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Viderman D, Nabidollayeva F, Aubakirova M, Sadir N, Tapinova K, Tankacheyev R, Abdildin YG. The Impact of Transcutaneous Electrical Nerve Stimulation (TENS) on Acute Pain and Other Postoperative Outcomes: A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:427. [PMID: 38256561 PMCID: PMC10816585 DOI: 10.3390/jcm13020427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
This study aimed to investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) in postoperative acute pain control. PubMed, Scopus, and Cochrane Library were searched on 1-8 December 2022, for randomized controlled trials on the analgesic effects of TENS. The outcomes were pain intensity and opioid use (primary), and postoperative (PO) adverse events, blood pressure, and the duration of hospital stay (secondary); PROSPERO CRD42022333335. A total of 40 articles were included in the meta-analysis. Pain intensity at rest and during coughing for all types of surgeries combined was lower in the TENS group (standardized mean difference (SMD) = -0.51 [-0.61, -0.41], p < 0.00001, 29 studies, and -1.28 [-2.46, -0.09], p-value = 0.03, six studies, respectively). There was a statistically significant decrease in morphine requirements, as well as in the incidence of postoperative nausea and vomiting, dizziness, and pruritus. There was no difference between the groups in postoperative pain intensity during walking, in blood pressure, and only a borderline difference in the length of hospital stay. The subgroup analysis by surgery type did not show significant differences between the groups in pain severity at rest. Thus, TENS has a potential for pain control and postoperative recovery outcomes.
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Affiliation(s)
- Dmitriy Viderman
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
- Department of Anesthesiology, Intensive Care and Pain Medicine, National Research Oncology Center, Astana 010000, Kazakhstan
| | - Fatima Nabidollayeva
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (F.N.); (Y.G.A.)
| | - Mina Aubakirova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
| | - Nurzhamal Sadir
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
| | - Karina Tapinova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
| | - Ramil Tankacheyev
- Department of Minimally Invasive Surgery, National Research Neurosurgery Center, Astana 010000, Kazakhstan;
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (F.N.); (Y.G.A.)
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Kashi AM, Khodaverdi S, Govahi A, Sarhadi S, Kaveh M, Sadegi K, Derakhshan R, Ajdary M, Chaichian S. Does transcutaneous electrical nerve stimulation reduce the laparoscopic related shoulder pain? Obstet Gynecol Sci 2024; 67:94-100. [PMID: 37817412 DOI: 10.5468/ogs.23101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/25/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE Although laparoscopic surgery is a good substitute for laparotomy in reducing postsurgical pain, many patients complain of shoulder pain after laparoscopic surgery and require pain-relief. Post-operative pain management leads to increased patient satisfaction. Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological, noninvasive modality that reduces pain by activating the descending inhibitory systems in the central nervous system. Given the importance of decreasing shoulder pain after gynecological laparoscopy, the current study aimed to investigate the management of shoulder pain in these patients using TENS. METHODS This was a retrospective case-control study. A total of 112 women aged 18-45 years who experienced shoulder pain due to gynecologic laparoscopic surgery were included in the study. Patients were divided into TENS and control groups. In the TENS group, TENS was used twice for 20 minutes each, but in the control group, the patients received regular treatment. Patients were evaluated at intervals of 2, 4, 8, 24, 48, and 72 hours after laparoscopy for shoulder pain score. RESULTS The results showed a significant decrease in visual analog scale scores at 2, 4, and 8-hour in the TENS group compared with the control group. At 24 hours evaluation, although the pain was reduced, the difference was not significant. At 48- and 72-hour assessment, all patients in each group reported zero score for severity of pain. CONCLUSION The findings suggest that TENS significantly reduces postoperative shoulder pain.
