Yan Wenli, Kan Zunqi, Yin Jiahui, Ma Yuxia
College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China.
Department of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Shandong, China.
Pain Ther. 2023 Jun;12(3):631-644. doi: 10.1007/s40122-023-00496-z. Epub 2023 Mar 19.
Epidural analgesia (EA) is the most widely used intervention for the reduction of labor pain; however, it is contra-indicated for patients with spinal deformity or allergy to anesthetics and may be refused by parturients. As a noninvasive and nonnarcotic analgesic intervention, transcutaneous electrical acupoint stimulation (TEAS) has gained increasing attention in recent years. Therefore, we performed a network meta-analysis to compare the efficacy and safety of TEAS and EA as measured by visual analog scale score, the failure rate of natural delivery, adverse events, and Apgar scores.
Relevant randomized controlled trials (RCTs) from four electronic databases (PubMed, EMBASE, Web of Science, and Cochrane CENTRAL) and clinical trials.gov were searched from inception until September 4, 2022. A random effects model was used during analysis, and outcomes were evaluated as standard mean difference (SMD), odds ratio (OR), and 95% confidence intervals (CrI) using STATA (version SE15.0), R (version 3.6.1), and ADDIS (version 1.16.8) software.
Ten RCTs comprising 1214 parturients were identified by screening. Six RCTs compared TEAS and controls, three compared EA and controls, and one compared TEAS and EA. No heterogeneity was found within the four outcomes. There was no significant difference in any outcomes between interventions or control treatments in terms of SMD, OR, and CrI. Combined with the highest surface under the cumulative ranking curve score, TEAS demonstrated possible better effects in the aspects of analgesic efficacy and safety under certain circumstances.
TEAS may be a potential alternative for parturients as a simple, noninvasive, and non-pharmacological intervention compared with EA in terms of analgesic efficacy and safety for mothers and neonates.
硬膜外镇痛（EA）是减轻分娩疼痛最广泛使用的干预措施；然而，它对于脊柱畸形或对麻醉剂过敏的患者是禁忌的，并且可能会被产妇拒绝。作为一种非侵入性和非麻醉性的镇痛干预措施，经皮穴位电刺激（TEAS）近年来越来越受到关注。因此，我们进行了一项网状Meta分析，以比较TEAS和EA在视觉模拟量表评分、自然分娩失败率、不良事件和阿氏评分方面的疗效和安全性。
检索了四个电子数据库（PubMed、EMBASE、科学网和Cochrane CENTRAL）以及ClinicalTrials.gov中从创建到2022年9月4日的相关随机对照试验（RCT）。分析过程中使用随机效应模型，并使用STATA（版本SE15.0）、R（版本3.6.1）和ADDIS（版本1.16.8）软件将结果评估为标准化均数差（SMD）、比值比（OR）和95%置信区间（CrI）。
通过筛选确定了10项RCT，共纳入1214名产妇。其中6项RCT比较了TEAS与对照组，3项比较了EA与对照组，1项比较了TEAS与EA。在四个结局指标中均未发现异质性。在SMD、OR和CrI方面，干预组与对照组在任何结局指标上均无显著差异。结合累积排序曲线下面积得分最高的情况，TEAS在某些情况下在镇痛效果和安全性方面可能具有更好的效果。
与EA相比，TEAS作为一种简单、非侵入性和非药物的干预措施，在对母亲和新生儿的镇痛效果和安全性方面，可能是产妇的一种潜在替代方法。
