58 patients underwent standard posterolateral thoracotomy for resectable lung cancer. Fifty patients were enrolled in the present study and randomized in two groups: TENS group (25 patients) who received postoperatively TENS for 5 days and placebo group (25 patients) without TENS.
Sample Count
58
Control
Placebo
placebo group(n=25)
Experiment
TENS group(n=25)
Indicator
IL-6IL-10TNF-αVisual analog scale(VAS)Forced expiratory volume(FEV)Forced vital capacity(FVC)Total intake of narcotic medicationSide effects
Auxiliary Medication
5mg morphine IV bolus at first, followed by 1.2 mg/h which can be maximally delivered by any patient with a 5-10 min lockout period for the first 48 POHs. Ketorolac (administered via an intramuscular route at a dose of 15 mg every 6-8 h) was given when the patient noticed strong pain; if the pain was uncontrollable, an additional dose of intramuscular administration of Pentazocine (30-60 mg) was used.
Stimulation Method
TENS
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
-
-
80 pulse/s and a pulse width of 250 µs
an asymmetric square biphasic wave
a strong but comfortable tingling sensation
30 min
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
-
-
-
Description The TENS units provided an asymmetric square biphasic wave form at a frequency of 80 pulse/s and a pulse width of 250 µs.The TENS group adjusted the stimulus intensity until a strong but comfortable tingling sensation was felt. TENS immediately started and were performed at intervals of 4 h each, all with a duration of 30 min in the first 48 POHs.
Anesthesia Method
GA
Clinical Trial Type
random,Both investigator 1 and the subject were blinded to the TENS therapy.
Contraindications
Presence of pacemaker
Effector
Of the 50 patients enrolled, two patients of TENS group and two patients of the placebo group were lost to follow-up. (i) Serum IL-6 (P = 0.001), IL-10 (P = 0.001) and TNF-α (P = 0.001) levels in TENS group were significantly lower than in the control group; (ii) VAS score in TENS group was significantly lower than in the control group (P < 0.001); (iii) recovery of FEV 1 (P = 0.02) and of FVC (P = 0.02) was statistically better in the TENS group than in control group; (iv) morphine requirement was lower in the TENS group with respect to placebo TENS (P = 0.004). After 48 POHs, no patient required supplementary dose of morphine. TENS group compared with placebo-group presented a significant reduction of non-opioid consumption (P = 0.002). TENS is a valuable strategy to alleviate post-thoracotomy pain with reduction of cytokine production and of analgesic consumption, and with positive effects on pulmonary ventilation function.
"Control of post-thoracotomy pain by transcutaneous electrical nerve stimulation: effect on serum cytokine levels, visual analogue scale, pulmonary function and medication."
Abstract
OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) has been used to control post-thoracotomy pain with contrasting results. We aimed to assess the efficacy of TENS on post-thoracotomy pain in relation of four criterion measurements as: (i) cytokines; (ii) pain; (iii) respiratory function and (iv) intake of narcotic medication. METHODS: Between January 2008 and October 2010, 58 patients underwent standard posterolateral thoracotomy for resectable lung cancer. Fifty patients were enrolled in the present study and randomized in two groups: TENS group (25 patients) who received postoperatively TENS for 5 days and placebo group (25 patients) without TENS. In both groups (i) serum cytokines (IL-6, IL-10, TNF-alpha) were measured by ELISA before surgery and at 6, 12, 24, 48, 72, 96 and 120 postoperative hours (POHs); (ii) at the same POHs, the pain score was measured using visual analogue scale (VAS) ranging from 0 to 10 levels; (iii) respiratory function (FEV 1% and FVC % of predicted value) were valuated on 72, 96 and 120 POHs; (iv) the total intake of narcotic medication given during postoperative period of 5 days was recorded. Repeated measures of analysis of variance assess the difference between two study groups. A value of P < 0.05 was considered statistically significant. RESULTS: Of the 50 patients enrolled, two patients of TENS group and two patients of the placebo group were lost to follow-up. (i) Serum IL-6 (P = 0.001), IL-10 (P = 0.001) and TNF-alpha (P = 0.001) levels in TENS group were significantly lower than in the control group; (ii) VAS score in TENS group was significantly lower than in the control group (P < 0.001); (iii) recovery of FEV 1 (P = 0.02) and of FVC (P = 0.02) was statistically better in the TENS group than in control group; (iv) morphine requirement was lower in the TENS group with respect to placebo TENS (P = 0.004). After 48 POHs, no patient required supplementary dose of morphine. TENS group compared with placebo-group presented a significant reduction of non-opioid consumption (P = 0.002). CONCLUSIONS: TENS is a valuable strategy to alleviate post-thoracotomy pain with reduction of cytokine production and of analgesic consumption, and with positive effects on pulmonary ventilation function."