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Affiliation(s)
- Abolfazl Mehdizadeh Kashi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
- Iranian Scientific Society of Minimally Invasive Gynecology, Tehran, Iran
| | - Sepideh Khodaverdi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Sarhadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mania Kaveh
- Department of Obstetrics and Gynecology, Zabol University of Medical Sciences, Zabol, Iran
| | - Kambiz Sadegi
- Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran
| | - Roya Derakhshan
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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Tabatabaei F, Tahernia H, Ghaedi A, Bazrgar A, Khanzadeh S. Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis. BMC Womens Health 2023; 23:576. [PMID: 37936116 PMCID: PMC10631181 DOI: 10.1186/s12905-023-02692-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compile existing evidence on the significance of the NLR in predicting endometriosis in order to aid clinical decision-making and outcomes. METHODS We searched ProQuest, Web of Science, and PubMed for related studies published before January 2, 2023. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported for each outcome. Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used Newcastle-Ottawa Scale (NOS) for quality assessment. RESULTS Overall, 18 article with were included in the analysis. A random-effect model revealed that patients with endometriosis had elevated levels of NLR compared to healthy controls (SMD = 0.79, 95% CI = 0.33 to 1.25, P < 0.001). Patients with endometriosis had elevated levels of NLR compared to those with other benign tumors (SMD = 0.85, 95% CI = 0.17 to 1.53, P = 0.014). In addition, NLR level of patients with stage III and IV endometriosis was not different from that of patients with stage I and II endometrioma (SMD = 0.30, 95% CI = -0.14 to 0.74, P = 0.18). However, NLR level was not different between endometriosis patients with and without peritoneal lesions (SMD = -0.12, 95% CI = -0.34to 0.10, P = 0.28), between patients with and without endometrioma (SMD = 0.20, 95% CI = -0.15 to 0.55, P = 0.26) and between endometriosis patients with and without deep lesions (SMD = 0.04, 95% CI = -0.20 to 0.28, P = 0.72). The pooled sensitivity of NLR was 0.67 (95% CI = 0.60-0.73), and the pooled specificity was 0.68 (95% CI, 0.62-0.73). CONCLUSIONS NLR might be utilized in clinics as a possible predictor to help clinicians diagnose endometriosis in affected women.
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Affiliation(s)
- Fatemeh Tabatabaei
- Department of Obstetrics and Gynaecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Gynaecologic Laparoscopic Surgeries, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
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Mottahedi M, Shamsi M, Babani SF, Goli S, Rizevandi P. Comparing the effect of transcutaneous electrical nerve stimulation and massage therapy on post laparoscopic shoulder pain: a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:764. [PMID: 37759246 PMCID: PMC10537143 DOI: 10.1186/s12891-023-06905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Shoulder pain is a common clinical problem after laparoscopic surgeries. The use of non-pharmacological massage and transcutaneous electrical nerve stimulation (TENS) as an adjunct to routine treatment is increasing to provide optimal pain relief. Therefore, we aimed to determine the effect of TENS and massage therapy on post laparoscopic shoulder pain (PLSP). METHODS This study was conducted on 138 patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into three groups: massage plus conventional pharmacological treatment (n = 46), TENS plus conventional pharmacological treatment (n = 46), and conventional pharmacological treatment (n = 46). Massage and TENS were performed three consecutive times after the patients regained consciousness in the inpatient wards. The intensity of Shoulder pain was evaluated using a visual analog scale before and 20 min after each treatment. RESULTS Both massage therapy and TENS led to a significant reduction in the intensity of PLPS compared to the control group in all three measured times (p < 0.001). However, no significant difference was observed between TENS and massage at any of the three-time points. CONCLUSIONS This study's findings demonstrated that massage and TENS techniques could reduce PLSP. TRIAL REGISTRATION Registered in the Iranian registry of clinical trials ( www.irct.ir ) in 05/02/2022 with the following code: IRCT20200206046395N1.
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Affiliation(s)
- Mobin Mottahedi
- Department of Operating Room, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MohammadBagher Shamsi
- Department of Physiotherapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samira Fatahi Babani
- Department of Operating Room, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahrbanoo Goli
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Parisa Rizevandi
- Department of Operating Room, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Johnson MI, Paley CA, Wittkopf PG, Mulvey MR, Jones G. Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060803. [PMID: 35744066 PMCID: PMC9230499 DOI: 10.3390/medicina58060803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.
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Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Correspondence: ; Tel.: +44-113-812-30-83
| | - Carole A. Paley
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Research & Development Department, Airedale NHS Foundation Trust, Steeton, Keighley BD20 6TD, UK
| | - Priscilla G. Wittkopf
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Matthew R. Mulvey
- Academic Unit of Primary and Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK;
| | - Gareth Jones
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
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Guo M, Liu S, Gao J, Han C, Yang C, Liu C. The effects of fentanyl, oxycodone, and butorphanol on gastrointestinal function in patients undergoing laparoscopic hysterectomy: a prospective, double-blind, randomized controlled trial. BMC Anesthesiol 2022; 22:53. [PMID: 35209847 PMCID: PMC8867837 DOI: 10.1186/s12871-022-01594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative opioid use is associated with postoperative bowel dysfunction, which causes longer hospital stay and higher healthcare costs. This study aimed to investigate the effect of the equivalent doses of fentanyl, oxycodone, and butorphanol on bowel function in patients undergoing laparoscopic hysterectomy. Methods In this randomized controlled trial, 135 patients undergoing laparoscopic hysterectomy received postoperative intravenous patient-controlled analgesia (IV-PCA) with fentanyl 8.3 μg/kg, butorphanol 0.16 mg/kg, and oxycodone 0.5 mg/kg (1: 20: 60), respectively. The primary outcome measure was the recovery of bowel function. We also evaluated and recorded the following nine indicators: pain score, sedation level, leukocyte count, percentage of neutrophils, plasma potassium levels, time to first ambulation, postoperative side effects, patients' satisfaction, and postoperative hospital length of stay. Results The mean time to flatus was significantly prolonged in Group B (45.2 ± 11.6 h) compared with Group F (33.1 ± 11.2 h, P < 0.001) and Group O (36.2 ± 10.9 h, P = 0.001). The incidence of somnolence and dizziness prove higher in Group B (P < 0.001). No statistical difference was observed in the mean time to tolerate oral diet, time to defecation, analgesic outcome, satisfaction score, time to first ambulation, and postoperative hospital length of stay. Conclusions Compared with fentanyl and oxycodone, butorphanol prolonged the recovery of bowel function with more severe somnolence and dizziness, suggesting that butorphanol is not well suitable for IV-PCA in patients undergoing laparoscopic hysterectomy. Trial registration ClinicalTrials.gov-NCT04295109. Date of registration: March, 2020.
