Skip to main content
SpringerLink
Log in

Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pulmonary Function, and Respiratory Muscle Strength After Posterolateral Thoracotomy: A Randomized Controlled Trial

  • THORACIC SURGERY
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU).

Methods

Patients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outcomes were evaluated before surgery, immediately after, 24 and 48 h after ICU admission.

Results

Forty-five patients were included. Regarding pain perception, there was no difference between groups (p = 0.172), but there was a significant reduction in pain intensity for patients receiving TENS after first physiotherapy session compared to baseline (4.7 ± 3.2 vs 3.3 ± 2.6; p < 0.05). All groups had a decrease in forced vital capacity (FVC) after surgery (p < 0.001). There was no difference between the groups regarding the use of analgesic medications, but a higher intake of morphine and acetaminophen were observed for the control (p = 0.037) and placebo group (p = 0.035), respectively.

Conclusion

The use of TENS provides a little benefit of pain (in the first 12 h) but failed to demonstrate any improvement in the recovery of ICU patients after 48 h of posterolateral thoracotomy.

Trial Registration

NCT02438241.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

TENS:

Transcutaneous electrical nerve stimulation

ICU:

Intensive care unit

FVC:

Forced vital capacity

RCT:

Randomized control trials

MAP:

Mean arterial pressure

RASS:

Richmond agitation-sedation scale

IG:

Intervention group

PG:

Placebo group

CG:

Control group

VAS:

Visual analogue scale

PFT:

Pulmonary function tests

FEV 1:

Forced expiratory volume in 1 second

FVC:

Forced vital capacity

IPmax:

Maximum inspiratory pressures

EPmax:

Maximum expiratory pressures

PC:

Epidural catheter

PVC:

Paravertebral catheter

References

  1. Savage C, McQuitty C, Wang D, Zwischenberger JB (2002) Postthoracotomy pain management. Chest Surg Clin N Am 12(2):251–263

    Article  Google Scholar 

  2. Landreneau RJ, Pigula F, Luketich JD, Keenan RJ, Bartley S, Fetterman LS et al (1996) Acute and chronic morbidity differences between muscle-sparing and standard lateral thoracotomies. J Thorac Cardiovasc Surg. 112(5):1346–1350; discussion 50-1

    Article  CAS  Google Scholar 

  3. Kavanagh BP, Katz J, Sandler AN (1994) Pain control after thoracic surgery. A review of current techniques. Anesthesiology 81(3):737–759

    Article  CAS  Google Scholar 

  4. Boisseau N, Rabary O, Padovani B, Staccini P, Mouroux J, Grimaud D et al (2001) Improvement of 'dynamic analgesia' does not decrease atelectasis after thoracotomy. Br J Anaesth 87(4):564–569

    Article  CAS  Google Scholar 

  5. Benedetti F, Amanzio M, Casadio C, Cavallo A, Cianci R, Giobbe R et al (1997) Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg 63(3):773–776

    Article  CAS  Google Scholar 

  6. Yegin A, Erdogan A, Kayacan N, Karsli B (2003) Early postoperative pain management after thoracic surgery; pre- and postoperative versus postoperative epidural analgesia: a randomised study. Eur J Cardiothorac Surg 24(3):420–424

    Article  Google Scholar 

  7. Grant RP (1999) Con: every postthoracotomy patient does not deserve thoracic epidural analgesia. J Cardiothorac Vasc Anesth 13(3):355–357

    Article  CAS  Google Scholar 

  8. Baidya DK, Khanna P, Maitra S (2014) Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 18(5):626–635

    Article  Google Scholar 

  9. Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150(3699):971–979

    Article  CAS  Google Scholar 

  10. Sbruzzi G, Silveira SA, Silva DV, Coronel CC, Plentz RD (2012) Transcutaneous electrical nerve stimulation after thoracic surgery: systematic review and meta-analysis of 11 randomized trials. Rev Bras Cir Cardiovasc 27(1):75–87

    Article  Google Scholar 

  11. Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother 1(2):100–107

    Article  Google Scholar 

  12. Rakel B, Cooper N, Adams HJ et al (2010) New transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. J Pain 11:230–238

    Article  Google Scholar 

  13. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al (2005) Standardisation of spirometry. Eur Respir J 26(2):319–338

