Malik Vishwas, Kiran Usha, Chauhan Sandeep, Makhija Neeti
Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun;34(2):216-220. doi: 10.4103/joacp.JOACP_336_15.
In patients undergoing open heart surgery, chest tubes are removed postoperatively when patients are well awake and stable. Pain during chest tube removal can be moderate to severe and can be the worst experience of hospitalization. Various modalities of pain relief during chest tube removal have been tried with variable results. We sought to examine the effect of transcutaneous electrical nerve stimulation (TENS) as an intervention for pain relief during chest tube removal after cardiac surgery.
In a tertiary care center, fifty patients undergoing open heart surgery were randomized into two groups. Group TENS ( = 25) received TENS from 30 min before and continued up to 30 min after chest tube removal. Control Group ( = 25) did not receive TENS. In both the groups, additional analgesic medication was provided on demand, besides the standard analgesic regime which was injection ketorolac 30 mg intramuscularly every 8 h. Patients were studied for pain during chest drain removal and pain related nausea, vomiting, and sense of well-being.
Mean visual analog pain score assessed for chest tube removal was significantly less 4.1 ± 1.2 ( < 0.05) in TENS Group as compared to 6.1 ± 0.8 in Control Group. Significantly greater number of patients ( = 14) ( < 0.05) in Control Group demanded additional analgesia as compared to TENS Group ( = 5). Feeling of well-being, improvement in appetite, and sleep was better in TENS Group as compared to Control Group.
We conclude that TENS might not replace the conventional analgesics but has definite adjuvant role in decreasing pain scores and improves sense of well-being during chest tube removal after cardiac surgery.
在接受心脏直视手术的患者中，术后当患者完全清醒且情况稳定时拔除胸管。拔除胸管时的疼痛可从中度到重度，可能是住院期间最糟糕的体验。人们尝试了多种在拔除胸管时缓解疼痛的方法，但效果各异。我们旨在研究经皮电刺激神经疗法（TENS）作为心脏手术后拔除胸管时缓解疼痛的一种干预措施的效果。
在一家三级医疗中心，50例接受心脏直视手术的患者被随机分为两组。TENS组（n = 25）在拔除胸管前30分钟开始接受TENS治疗，并持续至拔除胸管后30分钟。对照组（n = 25）不接受TENS治疗。两组除了每8小时肌肉注射30毫克酮咯酸的标准镇痛方案外，还按需提供额外的镇痛药物。对患者在拔除胸管时的疼痛以及与疼痛相关的恶心、呕吐和幸福感进行研究。
与对照组的6.1±0.8相比，TENS组拔除胸管时的平均视觉模拟疼痛评分显著更低，为4.1±1.2（P < 0.05）。与TENS组（n = 5）相比，对照组中有更多患者（n = 14）（P < 0.05）需要额外的镇痛。与对照组相比，TENS组的幸福感、食欲改善和睡眠情况更好。
我们得出结论，TENS可能无法替代传统镇痛药，但在降低心脏手术后拔除胸管时的疼痛评分以及改善幸福感方面具有明确的辅助作用。
