Transcutaneous electrical nerve stimulation for reducing postoperative acute pain after hip fracture surgery: a double-blinded randomized clinical trial. (2024)

PICO

Patient/Population

  • Patients undergoing hip surgery after hip fractures
  • American Society of Anesthesia (ASA) physical class I or II

(n=126)

Intervention

  • LS-TENS: Lumbar plexus and sciatic nerve + intrathecal spinal anesthesia in combination with an epidural catheter for postoperative analgesia
  • SW-TENS: Surgical wound + intrathecal spinal anesthesia in combination with an epidural catheter for postoperative analgesia

Comparison

  • Control- intrathecal spinal anesthesia in combination with an epidural catheter for postoperative analgesia

Outcomes

  • Pain (VAS) score
  • Total consumption of opioid analgesics
  • Postoperative nausea and vomiting (PONV)

Translatability:   (3/3) Easy                                    

Comments: Both LS-TENS and SW-TENS were effective in reducing postoperative pain and opioid necessity.

Limitations: The multidimensional nature of pain influenced by various factors. Single-center setting limits generalizability. Inability to create a true “sham” group due to routine PCA use. Variability in pain sensitivity among patients. Patients with hip fractures had diverse characteristics affecting pain responses

Appraisals:

Trustworthiness – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. The effect size was not reported and no CI were reported. (by CAT)

Metrics and
Journal Details:

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BTB

Intervention – 1

  • LS-TENS

Dose

  • Duration: Applied for 30 minutes
  • Intensity: Adjusted based on individual patient sensitivity, ranging between 9 and 15 mA

Periodicity

  • 2-hour intervals for the first 48 hours postoperatively

Local/Technic:

  • Local:  Lumbar plexus and sciatic nerve (4 electrodes – image). Mode: Modulation mode. Pulse Width: 60 μs. Frequency: 120 Hz

Intervention – 2

  • SW

Dose

  • Duration: Applied for 30 minutes at
  • Intensity: Adjusted based on individual patient sensitivity, ranging between 9 and 15 mA

Periodicity

  • 2-hour intervals for the first 48 hours postoperatively

Local/Technic:

Local:  Surgical wound (4 electrodes – image).  Mode: Modulation mode. Pulse Width: 60 μs . Frequency: 120 Hz

Intervention – 3

  • Intrathecal spinal anesthesia in combination with an epidural catheter for postoperative analgesia

Dose

  • Fentanyl: of 2 mL (10 μg/mL), at a basal infusion rate of 2 mL/h on demand 

Periodicity

  • Fentanyl : first 48 hours with a minimal lockout interval of 15 min

Local/Technic:

Intrathecal spinal anesthesia (0.5% heavy bupivacaine).

Epidural PCE: consisting  bolus doses of fentanyl, intravenous paracetamol, and intramuscular diclofenac

Citation:

Oksar, M., Kalaci, A., & Turhanoglu, S. (2024). Transcutaneous electrical nerve stimulation for reducing postoperative acute pain after hip fracture surgery: a double-blinded randomized clinical trial. European review for medical and pharmacological sciences28(7), 2788–2796. https://doi.org/10.26355/eurrev_202404_35907 

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