Asgari Zahra, Tavoli Zahra, Hosseini Reihaneh, Nataj Masoomeh, Tabatabaei Fatemeh, Dehghanizadeh Fatemeh, Haji-Amoo-Assar Hosein, Sepidarkish Mahdi, Montazeri Ali
Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
Pain Res Manag. 2018 Mar 18;2018:9715142. doi: 10.1155/2018/9715142. eCollection 2018.
Traditionally, laparoscopic procedures have been performed under general anesthesia. Spinal anesthesia is an effective alternative to general anesthesia. However, one of the intraoperative complications of performing laparoscopic surgery under spinal anesthesia is shoulder pain. This study aimed to compare the effect of transcutaneous electrical nerve stimulation (TENS) with fentanyl on pain relief in patients who underwent gynecologic laparoscopy under spinal anesthesia.
We conducted a prospective randomized clinical trial from May 2016 to March 2017. A sample of patients who underwent gynecological laparoscopy under spinal anesthesia was recruited. If they had shoulder pain, they randomly received either transcutaneous electrical nerve stimulation (TENS) or 50 mg of fentanyl. Pain intensity was measured using the single item visual analogue scale (VAS-10 cm) immediately before and 5, 10, 20, and 30 minutes after treatment. Also, the effect of higher doses of analgesia on pain relief was analyzed.
In all, 80 patients (40 patients in each group) were entered into the study. The mean pain intensity score was 9.02 ± 1.32 in the TENS group and 8.95 ± 1.33 in the fentanyl group at baseline ( = 0.80). Repeated measures analysis of variance indicated that there was no significant difference on overall pain scores between the two treatment groups adjusted for age, BMI, total analgesia used, and baseline pain score ( (1, 74) = 1.44, = 0.23). The use of analgesic drugs in the TENS group was significantly higher than the fentanyl group ( = 0.01). In addition, we found that nine patients (22.5%) complained of nausea/vomiting in the TENS group compared to thirteen patients (32.5%) in the fentanyl group ( = 0.31).
The findings indicated that TENS was not superior to fentanyl for pain relief in laparoscopic surgery. It seems that the correct use of TENS parameters might merit further investigation. This trial is registered with: IRCT2016031216765N3.
传统上，腹腔镜手术是在全身麻醉下进行的。脊髓麻醉是全身麻醉的一种有效替代方法。然而，在脊髓麻醉下进行腹腔镜手术的术中并发症之一是肩痛。本研究旨在比较经皮电刺激神经疗法（TENS）与芬太尼对脊髓麻醉下接受妇科腹腔镜手术患者疼痛缓解的效果。
我们在2016年5月至2017年3月进行了一项前瞻性随机临床试验。招募了在脊髓麻醉下接受妇科腹腔镜手术的患者样本。如果他们有肩痛，他们被随机接受经皮电刺激神经疗法（TENS）或50毫克芬太尼。在治疗前以及治疗后5、10、20和30分钟，使用单项视觉模拟量表（VAS-10厘米）测量疼痛强度。此外，分析了更高剂量镇痛对疼痛缓解的效果。
总共80名患者（每组40名患者）进入研究。在基线时，TENS组的平均疼痛强度评分为9.02±1.32，芬太尼组为8.95±1.33（P = 0.80）。重复测量方差分析表明，在根据年龄、体重指数、使用的总镇痛量和基线疼痛评分进行调整后，两个治疗组的总体疼痛评分没有显著差异（F(1, 74) = 1.44，P = 0.23）。TENS组使用镇痛药物的情况显著高于芬太尼组（P = 0.01）。此外，我们发现TENS组有9名患者（22.5%）抱怨恶心/呕吐，而芬太尼组有13名患者（32.5%）（P = 0.31）。
研究结果表明，在腹腔镜手术中，TENS在缓解疼痛方面并不优于芬太尼。似乎TENS参数的正确使用可能值得进一步研究。本试验已在以下机构注册：IRCT2016031216765N3。
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