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Objectives: Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery.

Methods: We searched Medline, Embase, Web of Science, Cochrane, Amed and Cinahl for RCTs and quasi-experimental studies (2010-2022), and WHO and ClinicalTrials.gov for ongoing/unpublished studies. Meta-analysis and subsequent Trial Sequential Analysis (TSA) was performed for all stated outcomes. Quality of evidence was assessed according to GRADE.

Results: Only three RCTs met the inclusion criteria (362 participants). The surgical procedures involved surgical abortion, gynecologic laparoscopy and hysteroscopy. The applied TENS frequency was 80 Hz and intensity 40-60 mA. There was no difference in pain intensity according to Visual Analogue Scale (VAS) at discharge from PACU between the TENS and opioid group (MD VAS -0.15, 95 % CI -0.38 to 0.09) (moderate level of evidence). Time in PACU was significantly shorter in the TENS group (MD -15.2, 95 % -22.75 to -7.67), and this finding was manifested by TSA (high-level of evidence). Opioid consumption in PACU was lower in the TENS group (MD Morphine equivalents per patient mg -3.42, 95 % -4.67 to -2.17) (high-level of evidence).

Conclusions: There was no detectable difference in postoperative pain relief between HFHI TENS and iv opioids after gynecological surgery. Moreover, HFHI TENS decreases recovery time and opioid consumption in PACU. HFHI TENS may be considered an opioid-sparing alternative for postoperative pain relief after gynecological surgery.

Systematic Review Registration: PROSPERO CRD42021231048.

Titel:	High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis.
Autor/in / Beteiligte Person:	Piasecki, A ; Ögren, C ; Thörn, SE ; Olausson, A ; Svensson, CJ ; Platon, B ; Wolf, A ; Andréll, P
Zeitschrift:	Scandinavian journal of pain, Jg. 24 (2023-10-12), Heft 1
Veröffentlichung:	2018- : [Berlin] : De Gruyter ; <i>Original Publication</i>: [Maryland Heights, MO] : Elsevier Science, c2010-, 2023
Medientyp:	academicJournal
ISSN:	1877-8879 (electronic)
DOI:	10.1515/sjpain-2023-0068
Schlagwort:	Pregnancy Female Humans Gynecologic Surgical Procedures Morphine therapeutic use Pain, Postoperative drug therapy Analgesics, Opioid therapeutic use Transcutaneous Electric Nerve Stimulation methods
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Meta-Analysis; Systematic Review; Journal Article Language: English [Scand J Pain] 2023 Oct 12; Vol. 24 (1). <i>Date of Electronic Publication: </i>2023 Oct 12 (<i>Print Publication: </i>2024). MeSH Terms: Analgesics, Opioid* / therapeutic use ; Transcutaneous Electric Nerve Stimulation* / methods ; Pregnancy ; Female ; Humans ; Gynecologic Surgical Procedures ; Morphine / therapeutic use ; Pain, Postoperative / drug therapy References: Benyamin, R, Trescot, AM, Datta, S, Buenaventura, R, Adlaka, R, Sehgal, N, et al.. Opioid complications and side effects. Pain Physician 2008;11:S105–20, https://doi.org/10.36076/ppj.2008/11/s105 . (PMID: 10.36076/ppj.2008/11/s105) ; Colvin, LA, Bull, F, Hales, TG. Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia. Lancet 2019;393:1558–68, https://doi.org/10.1016/s0140-6736(19)30430-1 . 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Anesth Analg 2014;118:85–113, https://doi.org/10.1213/ane.0000000000000002 . (PMID: 10.1213/ane.0000000000000002) Contributed Indexing: Keywords: acute pain; gynecologic surgery; intravenous opioids; postoperative pain; transcutaneous electrical nerve stimulation Substance Nomenclature: 0 (Analgesics, Opioid) ; 76I7G6D29C (Morphine) Entry Date(s): Date Created: 20231011 Date Completed: 20231222 Latest Revision: 20231222 Update Code: 20231222

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High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis.