Freynet Anne, Falcoz Pierre-Emmanuel
Department of Thoracic and Cardiovascular Surgery, Jean-Minjoz University Hospital, Besançon, France.
Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):283-8. doi: 10.1510/icvts.2009.219576. Epub 2009 Nov 12.
A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of transcutaneous electrical nerve stimulation (TENS) is effective in reducing post-thoracotomy pain. Of the 74 papers found with a report search, nine prospective randomized controlled trials (RCT), among which three were double-blind, presented the best evidence to answer the clinical question. All investigated the effect of TENS as an adjunct therapy for relieving acute post-thoracotomy pain in patients undergoing thoracic surgery. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that a vast majority - seven of the nine retrieved studies - were in favor of TENS as an adjuvant to narcotic analgesics for improving outcome after thoracic surgery. Indeed, the interest and benefit has been shown not only in the treatment of acute post-thoracotomy pain (pain scores and narcotic requirements were consistently lower in the TENS group as opposed to the Placebo-TENS group), but also when used together with narcotic analgesics to reduce the duration of recovery room stay and to increase chest physical tolerance (better coughing attempts during chest physiotherapy) with positive effects on pulmonary ventilator function [forced expiratory volume in 1 s (FEV(1)) and/or forced vital capacity (FVC)]. Specifically, the TENS treatment was shown to be ineffective when used alone in severe post-thoracotomy pain (i.e. posterolateral thoracotomy incision), but useful as an adjunct to other medications in moderate post-thoracotomy pain (i.e. muscle sparing thoracotomy incision) and very effective as the sole pain-control treatment in patients experiencing mild post-thoracotomy pain (i.e. video-assisted thoracoscopy incision). Hence, current evidence shows TENS associated with postoperative medications to be safe and effective in alleviating postoperative pain and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome after thoracic surgery.
根据结构化方案构建了一个最佳证据主题。所探讨的问题是经皮电刺激神经疗法（TENS）在减轻开胸术后疼痛方面是否有效。在通过报告检索找到的74篇论文中，9项前瞻性随机对照试验（RCT）提供了回答该临床问题的最佳证据，其中3项为双盲试验。所有试验均研究了TENS作为辅助治疗手段，对接受胸外科手术患者缓解开胸术后急性疼痛的效果。文中给出了这些论文的作者、期刊、发表日期、国家、研究类型、研究组、相关结局及结果。我们得出结论，9项检索研究中有7项，即绝大多数研究支持将TENS作为麻醉性镇痛药的辅助手段，以改善胸外科手术后的结局。事实上，不仅在治疗开胸术后急性疼痛方面（与假TENS组相比，TENS组的疼痛评分和麻醉药物需求持续较低）显示出其益处，而且在与麻醉性镇痛药联合使用时，还能缩短恢复室停留时间，并提高胸部物理耐受性（在胸部物理治疗期间咳嗽效果更好），对肺通气功能[1秒用力呼气量（FEV(1)）和/或用力肺活量（FVC）]产生积极影响。具体而言，单独使用TENS治疗严重开胸术后疼痛（即后外侧开胸切口）时显示无效，但在中度开胸术后疼痛（即保留肌肉开胸切口）中作为其他药物的辅助手段有用，而在轻度开胸术后疼痛（即电视辅助胸腔镜切口）患者中作为唯一的疼痛控制治疗非常有效。因此，目前的证据表明，TENS与术后药物联合使用在减轻术后疼痛和改善患者恢复方面是安全有效的，从而增加了可用医疗护理的选择，并改善了胸外科手术后的结局。
