Rohde Christine H, Taylor Erin M, Alonso Amanda, Ascherman Jeffrey A, Hardy Krista L, Pilla Arthur A
New York, N.Y. From the Division of Plastic and Reconstructive Surgery, Columbia University Medical Center; the Department of Biomedical Engineering, Columbia University; and the Department of Orthopedics, Mount Sinai School of Medicine.
Plast Reconstr Surg. 2015 May;135(5):808e-817e. doi: 10.1097/PRS.0000000000001152.
Pulsed electromagnetic fields have been shown to reduce postoperative pain, inflammation, and narcotic requirements after breast reduction and augmentation surgical procedures. This study examined whether pulsed electromagnetic field therapy could produce similar results in patients undergoing unilateral transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction, a significantly more complex and painful surgical procedure.
In this double-blind, placebo-controlled, randomized study, 32 patients undergoing unilateral TRAM flap breast reconstruction received active or sham pulsed electromagnetic field therapy. Pain levels were measured by using a visual analogue scale; narcotic use and wound exudate volume were recorded starting 1 hour postoperatively. Wound exudates were analyzed for interleukin-1β.
Mean visual analogue scale pain scores were 2-fold higher in the sham cohort at 5 hours and 4-fold higher at 72 hours (p < 0.01), along with a concomitant 2-fold increase in narcotic use in sham patients (p < 0.01). Wound exudate volume was 2-fold higher in the sham cohort at 24 hours (p < 0.01), and mean interleukin-1β concentration in wound exudates of sham patients was 5-fold higher at 24 hours (p < 0.001).
Pulsed electromagnetic field therapy significantly reduced postoperative pain, inflammation, and narcotic use following TRAM flap breast reconstruction, paralleling its effect in breast reduction patients. Both studies also report a significant reduction of interleukin-1β in the wound exudate, supporting a mechanism involving a pulsed electromagnetic field effect on nitric oxide/cyclic guanosine monophosphate signaling, which modulates the body's antiinflammatory pathways. Adjunctive pulsed electromagnetic field therapy could impact the speed and quality of wound repair in many surgical procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
脉冲电磁场已被证明可减轻乳房缩小术和隆胸手术后的疼痛、炎症并减少麻醉剂用量。本研究旨在探讨脉冲电磁场疗法对接受单侧腹直肌肌皮瓣（TRAM）乳房重建术的患者是否能产生类似效果，该手术是一种更为复杂且疼痛的外科手术。
在这项双盲、安慰剂对照、随机研究中，32例接受单侧TRAM瓣乳房重建术的患者接受了有源或假脉冲电磁场治疗。使用视觉模拟量表测量疼痛程度；术后1小时开始记录麻醉剂使用情况和伤口渗出液量。对伤口渗出液进行白细胞介素-1β分析。
假手术组在5小时时的平均视觉模拟量表疼痛评分高出2倍，在72小时时高出4倍（p<0.01），同时假手术患者的麻醉剂使用量增加了2倍（p<0.01）。假手术组在24小时时的伤口渗出液量高出2倍（p<0.01），假手术患者伤口渗出液中的平均白细胞介素-1β浓度在24小时时高出5倍（p<0.001）。
脉冲电磁场疗法显著减轻了TRAM瓣乳房重建术后的疼痛、炎症和麻醉剂使用，这与它在乳房缩小术患者中的效果相似。两项研究还报告伤口渗出液中的白细胞介素-1β显著减少，支持了一种涉及脉冲电磁场对一氧化氮/环磷酸鸟苷信号传导的影响的机制，该机制调节身体的抗炎途径。辅助性脉冲电磁场疗法可能会影响许多外科手术中伤口修复的速度和质量。
临床问题/证据水平：治疗性，I级。
