Postoperative and preincisional electrical nerve stimulation TENS reduce postoperative opioid requirement after major spinal surgery.
OBJECTIVE
Preincisional and postoperative transcutaneous electrical nerve stimulation (TENS) administration reduces postoperative opioid demand in abdominal surgery. Aim of this study was to find out whether a comparable effect of TENS applies in major spinal surgery.


METHODS
Thirty-eight patients of both sex scheduled for lumbar interbody fusion were enrolled and divided randomly into 3 groups. Group A received TENS preincisional and postoperative, group B received this treatment postoperative only, and group C was the sham controlled. The postoperative demand on piritramid to achieve a visual anlog scale pain score <3 was delivered either by nurse or by a patient-controlled analgesia pump, when the patients were alert. The setting of the patient-controlled analgesia pump, bolus of piritramid 2 mg intravenously (IV), lockout time of 20 minutes, and maximum dose of piritramid 15 mg within 4 hours, the coanalgesic therapy diclofenac 75 mg IV, and the rescue medication metamizol 1 g IV was identical for all patients. The total amount of piritramid administered over the first 24 hours after surgery and an optional rescue medication were recorded.


RESULTS
All groups were compared by pairs. The postoperative demand on piritramid differed significantly A versus B (P<0.05), A versus C (P<0.05), and B versus C (P<0.05). Neither sex, body mass index, current, duration, and type of operation nor the occurrence of hypotensive phases showed any significant association with postoperative piritramid demand. The necessity of rescue medication was significantly higher in group C than in group A.


CONCLUSIONS
Postoperative TENS as well as the combination of preincisional and postoperative TENS therapy reduce the postoperative demand of piritramid in major spinal surgery in a safe and simple way free of systemic side effects.
Paracelsus Medizinische Privatuniversität, Salzburg, Austria. a.f.unterrainer@salk.at
Axel Friedrich
AF
Unterrainer
Catrin
C
Friedrich
Michael H
MH
Krenn
Wolfgang P
WP
Piotrowski
Stefan M
SM
Golaszewski
Wolfgang
W
Hitzl
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage; D004177:Dipyrone / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000628:therapy*; D010892:Pirinitramide / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D013131:Spine / Q000601:surgery*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D010892:Pirinitramide; D004177:Dipyrone