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Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after hysteroscopy: a randomized controlled study

Obstetrics & Gynecology Science 2020년 63권 5호 p.660 ~ 669
Platon Birgitta, Thorn Sven-Egron, Mannheimer Clas, Andrell Paulin,
소속 상세정보
 ( Platon Birgitta ) - Sahlgrenska University Hospital Department of Anaesthesiology and Intensive Care Medicine
 ( Thorn Sven-Egron ) - University of Gothenburg Institute of Clinical Sciences at Sahlgrenska Academy Department of Anesthesiology and Intensive Care Medicine
 ( Mannheimer Clas ) - Sahlgrenska University Hospital Sahlgrenska Academy at University of Gothenburg Multidisciplinary Pain Center Kungalv Hospital Kungalv and Institute of Medicine
 ( Andrell Paulin ) - University of Gothenburg Institute of Clinical Sciences at Sahlgrenska Academy Department of Anesthesiology and Intensive Care Medicine

Abstract


Objective: To compare the time spent in the Post-Anesthesia Care Unit (PACU) and the pain-relieving effects of treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after hysteroscopy.

Methods: All patients who postoperatively reported a visual analogue scale (VAS) pain score of ≥3 were included in the study. TENS treatment was given with a stimulus intensity between 40 and 60 mA for 1 minute and repeated once if there was insufficient pain relief. In the opioid group, a fractionated dose of 5 mg morphine was administered. If the patient reported insufficient pain relief after the assigned treatment, the patient was reassigned to the other treatment group.

Results: Seventy-four women were randomized to TENS (n=38) or IV opioids (n=36) for treatment. Both groups reported significant pain relief after discharge from the PACU, with a decrease of VAS scores from 5.6 to 1.4 in the TENS group (P<0.001) and 5.1 to 1.3 in the opioid group (P<0.001). There were no significant differences between the groups. When only the responders in both groups, i.e., patients with VAS scores of <3 on respectively assigned treatments, were compared, the TENS responders (n=22) were found to have spent a significantly shorter time in the PACU (91 vs. 69 minutes, P=0.013) compared to the opioid responders (n=20).

Conclusion: Using TENS as first line of pain relief may reduce the need for postoperative opioids. In addition, TENS appears preferable as the first line of treatment due to its association with a shorter time spent in the PACU if the patient responds to the treatment.

키워드

Hysteroscopy; Pain management; Opioids; TENS

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