia. Objectif Objectif :: La composante rachidienne de la technique rachidienne péridurale combinée (RPC) fournit une analgésie importante, mais limitée, pendant le travail obstétrical. La neurostimulation transcutanée (NST) est connue pour moduler la douleur 1 , entre autres selon la fréquence de stimulation choisie. 2 Comme les potentiels d'action nerveuse sont bloqués par les anesthésiques locaux d'une manière qui dépend de la fréquence, 3 nous avons pensé qu'une unité de NST pourrait augmenter la qualité et la durée de la composante rachidienne de l'analgésie RPC. Méthode Méthode :: Quarante parturientes en travail actif spontané, porteuses d'un foetus unique, à terme et en présen-tation du sommet, ont été réparties au hasard et à double insu. Elles ont reçu une analgésie RPC standard avec une unité active ou inactive de NST. Avant la mise en place de l'analgésie RPC, l'intensité des seuils de NST a été déterminée avec des électrodes placées sur les muscles paravertébraux à T 10 -L 1 , et S 2-4 ; l'installation de la NST a été standardisée quant au mode, au cycle et la durée du stimulus. On a recueilli, à intervalles déterminés, des données sur la douleur (EVA), le niveau sensitif (piqûre), le blocage moteur (Bromage), la dilatation cervicale et la durée de l'analgésie et, à la naissance, sur l'évolution foetale et néonatale. Résultats Résultats :: Il n'y a pas eu de différence intergroupe pour la durée ...

Transcutaneous electrical nerve stimulation for the relief of post‐partum uterine contraction pain during breast‐feeding: A randomized clinical trial

“…The parameters of stimulation are determinant for TENS therapy to be successful . For Wang et al ., the frequency, amplitude and time of treatment caused diverging results.…”

Transcutaneous Electrical Nerve Stimulation Improves Low Back Pain during Pregnancy

“…TENS performed to the back has been compared with control groups and various modalities during labor pain, and there was no significant difference between TENS and other groups in the number of women undergoing cesarean section or assisted vaginal delivery [22,23,25]. Chao et al [24] have reported that, while TENS used during labor pain did not increase the cesarean rate, it tended to significantly increase assisted delivery (RR: 4.50).…”

“…Primarily, TENS is used for the relief of pain for all types of musculoskeletal pain including LBP of any etiology. TENS has been increasingly and safely used especially for pain relief during labor and delivery [20,21,22,23,24,25]. …”

Analgesia adjuvante e alternativa

“…A TENS proporciona analgesia pós-operatória com evidente redução no consumo de analgésicos. Ela tem sido usada com relativo êxito no tratamento de dores aguda e crônica, mas o resultado no trabalho de parto e na cesariana não foi conclusivo em sua combinação com a anestesia regional [61][62][63][64][65][66] .…”

“…TENS provides for postoperative analgesia, reducing the dose of analgesics taken. It has been used with relative success to treat acute and chronic pain, but the result in labor and cesarean section is nonconclusive when combined with regional anesthesia [61][62][63][64][65][66] .…”