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Affiliation(s)
- Minna Guo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shijiang Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Gao
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Chuanbao Han
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cunming Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Rahbar M, Ranjbar Kiyakalayeh S, Mirzajani R, Eftekharsadat B, Dolatkhah N. Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial. Clin Rehabil 2021; 36:669-682. [PMID: 34964679 DOI: 10.1177/02692155211070451] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. DESIGN Single-blind randomized clinical trial. SETTING Outpatient setting. SUBJECTS Patients with frozen shoulder. INTERVENTION Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. MAIN MEASURES The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. RESULTS Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [-4.63 (-5.58--3.67) vs. -2.22 (-2.96--1.47), P < 0.001 and -23.08 (-28.63--17.53) vs. -13.04 (-17.93--8.16), P = 0.008, respectively] and one month after the beginning of the treatment [-5.58 (-6.45--4.72) vs. -3.61 (-4.60--2.62), P < 0.001 and -33.43 (-40.85--26.01) vs. -20.03 (-26.00--14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45-40.13) vs. 10.17 (1.02-19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. CONCLUSIONS Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients.
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Affiliation(s)
- Mohammad Rahbar
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Reza Mirzajani
- Palliative Care Medicine Department, Faculty of Medicine, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, 48432Tabriz University of Medical Sciences, Tabriz, Iran
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Kim HY, Choi JB, Min SK, Chang MY, Lim GM, Kim JE. A randomized clinical trial on the effect of a lidocaine patch on shoulder pain relief in laparoscopic cholecystectomy. Sci Rep 2021; 11:1052. [PMID: 33441917 PMCID: PMC7806955 DOI: 10.1038/s41598-020-80289-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/18/2020] [Indexed: 01/29/2023] Open
Abstract
The incidence of laparoscopy-related shoulder pain reaches 90% in women. We evaluated the effect of lidocaine patch 5% on the shoulder pain after laparoscopic cholecystectomy (LC) in female patients. Total 63 female patients were randomly allocated to patch group (n = 31) and control group (n = 32). Patch group received lidocaine patch 5% and dressing retention tape on both shoulder, and control group received only dressing retention tape. Abdominal and shoulder pains were evaluated with rating on numeric rating scale (0 = no pain and 10 = the worst pain) at baseline and at 30 min, 6 h, 24 h, and 48 h after surgery. There were no significant differences in patient characteristics and operation details. The overall incidence of shoulder pain was significantly lower in patch group than in control group (42% vs. 78%, P = 0.005). The severity of shoulder pain also was significantly reduced in patch group compared to control group at 24 h and 48 h after surgery (P = 0.01 and P = 0.015, respectively). Complications related to lidocaine patch were not found except nausea. Lidocaine patch 5% reduced the incidence and severity of postoperative shoulder pain in female patients undergoing LC without complications.
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Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Sang Kee Min
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Min Ying Chang
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Gang Mee Lim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Ji Eun Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Republic of Korea.
