高频高强度经皮电神经刺激与阿片类药物在妇科手术后缓解疼痛的比较：系统评价和荟萃分析。

High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis.

机构信息

Department of Anaesthesiology and Intensive Care/Pain Centre, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.

Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

出版信息

Scand J Pain. 2023 Oct 12;24(1). doi: 10.1515/sjpain-2023-0068. eCollection 2024 Jan 1.

DOI:10.1515/sjpain-2023-0068

PMID:37819201

Abstract

OBJECTIVES

Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery.

METHODS

We searched Medline, Embase, Web of Science, Cochrane, Amed and Cinahl for RCTs and quasi-experimental studies (2010-2022), and WHO and ClinicalTrials.gov for ongoing/unpublished studies. Meta-analysis and subsequent Trial Sequential Analysis (TSA) was performed for all stated outcomes. Quality of evidence was assessed according to GRADE.

RESULTS

Only three RCTs met the inclusion criteria (362 participants). The surgical procedures involved surgical abortion, gynecologic laparoscopy and hysteroscopy. The applied TENS frequency was 80 Hz and intensity 40-60 mA. There was no difference in pain intensity according to Visual Analogue Scale (VAS) at discharge from PACU between the TENS and opioid group (MD VAS -0.15, 95 % CI -0.38 to 0.09) (moderate level of evidence). Time in PACU was significantly shorter in the TENS group (MD -15.2, 95 % -22.75 to -7.67), and this finding was manifested by TSA (high-level of evidence). Opioid consumption in PACU was lower in the TENS group (MD Morphine equivalents per patient mg -3.42, 95 % -4.67 to -2.17) (high-level of evidence).

CONCLUSIONS

There was no detectable difference in postoperative pain relief between HFHI TENS and iv opioids after gynecological surgery. Moreover, HFHI TENS decreases recovery time and opioid consumption in PACU. HFHI TENS may be considered an opioid-sparing alternative for postoperative pain relief after gynecological surgery.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021231048.

摘要

目的

阿片类药物在术后镇痛中很重要，但它们的使用可能会引起许多副作用。经皮电神经刺激（TENS）已被用于急性疼痛治疗，具有剂量依赖性镇痛作用，因此是静脉（iv）阿片类药物用于术后镇痛的替代方法。本荟萃分析的目的是比较高频高强度（HFHI 或 intense）TENS 与 iv 阿片类药物在术后疼痛强度、麻醉后恢复室（PACU）恢复时间和择期妇科手术后阿片类药物消耗方面的差异。

方法

我们检索了 Medline、Embase、Web of Science、Cochrane、Amed 和 Cinahl 中的 RCT 和准实验研究（2010-2022 年），以及 WHO 和 ClinicalTrials.gov 中的正在进行/未发表的研究。对所有报告的结果进行了荟萃分析和随后的试验序贯分析（TSA）。根据 GRADE 评估证据质量。

结果

只有三项 RCT 符合纳入标准（362 名参与者）。手术涉及人工流产、妇科腹腔镜和宫腔镜。应用的 TENS 频率为 80Hz，强度为 40-60mA。根据从 PACU 出院时的视觉模拟量表（VAS），TENS 组与阿片类药物组的疼痛强度无差异（MD VAS -0.15，95%CI -0.38 至 0.09）（中等质量证据）。TENS 组 PACU 时间明显缩短（MD -15.2，95%CI -22.75 至 -7.67），这一发现通过 TSA 得到证实（高质量证据）。TENS 组 PACU 中阿片类药物消耗较低（MD 吗啡等效物每患者毫克 -3.42，95%CI -4.67 至 -2.17）（高质量证据）。