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Shekouhi R, Farz F, Sohooli M, Mohammadi S, Abbasi A, Razaghi M, Fereydouni M, Sohrabi M, Seyed-Alagheband SA, Darabi MH. Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis. Hernia 2023; 27:1363-1373. [PMID: 37597107 DOI: 10.1007/s10029-023-02861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000-48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain. METHODS A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient's clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported. RESULTS A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments. CONCLUSION Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.
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Affiliation(s)
- R Shekouhi
- Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran
| | - F Farz
- Najafabad University of Medical Sciences, Isfahan, Iran
| | - M Sohooli
- Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran
| | - S Mohammadi
- University of Chicago, Medical Center, Chicago, USA
| | - A Abbasi
- Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran
| | - M Razaghi
- Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran
| | - M Fereydouni
- University of North Carolina at Charlotte, Charlotte, USA
| | - M Sohrabi
- Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran
| | | | - M H Darabi
- Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran.
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Agrawal S, Szmit M, Wełna M, Rudnicki J, Agrawal A, Goździk W. Transcutaneous electrical acupoint stimulation to reduce opioid consumption in patients undergoing inguinal hernia repair: protocol for a randomized controlled trial. Trials 2022; 23:1064. [PMID: 36581999 PMCID: PMC9801607 DOI: 10.1186/s13063-022-07019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) in the postoperative treatment of patients undergoing inguinal hernia repair compared with sham and no treatment group. METHODS This study is a protocol for a three-armed, single-blinded, placebo-controlled randomized controlled trial. Ninety participants scheduled for inguinal hernia repair will be randomly assigned to the TEAS group (n = 30), sham group (n = 30), and control group (n = 30). The TEAS group will receive treatment using four portable coin-sized electro-stimulators at both local and distal acupuncture points. The sham group will receive sham treatment with mock electrostimulation. The treatment groups will receive mixed frequency stimulation (alternating at 2 and 100 Hz every 3 s) in continuous mode for 30 min at intervals of 2 h for 24 h postoperatively. The control group will receive postoperative pain control using patient-controlled analgesia (PCA) device. The primary outcome is the total morphine dose received in the postoperative period (mg) using PCA 24 h after surgery. The number of PCA demands (i.e., times the button will be pressed) and delivered bolus doses, score on the Visual Analogue Scale, opioid-related side effects, the requirement for supplemental medications, score on the Hospital Anxiety and Depression Scale (HADS), and blood levels of stress hormones cortisol and prolactin. DISCUSSION The results of this trial will determine whether TEAS with intensified stimulation protocol is a safe and effective option for reducing analgesic consumption and postoperative pain. TRIAL REGISTRATION ISRCTN76428396. Registered on 05 October 2020. https://www.isrctn.com/ISRCTN76428396.
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Affiliation(s)
- Siddarth Agrawal
- grid.4495.c0000 0001 1090 049XDepartment of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland ,grid.4495.c0000 0001 1090 049XDepartment of Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Szmit
- grid.4495.c0000 0001 1090 049XDepartment of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Wełna
- grid.4495.c0000 0001 1090 049XDepartment of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- grid.4495.c0000 0001 1090 049XDepartment of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Anil Agrawal
- grid.4495.c0000 0001 1090 049XSecond Department of General and Oncological Surgery, Wroclaw Medical University, Borowska 213 St, 50-556 Wroclaw, Poland
| | - Waldemar Goździk
- grid.4495.c0000 0001 1090 049XDepartment of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
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Szmit M, Agrawal S, Goździk W, Kübler A, Agrawal A, Pruchnicki P, Woźniak M, Nowak M, Bartoszewicz B, Rudnicki J. Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Analgesic Requirement in Patients Undergoing Inguinal Hernia Repair: A Randomized, Placebo-Controlled Study. J Clin Med 2021; 10:E146. [PMID: 33406735 PMCID: PMC7794768 DOI: 10.3390/jcm10010146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
Given the rising rate of opioid-related adverse drug events during postsurgical pain management, a nonpharmacologic therapy that could decrease analgesic medication requirements would be of immense value. We designed a prospective, placebo-and-randomized controlled trial to assess the clinical effect of transcutaneous acupoint electrical stimulation (TEAS) on the postoperative patient-controlled analgesia (PCA) requirement for morphine, as well as side effects and recovery profile after inguinal hernia repair. Seventy-one subjects undergoing inguinal hernia repair with a standardized anesthetic technique were randomly assigned to one of three analgesic treatment regimens: PCA + TEAS (n = 24); PCA + sham-TEAS (no electrical stimulation) (n = 24), and PCA only (n = 23). The postoperative PCA requirement, pain scores, opioid-related side effects, and blood cortisol levels were recorded. TEAS treatment resulted in a twofold decrease in the analgesic requirement and decreased pain level reported by the patients. In addition, a significant reduction of cortisol level was reported in the TEAS group at 24 h postoperatively compared to the sham and control groups. We conclude that TEAS is a safe and effective option for reducing analgesic consumption and postoperative pain following inguinal hernia repair.
