The results of a new clinical trial, published in the journal Aesthetic Plastic Surgery, have added to growing evidence that using Transcutaneous Peripheral Nerve Stimulation TPNS (also know as Transcutaneous Electrical Nerve Stimulation TENS) postoperatively significantly reduces pain intensity and the need for analgesic pain relief.
Dr Milla Pompilio da Silva and colleagues at the Federal University of São Paulo (UNIFESP), São Paulo, Brazil included 42 subjects undergoing liposuction surgery in the trial. Participants were randomly assigned to receive either standard pain relief plus active TPNS or standard pain relief plus sham TPNS (i.e. an inactive form of TPNS).
“This randomised double-blind, controlled trial showed that TPNS can be safely used as adjunct analgesic therapy after liposuction.”
“TPNS effectively led to a substantial reduction in postoperative pain and analgesic consumption when administered in combination with morphine and dipyrone in a multimodal analgesic regimen,” the researchers reported.
The findings showed that 95% of patients receiving active TPNS experienced a significant reduction in pain. Pain was measured on a visual analogue scale (VAS) and patients receiving active TPNS reported no pain at 6-, 12- and 24-hour post-operative time points. In comparison, for those receiving sham TPNS pain was not significantly reduced.
“Also, 95% of patients in the TPNS group and 38% of controls reported being satisfied with the TPNS treatment for pain relief, with a significant difference between groups,” reported Dr da Silva.
The researchers explained that high-frequency TPNS works to reduce pain via a different route than low-dose morphine. However, TPNS in combination with low-dose morphine can activate delta-opioid receptors that are usually only activated by high-dose morphine.
The reduction in pain also had a significant impact on patients requests for analgesia, with 95% of patients in the sham TPNS group requesting pain relief 6-hours after surgery compared to 0% in the active TPNS group.
No adverse effects were reported in the active TPNS group however 33.3 % of patients in the sham TPNS group reported drowsiness and nausea.
SO the question is - why in the era of some of the greatest advancements in medical technology & known opioid issues are we not using, implementing or at least trialling effective pain relief alternatives or adjuncts?
Next article we will discuss opioid use post-operatively including my own recent personal experience
BMJ article - Post-surgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study
Da Silva MP et al. (2015) Aesth Plast Surg Published online 10 February 2015 DOI 10.1007/s00266-015-0451-6