Comparison of continuous and intermittent transcutaneous electrical nerve stimulation in postoperative pain management after coronary artery bypass grafting: a randomized, placebo-controlled prospective study.
ABSTRACT 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).
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 (VAS(0)), at the 12th hour (VAS(12)), and at the 24th hour (VAS(24)); and analgesic intake.
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 VAS(12) and VAS(24) 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 VAS(12) and VAS(24) 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).
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.
- SourceAvailable from: Rodrigo Della Méa Plentz[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the effects of transcutaneous electric nerve stimulation (TENS) on pain and pulmonary function during the postoperative period after thoracic surgery by performing a systematic review and meta-analysis of randomized trials. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, EMBASE and LILACS, besides a manual search, from inception to August, 2011. Randomized trials were included, comparing TENS associated or not with pharmacological analgesia vs. placebo TENS associated or not with pharmacological analgesia or vs. pharmacological analgesia alone to assess pain (visual analog scale - VAS) and/or pulmonary function represented by forced vital capacity (FVC) in postoperative thoracic surgery patients (pulmonary or cardiac with approach by thoracotomy or sternotomy). Of the 2.489 articles identified, 11 studies were included. In the approach by thoracotomy, TENS associated with pharmacological analgesia reduced pain compared to the placebo TENS associated with pharmacological analgesia (VAS -1.29; CI95%: -1.94 to - 0.65). In the approach by sternotomy, TENS associated with pharmacological analgesia also reduced pain compared to the placebo TENS associated with pharmacological analgesia (VAS -1.33; 95%CI: -1.89 to 0.77) and compared to pharmacological analgesia alone (VAS -1.23; 95%CI: -1.79 to -0.67). There was no significant improvement in FVC (0.12 L; 95%CI: -0.27 to 0.51). TENS associated with pharmacological analgesia provides pain relief compared to the placebo TENS in postoperative thoracic surgery patients both approached by thoracotomy and sternotomy. In the sternotomy it also provides more effective pain relief compared to pharmacological analgesia alone, but has no significant effect on pulmonary function.Brazilian Journal of Cardiovascular Surgery 03/2012; 27(1):75-87. DOI:10.5935/1678-9741.20120012
- [Show abstract] [Hide abstract]
ABSTRACT: We have developed a SPICE model for the ohmic side of AC-coupled Si microstrip detectors where interstrip isolation is obtained via field plates. The interstrip isolation has been measured in various conditions by varying the field plate voltage. Simulations have been compared with experimental data in order to determine the values of the SPICE parameters for different voltages applied to the field plates. The model is able to predict correctly the frequency dependence of the coupling between adjacent strips. Furthermore, we have used such model for the study of the signal propagation along the detector when a current signal is injected in a strip. Only electrical coupling is considered here, without any contribution due to charge sharing derived from carrier diffusion. For this purpose, the AC pads of the strips have been connected to a read-out electronics and the current signal has been injected into a DC pad. Good agreement between measurements and simulations has been reached for the central strip and the first neighbours. Experimental tests and computer simulations have been performed for four different strip and field plate layouts, in order to investigate how the detector geometry affects the parameters of the SPICE model and the signal propagation. Furthermore we have considered neutron irradiated devices to study the modifications induced by radiation on the detector performance and the impact on the SPICE modelIEEE Transactions on Nuclear Science 07/1997; DOI:10.1109/23.603741 · 1.46 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat musculoskeletal pain, but it may also be indicated for postoperative analgesia. The objective of this study was to evaluate the analgesic effects of TENS on post-thoracotomy. Thirty patients between 18 and 60 years of age undergoing thoracotomy for lung cancer resection on the second postoperative day were included in this study. Patients were divided into two groups (G1 and G2). G1 patients were treated with TENS; and in G2 (without TENS) electrodes were placed but the equipment was not turned on. TENS was maintained for one hour. The visual analogue scale was used to evaluate the analgesic effects on three moments: before TENS (M0), immediately after TENS (M1), and one hour later (M2), with the patient at rest, elevation of the upper limbs, change in decubitus, and coughing. The intensity of pain at rest was higher in G2 immediately after TENS, but not one hour after the procedure. There was no difference between both groups with elevation of the upper limbs, decubitus change, and coughing. With the use of TENS for one hour on the second post-thoracotomy day in patients who received fentanyl (50 μg) associated with bupivacaine (5 mL), a reduction in pain intensity was observed at rest immediately after TENS; with elevation of the upper limbs, change in decubitus, and coughing, a reduction in pain severity was not observed.Revista brasileira de anestesiologia 09/2011; 61(5):561-7, 308-10. DOI:10.1016/S0034-7094(11)70067-8 · 0.42 Impact Factor