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Kaya Uğur B, Pirbudak L, Öztürk E, Balat Ö, Uğur MG. Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study. Turk J Obstet Gynecol 2020; 17:186-195. [PMID: 33072423 PMCID: PMC7538827 DOI: 10.4274/tjod.galenos.2020.28928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023] Open
Abstract
Objective: To compare spinal anesthesia (SA) with general anesthesia (GA) in gynecologic laparoscopic surgery regarding anesthetic parameters and patient satisfaction together with an assessment of total oxidant, antioxidant levels, and Oxidative Stress index (OSI). Materials and Methods: Sixty patients who were planned to undergo gynecologic laparoscopy were randomized into group G (GA) and group S (SA). Demographics, adverse events and anesthetic parameters were recorded before induction, after induction, and at the 5th, 10th, 15th, 30th, 60th, 90th, and 120th minutes. Patients and surgeons completed questionnaires. Total antioxidant capacity (TAC), total oxidant level (TOL), and OSI were measured. Results: There was no difference between the groups in terms of hemodynamic parameters except heart rate at 30th minute and mean arteral pressure at 10th, 15th, 30th, and 60th minute (p<0.05). The postoperative arterial blood pH value was lower in group S (p=0.021). Intraoperative hypotension was lower in group S (p=0.038). There was more intraoperative hypotension in group S when compared with group G (p=0.038). Postoperative analgesic consumption was higher and onset of postoperative pain was shorter in group G (p=0.001 for both). There was no difference between the groups in terms of patient and surgeon satisfaction. There was no difference in terms of TAC, TOL, and OSI between the groups (p=0.862, p=0.940, and p=0.728, respectively). Conclusion: SA may become a reliable alternative to GA in gynecologic laparoscopy when hemodynamic and respiratory parameters, patient and surgeon satisfaction, as well as total oxidant, antioxidant levels, and OSI are considered.
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Affiliation(s)
- Berna Kaya Uğur
- Gaziantep University Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Lütfiye Pirbudak
- Gaziantep University Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Ebru Öztürk
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Özcan Balat
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
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Raimondo D, Borghese G, Mastronardi M, Mabrouk M, Salucci P, Lambertini A, Casadio P, Tonini C, Meriggiola MC, Arena A, Tarozzi G, Seracchioli R. Laparoscopic surgery for benign adnexal conditions under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach. J Gynecol Obstet Hum Reprod 2020; 49:101813. [PMID: 32426576 PMCID: PMC7229474 DOI: 10.1016/j.jogoh.2020.101813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
In general surgery locoregional anaesthesia increased laparoscopy advantages. 28 women submitted to gynaecological laparoscopy for benign adnexal conditions. 13 patients under spinal anaesthesia, 15 under general anaesthesia. Less postoperative pain and reduced need f opioids in the spinal anaesthesia arm. Earlier mobilization and return of bowel function in the spinal anaesthesia arm.
Background Laparoscopic gynaecological surgery is commonly performed under general anaesthesia with endotracheal intubation. In general surgery, locoregional anaesthesia was applied to laparoscopic procedures, increasing minimally invasive surgery advantages. Aims To assess and compare postoperative pain after laparoscopic adnexal procedures for benign conditions under spinal anaesthesia (SA) versus general anaesthesia (GA). Furthermore, anaesthesiologic, surgical and clinical data were evaluated in both groups. Materials and Methods This is a prospective cohort study performed in a tertiary level referral centre for minimally invasive gynaecological surgery (Gynaecology and Human Reproduction Physiopathology, University of Bologna). Women scheduled for adnexal laparoscopic surgery for benign conditions between February and May 2019 were assigned to receive either SA or GA with endotracheal intubation. A sample size of 13 women per group was needed to detect a 2-point difference in pain scores. Main findings 13 women were enrolled in the SA arm, 15 in the GA arm. In the SA cohort, the most common intraoperative adverse event was shoulder pain, reported by 3/12 women. At 1, 8, 12, 24 and 48 h after surgery pain was significantly lower in the SA arm (p < .05). Patients submitted to SA experienced no need for opioid drugs administration, unlike those receiving GA. Patients’ mobilization and return of bowel function were noted significantly earlier in the SA group (p < .05). Conclusions SA is a feasible, safe and effective anaesthesiologic technique for laparoscopic gynaecological procedures for benign conditions, allowing a better control of postoperative pain. Women undergoing SA achieve earlier mobilization and bowel canalization. During the Covid-19 pandemics, SA could be useful in reducing the need for invasive procedures on respiratory tract.
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Affiliation(s)
- Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Giulia Borghese
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Manuela Mastronardi
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Alexandria, Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria Governorate, Egypt.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cambridge Clinical School, Box 223, The Rosie Hospital, Robinson Way, Cambridge CB2 0SW, United Kingdom
| | - Paolo Salucci
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Agnese Lambertini
- Anaesthesiology and Resuscitation Unit, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Paolo Casadio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Claudia Tonini
- Anaesthesiology and Resuscitation Unit, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Maria Cristina Meriggiola
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Giulia Tarozzi
- Anaesthesiology and Pain Medicine Unit, Dipartimento dell'Emergenza-Urgenza, S. Orsola Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
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