Comparison of Continuous and Intermittent Transcutaneous Electrical Nerve Stimulation in Postoperative Pain Management after Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Prospective Study
DOI:
https://doi.org/10.1532/HSF98.20081139Abstract
Objective: We compared the effectiveness of continuous transcutaneous electrical nerve stimulation (TENS) and intermittent TENS in the management of pain after coronary artery bypass grafting (CABG).
Methods: We randomized 100 patients who had undergone median sternotomy for CABG into 4 groups with 25 patients each: (1) continuous TENS (CTENS) and pharmacologic analgesia, (2) intermittent TENS (ITENS) and pharmacologic analgesia, (3) placebo TENS (PTENS) and pharmacologic analgesia, and (4) pharmacologic analgesia alone (control). We studied these groups with regard to the relief of postoperative pain during the first 24 hours. For each patient we recorded the following: demographic characteristics; vital signs; intensity of pain with a visual analogue scale (VAS) before treatment (VAS0), at the 12th hour (VAS12), and at the 24th hour (VAS24); and analgesic intake.
Results: The groups were comparable with respect to age, sex, and body mass index at baseline. Mean VAS scores decreased within each group; however, the mean VAS12 and VAS24 scores decreased significantly in the CTENS and ITENS groups, compared with PTENS and control groups (P < .05). We found no significant difference between the CTENS and ITENS groups with respect to decreasing VAS12 and VAS24 scores (P > .05). Narcotic intake was significantly less in the CTENS and ITENS groups than in the control and PTENS groups (P < .01). Furthermore, narcotic requirements were significantly lower in the CTENS group than in the ITENS group (P < .01).
Conclusions: CTENS and ITENS after median sternotomy for CABG decreased pain and reduced narcotic requirements more than in the PTENS and control treatments during first postoperative 24 hours. Neither CTENS nor ITENS is superior to the other in decreasing pain; however, CTENS leads to a greater reduction in the narcotic requirement than ITENS.
References
Ali J, Yaffe CS, Serrette C. 1981. The effect of transcutaneous electric nerve stimulation on postoperative pain and pulmonary function. Surgery 89:507-12.nBayindir O, Paker T, Akpinar B, Erenturk S, Askin D, Aytac A. 1991. Use of transcutaneous electrical nerve stimulation in the control of postoperative chest pain after cardiac surgery. J Cardiothorac Vasc Anesth 5:589-91.nChapman CR, Syrjala KL. 2001. Measurement of pain. In: Loesser JD, ed. Bonica's management of pain. Philadelphia, Pa: Lippincott, Williams, & Wilkins. p 311-6.nChulay M, Brown J, Summer W. 1982. Effect of postoperative immobilization after coronary artery bypass surgery. Crit Care Med 10:176-9.nCipriano G Jr, de Camargo Carvalho AC, Bernardelli GF, Tayar Peres PA. 2008. Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity. Interact Cardiovasc Thorac Surg 7:539-43.nCooperman AM, Hall B, Mikalacki K, Hardy R, Sadar E. 1977. Use of transcutaneous electrical stimulation in the control of postoperative pain: results of a prospective, randomized, controlled study. Am J Surg 133:185-7.nEmmiler M, Solak Ö, Kocogullari C, Dundar U, Ayva E, Ela Y, Cekirdekci A, Kavuncu V. 2008. Control of acute postoperative pain by transcutaneous electrical nerve stimulation after open cardiac operations: a randomized placebo-controlled prospective study. Heart Surg Forum 11:E300-3.nErdogan M, Erdogan A, Erbil N, Karakaya HK, Demircan A. 2005. Prospective, randomized, placebo-controlled study of the effect of TENS on postthoracotomy pain and pulmonary function. World J Surg 29:1563-70.nFilos KS, Lehmann KA. 1999. Current concepts and practice in postoperative pain management: need for a change? Eur Surg Res 31:97-107.nFitzpatrick GJ, Moriarty DC. 1988. Intrathecal morphine in the management of pain following cardiac surgery. Br J Anaesth 60:639-44.nForster EL, Kramer JF, Lucy SD, Scudds RA, Novick RJ. 1994. Effect of TENS on pain, medications, and pulmonary function following coronary artery bypass graft surgery. Chest 106:1343-8.nHymes AC, Yonehiro EG, Raab DE, Nelson GD, Printy AL. 1974. Electrical surface stimulation for treatment and prevention of ileus and atelectasis. Surg Forum 25:222-4.nJenkins SC, Soutar SA, Loukota JM, Johnson LC, Moxham J. 1989. Physiotherapy after coronary artery surgery: are breathing exercises necessary? Thorax 44:634-9.nKonstantatos A, Silvers AJ, Myles PS. 2008. Analgesia best practice after cardiac surgery. Anesthesiol Clin 26:591-602.nLocicero J. 2005. General principles of postoperative care. In: Shields TW, Locicero J, Ponn PB, Rusch VW, eds. General thoracic surgery. Philadelphia, Pa: Lippincott, Williams, & Wilkins. p 601-9.nPasero C, Paice JA, McCaffery M. 1999. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C, eds. Pain: clinical manual. St Louis, Mo: Mosby. p 15-34.nRooney SM, Jain S, McCormack P, Bains MS, Martini N, Goldiner PL. 1986. A comparison of pulmonary function tests for postthoracotomy pain using cryoanalgesia and transcutaneous nerve stimulation. Ann Thorac Surg 41:204-7.nSchomburg FL, Carter-Baker SA. 1983. Transcutaneous electrical nerve stimulation for postlaparotomy pain. Phys Ther 63:188-93.nSolak Ö, Turna A, Pekcolaklar A, et al. 2007. Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiovasc Surg 55:182-5.nSoloman BA, Viernstein MC, Long DM. 1980. Reduction of postoperative pain and narcotic use by transcutaneous electrical nerve stimulation. Surgery 87:142-6.nStratton SA, Smith MM. 1980. Postoperative thoracotomy: effect of transcutaneous nerve stimulation on forced vital capacity. Phys Ther 60:45-7.nVanderArk GD, McGrath KA. 1975. Transcutaneous electrical stimulation in treatment of postoperative pain. Am J Surg 130:338-40.nYeager MP, Glass DD, Neff RK, Brinck-Johnsen T. 1987. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 66:729-36.n