    Article  CAS  Google Scholar 

  14. Erdogan M, Erdogan A, Erbil N, Karakaya HK, Demircan A (2005) Prospective, randomized, placebo-controlled study of the effect of TENS on postthoracotomy pain and pulmonary function. World J Surg 29(12):1563–1570

    Article  Google Scholar 

  15. Baki ED, Oz G, Kokulu S, Ulasli AM, Ela Y, Sivaci RG et al (2015) Comparison of transcutaneous electrical nerve stimulation and paravertebral block for postthoracotomy pain relief. Thorac Cardiovasc Surg 63(6):514–518

    Article  Google Scholar 

  16. Fiorelli A, Morgillo F, Milione R, Pace MC, Passavanti MB, Laperuta P et al (2012) Control of post-thoracotomy pain by transcutaneous electrical nerve stimulation: effect on serum cytokine levels, visual analogue scale, pulmonary function and medication. Eur J Cardiothorac Surg. 41(4):861–868; discussion

    Article  Google Scholar 

  17. Liu YC, Liao WS, Lien IN (1985) Effect of transcutaneous electrical nerve stimulation for post-thoracotomic pain. Taiwan Yi Xue Hui Za Zhi J Formosan Med Assoc 84(7):801–809

    CAS  Google Scholar 

  18. Warfield CA, Stein JM, Frank HA (1985) The effect of transcutaneous electrical nerve stimulation on pain after thoracotomy. Ann Thorac Surg 39(5):462–465

    Article  CAS  Google Scholar 

  19. Erden S, Senol CS (2015) The effect of transcutaneous electrical nerve stimulation on post-thoracotomy pain. Contemp Nurse 51(2–3):163–170

    Article  Google Scholar 

  20. Solak O, Turna A, Pekcolaklar A, Metin M, Sayar A, Solak O et al (2007) Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiovasc Surg 55(3):182–185

    Article  CAS  Google Scholar 

  21. Chandra A, Banavaliker JN, Das PK, Hasti S (2010) Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain. Indian J Anaesth 54(2):116–120

    Article  Google Scholar 

  22. Ferreira FC, Issy AM, Sakata RK (2011) Assessing the effects of transcutaneous electrical nerve stimulation (TENS) in post-thoracotomy analgesia. Rev Bras Anestesiol 61(5):561–7, 308–10

  23. Varela G, Brunelli A, Rocco G, Marasco R, Jiménez MF, Sciarra V, Aranda JL, Gatani T (2006) Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. Eur J Cardiothorac Surg 30(4):644–648

    Article  Google Scholar 

  24. Attri JPKR, Kaur H, Makhni R (2016) Post thoracotomy pain management: a review of current available modalities. Northern J ISA 1:7–10

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Programa de Pós-Graduação Em Ciências Pneumológicas, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035002, Brazil

    Hermann H. Husch & Graciele Sbruzzi

  2. Centro Universitário Ritter dos Reis – UniRitter, Rua Orfanotrófio 555, Porto Alegre, RS, 90840-440, Brazil

    Hermann H. Husch

  3. Department of Clinical Research and Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK

    Guilherme Watte

  4. Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, R. SarmentoLeite, 245, Porto Alegre, RS, 90050-170, Brazil

    Guilherme Watte, Matheus Zanon & Gabriel Sartori Pacini

  5. Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020-160, Brazil

    Daniella Birriel

  6. Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil

    Pauline L. Carvalho & Adriana Kessler

  7. Universidade Federal Do Rio Grande Do Sul, Felizardo St 750, Porto Alegre, RS, 90690-200, Brazil

    Graciele Sbruzzi

Authors
  1. Hermann H. Husch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guilherme Watte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matheus Zanon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriel Sartori Pacini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniella Birriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pauline L. Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adriana Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Graciele Sbruzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Graciele Sbruzzi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Husch, H.H., Watte, G., Zanon, M. et al. Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pulmonary Function, and Respiratory Muscle Strength After Posterolateral Thoracotomy: A Randomized Controlled Trial. Lung 198, 345–353 (2020). https://doi.org/10.1007/s00408-020-00335-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-020-00335-4

Keywords

Search

Navigation