Lang Thomas, Barker Renate, Steinlechner Barbara, Gustorff Burkhard, Puskas Tivadar, Gore Odette, Kober Alexander
Department of Anesthesia and Intensive Care, University of Vienna, Vienna, Austria.
J Trauma. 2007 Jan;62(1):184-8; discussion 188. doi: 10.1097/01.ta.0000197176.75598.fc.
In Central Europe, ambulances for patients suffering from pain caused by nonlife-threatening trauma, such as hip fractures are staffed by medical personnel (medics) without physicians. Thus, there is an urgent need for nonpharmacological interventions that can be applied during the transport by basic life-support (BLS) medical personnel.
In all, 101 patients were screened for participation in this randomized placebo-controlled double-blind study, and randomly assigned to two groups (verum and sham transcutaneous electrical nerve stimulation [TENS]). First, medic A recorded all baseline parameters and measurements, then medic B performed TENS in absence of medic A. At the end of transportation, medic A performed data collection. Each patient was asked to grade his/her pain and anxiety level on visual analog scales (VAS, 0 to 100 mm).
From 101 screened patients fulfilling the entry criteria, 29 declined consent and 9 had to be excluded from the analysis because of their final diagnosis. Therefore, the data from 30 patients (group 1, verum TENS) as well as from 33 patients (group 2 [control], sham TENS) were analyzed. No significant differences in potentially influencing factors were found before treatment. Pain scores upon arrival at the hospital differed significantly between group 1 and group 2 (p < 0.01). In group 1, pain reduction was observed between departure from the site of emergency and arrival at the hospital (VAS: 89 +/- 9 to 59 +/- 6 mm), whereas pain scores remained nearly unchanged in group 2 (VAS: 86 +/- 12 to 79 +/- 11 mm).
Our findings show that TENS is a valuable and fast-acting pain treatment under the difficult circumstances of "out-of-hospital rescue". Because of its lack of side effects, it could also be a valuable tool in the hospital.
在中欧，用于运送因非危及生命的创伤（如髋部骨折）而疼痛的患者的救护车由没有医生的医务人员（急救人员）配备。因此，迫切需要一种非药物干预措施，以便在基础生命支持（BLS）医务人员转运患者期间应用。
总共筛选了101名患者参与这项随机安慰剂对照双盲研究，并随机分为两组（真皮下电刺激神经疗法 [TENS] 和假TENS）。首先，急救人员A记录所有基线参数和测量值，然后急救人员B在急救人员A不在场的情况下进行TENS治疗。运输结束时，急救人员A进行数据收集。要求每位患者在视觉模拟量表（VAS，0至100毫米）上对其疼痛和焦虑程度进行评分。
在101名符合入选标准的筛选患者中，29人拒绝同意，9人因最终诊断而被排除在分析之外。因此，分析了30名患者（第1组，真TENS）和33名患者（第2组[对照组]，假TENS）的数据。治疗前在潜在影响因素方面未发现显著差异。第1组和第2组到达医院时的疼痛评分存在显著差异（p < 0.01）。在第1组中，从离开急救现场到到达医院期间观察到疼痛减轻（VAS：89±9至59±6毫米），而第2组的疼痛评分几乎保持不变（VAS：86±12至79±11毫米）。
我们的研究结果表明，在“院外救援”的困难情况下，TENS是一种有价值且起效快的疼痛治疗方法。由于其无副作用，它在医院中也可能是一种有价值的工具。
