Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain

Abstract

The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15–40 years scheduled to undergo elective posterolateral thoracotomy were divided into two groups of 30 each. Patients were alternatively assigned to one of the groups. In group I, only thoracic epidural analgesia with local anaesthetics was given at regular intervals; however, an identical apparatus which did not deliver an electric current was applied to the control (i.e. group I) patients. While in group II, TENS was started immediately in the recovery period in addition to the epidural analgesia. A 0–10 visual analog scale (VAS) was used to assess pain at regular intervals. The haemodynamics were also studied at regular intervals of 2 h for the first 10 h after the surgery. When the VAS score was more than three, intramuscular analgesia with diclofenac sodium was given. The VAS score and the systolic blood pressure were comparable in the immediate postoperative period (P = NS) but the VAS score was significantly less in group II at 2, 4, 6, 8 h (P < 0.01, P < 0.05, P < 0.05, P < 0.05, respectively), and at 10 h the P value was not significant. Similarly, the systolic blood pressure was significantly less in group II at 2, 4, 6 h after surgery, that is P < 0.02, P < 0.01, P < 0.01, respectively, but at 8 and 10 h the pressures were comparable in both the groups. Adding TENS to epidural analgesia led to a significant reduction in pain with no sequelae. The haemodynamics were significantly stable in group II compared to group I. TENS is a valuable strategy to alleviate postoperative pain following thoracic surgery with no side effects and with a good haemodynamic stability; however, the effects are short lasting.

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

“…[91][92][93] Given its safety profile, TENS can be considered as an adjunct in patients who do not respond to conventional analgesic techniques or who experience severe side effects.…”

Transcutaneous electrical nerve stimulation to reduce pain in post-op thoracotomy patients: A physical therapists′ perspective

“…The positive results obtained in the study by Chandra et al . [1] and also in previous studies[45] show that TENS will be of benefit to the patient and also to the physical therapist to facilitate airway clearance and early mobilisation.…”

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).…”