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Affiliation(s)
- Mateusz Szmit
- Department and Clinic of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (J.R.)
| | - Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Department of Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Waldemar Goździk
- Department and Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Andrzej Kübler
- Department and Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anil Agrawal
- Second Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Piotr Pruchnicki
- Department of Acoustics and Multimedia, Faculty of Electronics, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland;
| | - Marta Woźniak
- Department of Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Matylda Nowak
- Department of Design, The Eugeniusz Geppert Academy of Art and Design, 50-416 Wroclaw, Poland;
| | - Bartłomiej Bartoszewicz
- Department of Econometrics and Operations Research, Wroclaw University of Economics and Business, 53-345 Wroclaw, Poland;
| | - Jerzy Rudnicki
- Department and Clinic of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (J.R.)
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Faiz SHR, Nikoubakht N, Imani F, Ziyaeifard M, Sadegh H, Rahimzadeh P. Comparison of Two Acupuncture Protocols (K1, DU25 or K1, DU26) Efficacy on Recovery Time of Patients After General Anesthesia, a Randomized Control Clinical Trial. Anesth Pain Med 2019; 9:e96172. [PMID: 31903336 PMCID: PMC6935292 DOI: 10.5812/aapm.96172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Acupuncture has been used for more than two thousand years as part of traditional Chinese medicine. Objectives This randomized prospective clinical trial aimed to compare the effect of acupuncture on K1 (Yongquan) and DU26 (Renghong) with acupuncture on K1 (Yongquan) and DU25 (Suliao), with sham acupuncture on the recovery time of general anesthesia. Methods The patients (51) were randomly assigned to three groups: (A) acupuncture on K1 and DU26, (B) acupuncture on K1 and DU25, and (C) sham acupuncture. In each group, at the end of surgery acupuncture was performed accordingly for twenty minutes and the Bispectral Index (BIS) values at end of surgery, 5th minute, 10th minute, 15th minute and 20th minute as well as time of extubation and time of eye opening after the end of surgery were evaluated. Results BIS study at 5th minute, 10th minute and 15th minute after the end of surgery in the groups revealed a significant difference between sham acupuncture group and both A and B acupuncture groups, which was higher in groups A and B in comparison with sham acupuncture group. Time of opening eyes and time of extubation after the end of surgery between group A and sham acupuncture group differed significantly, which was earlier in group A. There was no significant difference between group B and sham acupuncture group in terms of eye opening and extubation time. Conclusions Acupuncture on K1 and DU26 accelerates restoring of consciousness and shortens of eye opening and extubation after general anesthesia, but on K1 and DU25 only speeds up retrieving of consciousness without significant effect on time of eye opening or extubation after general anesthesia.
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Affiliation(s)
- Seyed Hamid Reza Faiz
- Pain Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nasim Nikoubakht
- Pain Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohsen Ziyaeifard
- Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hossein Sadegh
- Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Poupak Rahimzadeh
- Pain Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Corresponding Author: Professor of Anesthesiology, Pain Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Fanara B, Lambiel S. Effect of Auricular Acupuncture on Propofol Induction Dose: Could Vagus Nerve and Parasympathetic Stimulation Replace Intravenous Co-Induction Agents? Med Acupunct 2019; 31:103-108. [PMID: 31031876 DOI: 10.1089/acu.2018.1327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: Auricular acupuncture, through a combination of several points, can produce sedative and analgesic effects. The aim of this study was to compare the induction dose of propofol required to obtain a loss of response to verbal commands, with and without a preoperative combination of auricular points. Materials and Methods: This study involved American Society of Anesthesiologists physical status I and II patients, ages 18- 65, of either sex, having elective ambulatory surgery (digestive or gynecologic) under general anesthesia. The subjects were allocated to 2 groups: (1) patients treated by auricular acupuncture (group AA), compared with (2) patients not treated by auricular acupuncture (group NA). Propofol injection was initiated in each group, 10 mg, every 5 seconds, in order for the anesthetist to determine the minimum dose until there was a loss of response to verbal commands (the clinical hypnotic endpoint). At this point, the main outcome-the dose of propofol given-was noted. Results: There were 32 patients in this study (16 in each group). Age, height, weight, and body mass index were similar in the groups (P ≥ 0.05). The required induction propofol dose was 17.7% lower in group AA than in group NA-a statistically significant difference (P ≤ 0.05). The mean induction dose indexed to weight was 2.18 mg/kg (range: 1.53-3.13 mg/kg) in group NA and 1.79 mg/kg (range: 1.12-2.11 mg/kg) in group AA. There were no complications. Conclusions: Auricular acupuncture is a method for stimulating the vagus nerve and parasympathetic nervous system. Preoperative auricular acupuncture enabled reductions of induction doses of propofol for general anesthesia without any clinically important side-effects.
