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.
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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; · 1.22 Impact Factor
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ABSTRACT: The use of transcutaneous electrical nerve stimulation (TENS) as non-pharmacological therapeutic modality is increasing. The types of TENS used clinically are conventional TENS, acupuncture TENS and intense TENS. Their working is believed to be based on gate control theory of pain and activation of endogenous opioids. TENS has been used in anaesthesia for treatment of post-operative analgesia, post-operative nausea vomiting and labour analgesia. Evidence to support analgesic efficacy of TENS is ambiguous. A systematic search of literature on PubMed and Cochrane Library from July 2012 to January 2014 identified a total of eight clinical trials investigating post-operative analgesic effects of TENS including a total of 442 patients. Most of the studies have demonstrated clinically significant reduction in pain intensity and supplemental analgesic requirement. However, these trials vary in TENS parameters used that is, duration, intensity, frequency of stimulation and location of electrodes. Further studies with adequate sample size and good methodological design are warranted to establish general recommendation for use of TENS for post-operative pain.Indian journal of anaesthesia 07/2014; 58(4):388-93.