Baki Elif Dogan, Öz Gürhan, Kokulu Serdar, Ulaşlı Alper Murat, Ela Yüksel, Sıvacı Remziye Gul, Şenay Hasan, Doğan Gökcen
Department of Anesthesiology and Reanimation, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey.
Department of Thoracic Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey.
Thorac Cardiovasc Surg. 2015 Sep;63(6):514-8. doi: 10.1055/s-0035-1544212. Epub 2015 Feb 16.
Inadequate relief of postthoracotomy pain is a major reason of increased occurrence of postoperative complications. We aimed to investigate and compare the effects of transcutaneous electrical nerve stimulation (TENS) and paravertebral block (PVB) to relieve pain after thoracotomy procedures.
We studied 40 patients who underwent thoracotomy. Patients were randomly allocated to receive either PVB (group P, n = 20) or TENS (group T, n = 20) for postoperative pain. The electrodes of TENS were placed 2 cm under and 2 cm over the thoracotomy cut on both posterior and anterior sides. The surgeon inserted paravertebral catheters using direct vision at the end of the surgery. A patient-controlled analgesia (PCA) device was connected to all patients. Visual analog scales, patient demand, and consumption of tramadol were evaluated postoperatively.
Mean visual analog scale (VAS) values were significantly lower in group P for all time points. The patients in group P needed lower amounts of opioid (tramadol) and the difference was statistically significant (258.4 ± 13.52 mg vs. 314.4 ± 8.65 mg, p = 0.005). In addition, the number of demand attempts recorded from the PCA device was significantly lower in group P (14.95 ± 13.64 vs. 26.7 ± 17.34, respectively and p < 0.001).
TENS has beneficial effects for pain relief after thoracotomy, without any side effects; however, it cannot provide sufficient pain relief when compared with PVB.
开胸术后疼痛缓解不足是术后并发症发生率增加的主要原因。我们旨在研究和比较经皮电刺激神经疗法（TENS）和椎旁阻滞（PVB）缓解开胸术后疼痛的效果。
我们研究了40例行开胸手术的患者。患者被随机分配接受PVB（P组，n = 20）或TENS（T组，n = 20）以缓解术后疼痛。TENS电极放置在开胸切口前后侧下方2 cm和上方2 cm处。外科医生在手术结束时直视下插入椎旁导管。所有患者均连接患者自控镇痛（PCA）装置。术后评估视觉模拟量表、患者需求和曲马多消耗量。
P组在所有时间点的平均视觉模拟量表（VAS）值均显著较低。P组患者所需阿片类药物（曲马多）量较低，差异具有统计学意义（258.4±13.52 mg对314.4±8.65 mg，p = 0.005）。此外，P组从PCA装置记录的需求尝试次数显著较低（分别为14.95±13.64对26.7±17.34，p < 0.001）。
TENS对开胸术后疼痛缓解有有益作用，且无任何副作用；然而，与PVB相比，它不能提供足够的疼痛缓解。