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Affiliation(s)
- Benoît Fanara
- Anesthesiology Department, Mont Blanc Regional Hospital, Sallanches-Chamonix, France.,Acupuncture Department, Clinic Dr. Benoît Fanara, Annecy-le-Vieux, Annecy, France
| | - Silvia Lambiel
- Ear-Nose-and-Throat Unit, Departement des Neurosciences Cliniques, Geneva University Hospital, Genève, Switzerland
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Lam WL, Yeung WF, Wong MK, Cheung CW, Chan KKL, Ngan HYS, Wong CKH, Chen HY, Lao L. Combined electroacupuncture and auricular acupuncture for postoperative pain after abdominal surgery for gynecological diseases: study protocol for a randomized controlled trial. Trials 2018; 19:8. [PMID: 29301556 PMCID: PMC5755011 DOI: 10.1186/s13063-017-2359-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 11/28/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Postoperative pain is a major complaint following abdominal surgery for gynecological diseases. Effective postoperative pain control after abdominal surgery is particularly important for patient recovery, mobility, and satisfaction. Acupuncture has been commonly used for pain management. However, its efficacy in postoperative pain control is inconclusive and health economic evaluation is limited. METHODS A randomized, sham-controlled, patient- and- assessor-blind trial is designed to evaluate the efficacy and safety of acupuncture in managing postoperative pain following abdominal surgery of gynecological diseases. Patients who are eligible for laparotomy with a midline incision for gynecological neoplasia, including ovarian mass, uterine mass, and cervical lesions, will be recruited. Seventy-two participants will be randomly allocated to an acupuncture or non-invasive sham control in a 1:1 ratio. Treatment will be done within 2 h before operation, upon arrival to the ward and once daily for 5 days. The Pain Numerical Rating Scale (NRS) on the first 5 days during hospitalization will be the primary outcome and will be analyzed using the area-under-the-curve (AUC) method. The secondary outcome measures include frequency of rescue analgesic use during hospital stay, cumulative morphine consumption; quality of recovery as measured by time to recovery variables and the Quality of Recovery-9 (QoR-9); quality of life as measured by the Short Form-6 dimension (SF-6D) and EuroQol-5 Dimension-5 Level (EQ-5D-5 L). The incremental cost-effectiveness ratio of acupuncture vs sham acupuncture will be calculated. DISCUSSION This study protocol provides an example of integrative medicine practice in a hospital setting for the management of postoperative pain using acupuncture treatment. The acupuncture treatment protocol, if proven to be effective, can be implemented in routine settings to play a role in postoperative pain management for patients who have undergone abdominal surgery for gynecological diseases. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02851186 . Registered on 19 July 2016.
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Affiliation(s)
- Wing Lok Lam
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Wing Fai Yeung
- School of Nursing, the Hong Kong Polytechnic University, Kowloon, Hong Kong, Special Administrative Region of China
| | - Mei Kuen Wong
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Chi Wai Cheung
- Department of Anesthesiology, The University of Hong Kong, 4/F, K Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Karen Kar Loen Chan
- Department of Obstetrics and Gynecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Hextan Yuen Sheung Ngan
- Department of Obstetrics and Gynecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Hai Yong Chen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
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Sham Electroacupuncture Methods in Randomized Controlled Trials. Sci Rep 2017; 7:40837. [PMID: 28106094 PMCID: PMC5247761 DOI: 10.1038/srep40837] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
Sham electroacupuncture (EA) control is commonly used to evaluate the specific effects of EA in randomized-controlled trials (RCTs). However, establishing an inert and concealable sham EA control remains methodologically challenging. Here, we aimed to systematically investigate the sham EA methods. Eight electronic databases were searched from their inception to April 2015. Ten out of the 17 sham EA methods were identified from 94 RCTs involving 6134 participants according to three aspects: needle location, depth of needle insertion and electrical stimulation. The top three most frequently used types were sham EA type A, type L and type O ordinally. Only 24 out of the 94 trials reported credibility tests in six types of sham EA methods and the results were mainly as follows: sham EA type A (10/24), type B (5/24) and type Q (5/24). Compared with sham EA controls, EA therapy in 56.2% trials reported the specific effects, of which the highest positive rate was observed in type N (3/4), type F (5/7), type D (4/6) and type M (2/3). In conclusion, several sham EA types were identified as a promising candidate for further application in RCTs. Nonetheless, more evidence for inert and concealable sham EA control methods is needed.
