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

Alka Chandra, Jayant N Banavaliker, Pradeep K Das, Sheel Hasti, Alka Chandra, Jayant N Banavaliker, Pradeep K Das, Sheel Hasti

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.

Keywords: Postoperative pain; thoracic epidural analgesia; thoracotomy; transcutaneous electrical nerve stimulation.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Mean systolic BP plotted against time.
Figure 2
Figure 2
Mean VAS score plotted against time

References

    1. Holte K, Kehlet H. Effect of postoperative epidural analgesia on surgical outcome. Minerva Anestesiol. 2002;68:157–61.
    1. Cooper DW, Ryall DM, Hardy FE, Lindsay SL Eldabe SS. Patient-controlled extradural analgesia with bupivacaine, fentanyl or a mixture of both, after caesarian section. Br j Anaesth. 1996;76:611–5.
    1. de Beer DA, Thomas ML. Caudal additives in children-solutions or problems? Br J Anaesth. 2003;90:487–98.
    1. McCallum MI, Glynn CJ, Moore RA, Lammer P, Phillips AM. Transcutaneous electrical nerve stimulation in the management of acute postoperative pain. Br J Anaesth. 1988;61:308–12.
    1. Benedetti F, Amanzio M, Casadio C, Cavallo A, Cianci R, Giobbe R, et al. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac surg. 1997;63:773–6.
    1. Warfield CA, Stein JM, Frank HA. The effect of transcutaneous electrical nerve stimulation on pain after thoracotomy. Ann Thorac Surg. 1985;39:462–5.
    1. Gerner P. Post-thoracotomy pain management problems. Anesthesiol Clin. 2008;26:355–67.
    1. Hamza MA, White PF, Ahmed HE, Ghoname EA. Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anesthesiology. 1999;91:1232–8.
    1. Kotani N, Hashimoto H, Sato Y, Sessler DI, Yoshioka H, Kitayama M, et al. Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement and sympathoadrenal responses. Anesthesiology. 2001;95:349–56.
    1. Bushnell MC, Marchand S, Tremblay N, Duncan GH. Electrical stimulation of peripheral and central pathways for the relief of musculoskeletal pain. Can J Physiol Pharmacol. 1991;69:697–703.
    1. Campbell TS, Ditto B. Exaggeration of blood pressure-related hypoalgesia and reduction of blood pressure with low frequency transcutaneous electric nerve stimulation. Psychophysiology. 2002;39:473–81.
    1. Gilbert JM, Gledhill T, Law N, George C. Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy. Br J Surg. 1986;73:749–51.
    1. Sodipo Jo, Adedeji SA, Olumide O. Postoperative pain relief by transcutaneous electrical nerve stimulation (TENS) Am J Chin Med. 1980;8:190–4.
    1. Erdogan M, Erdogan A, Erbil N, Karakaya HK, Demircan A. Prospective, Randomized, Placebo-controlled Study of the Effect of TENS on postthoracotomy pain and pulmonary function. World J Surg. 2005;29:1563–70.
    1. Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative epidural analgesia. Br J Anaesth. 2001;87:47–61.
    1. Freynet A, Falcoz PE. Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interact Cardiovasc Thorac Surg. 2010;10:283–8.

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