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)
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 sciences, 28(7), 2788–2796. https://doi.org/10.26355/eurrev_202404_35907