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Eidy M, Fazel MR, Janzamini M, Haji Rezaei M, Moravveji AR. Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e35050. [PMID: 27275401 PMCID: PMC4893426 DOI: 10.5812/ircmj.35050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/29/2016] [Accepted: 02/21/2016] [Indexed: 11/17/2022]
Abstract
Background Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. Objectives The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. Patients and Methods This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. Results The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. Conclusions TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.
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Affiliation(s)
- Mohammad Eidy
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Reza Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Monir Janzamini
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Monir Janzamini, Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540021; +98-9123976157, Fax: +98-3155540111, E-mail:
| | - Mostafa Haji Rezaei
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Ali Reza Moravveji
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Liu XL, Tan JY, Molassiotis A, Suen LKP, Shi Y. Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:657809. [PMID: 26568767 PMCID: PMC4620376 DOI: 10.1155/2015/657809] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/19/2015] [Accepted: 09/03/2015] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of Acupuncture-point stimulation (APS) in postoperative pain control compared with sham/placebo acupuncture or standard treatments (usual care or no treatment). Only randomized controlled trials (RCTs) were included. Meta-analysis results indicated that APS interventions improved VAS scores significantly and also reduced total morphine consumption. No serious APS-related adverse effects (AEs) were reported. There is Level I evidence for the effectiveness of body points plaster therapy and Level II evidence for body points electroacupuncture (EA), body points acupressure, body points APS for abdominal surgery patients, auricular points seed embedding, manual auricular acupuncture, and auricular EA. We obtained Level III evidence for body points APS in patients who underwent cardiac surgery and cesarean section and for auricular-point stimulation in patients who underwent abdominal surgery. There is insufficient evidence to conclude that APS is an effective postoperative pain therapy in surgical patients, although the evidence does support the conclusion that APS can reduce analgesic requirements without AEs. The best level of evidence was not adequate in most subgroups. Some limitations of this study may have affected the results, possibly leading to an overestimation of APS effects.
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Affiliation(s)
- Xian-Liang Liu
- 10th People's Hospital of Tongji University, 301 Yanchang Road, Shanghai 200072, China
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 1100 Nudgee Road, Banyo, Brisbane, QLD 4014, Australia
- School of Nursing, Jinggangshan University, 28 Xueyuan Road, Ji'an 343009, China
| | - Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lorna K. P. Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yan Shi
- 10th People's Hospital of Tongji University, 301 Yanchang Road, Shanghai 200072, China
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Lu Z, Dong H, Wang Q, Xiong L. Perioperative acupuncture modulation: more than anaesthesia. Br J Anaesth 2015; 115:183-93. [DOI: 10.1093/bja/aev227] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Chung YC, Chien HC, Chen HH, Yeh ML. Acupoint Stimulation to Improve Analgesia Quality for Lumbar Spine Surgical Patients. Pain Manag Nurs 2014; 15:738-47. [DOI: 10.1016/j.pmn.2013.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 07/14/2013] [Accepted: 07/25/2013] [Indexed: 11/26/2022]
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12
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Integrative acupoint stimulation to alleviate postoperative pain and morphine-related side effects: a sham-controlled study. Int J Nurs Stud 2013; 51:370-8. [PMID: 23866092 DOI: 10.1016/j.ijnurstu.2013.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 06/06/2013] [Accepted: 06/11/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although it can be reduced, postoperative pain remains a problem. Acupressure with electric stimulation may be more effective for postoperative pain management than acupressure alone. OBJECTIVES This study aimed to evaluate the effects of integrative acupoint stimulation (IAS) on the relief of postoperative pain and on the reduction of morphine-related side effects. DESIGN A single-blinded, sham-controlled study with three groups. SETTING An orthopedic ward in a 2900-bed teaching medical center. PARTICIPANTS Forty-five subjects in each of three groups. METHODS Each subject received a multimedia course on patient-controlled analgesia (PCA) before surgery to learn about the use of narcotic analgesics and the operation of the PCA device. Treatment was as follows: (1) for the IAS group, auricular acupressure combined with transcutaneous electric acupoint stimulation (TEAS) at the true acupoint; (2) for the sham group, acupoint stimulation in the same manner but at a sham acupoint or without embedding seeds and pressure; (3) for the control group, no IAS intervention. RESULTS Pain scores were significantly lower in the IAS group than the other two groups at 2h and 4h after returning to the ward, and 24h after surgery. The analgesic requirement during the 72h after surgery and the overall incidence of morphine-related side effects were significantly lower in the IAS group. CONCLUSION The study demonstrates that combined auricular acupressure and TEAS decreased postoperative pain, the use of equianalgesic morphine, and morphine-related side effects. IAS provides better analgesia when used in conjunction with PCA after lumbar spine surgery and can be regarded as a component of multimodal analgesia.
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Affiliation(s)
- Simon Hayhoe
- Dr Simon Hayhoe, Anaesthetic Department, Colchester University Hospital, Colchester CO4 5JL, Essex, UK
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