THE EFFECT OF LOCATION OF TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATIONON POSTOPERATIVE OPIOID ANALGESIC REQUIREMENT - ACUPOINT VERSUS NONACUPOINT STIMULATION
L. Chen et al., THE EFFECT OF LOCATION OF TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATIONON POSTOPERATIVE OPIOID ANALGESIC REQUIREMENT - ACUPOINT VERSUS NONACUPOINT STIMULATION, Anesthesia and analgesia, 87(5), 1998, pp. 1129-1134
Transcutaneous electrical nerve stimulation (TENS) has been used as a
complementary (supplemental) therapy to opioid analgesics for pain rel
ief after surgery. Simultaneous stimulation ata classical Chinese acup
oint site and periincisional dermatomes significantly decreases the po
stoperative analgesic requirement. This sham-controlled study was de s
igned to assess the relative effectiveness of acupoint versus nonacupo
int stimulation on the postoperative hydromorphone (HM) requirement, t
he incidence of opioid-related side effects, and the overall recovery
profile. One hundred women undergoing total abdominal hysterectomy or
myomectomy procedures with a standardized general anesthesia were rand
omly assigned to one of four postoperative analgesic treatment regimen
s (n = 25 each): Group I = sham-TENS (no electrical current) at the Zu
sanli (ST36) acupoints, Group II = nonacupoint-TENS at the shoulders,
Group III = dermatomal-TENS at the level of the surgical incision, and
Group IV = acupoint-TENS at the Zusanli acupoints. The frequency of T
ENS was set in the standard dense-and-disperse mode of 2/100 Hz. The i
ntensity of stimulation was set at 0 mA for patients in Group I and at
9-12 mA for patients in Groups IT, III, and IV. A patient-controlled
analgesia (PCA) device programmed to deliver bolus doses of HM 0.2-0.4
mg IV on demand with a minimal lockout interval of 10 min was used to
quantify the postoperative opioid analgesic requirement. Standard 100
-mm visual analog scales were used to assess pain, as well as sedation
, fatigue, and nausea, at specific intervals after surgery. The number
s of PCA demands and delivered bolus doses, requirements for supplemen
tal medication, and any opioid-related side effects were recorded. In
the first 24 h postoperatively, the opioid requirements in Groups III
and IV were decreased by 37% and 39%, respectively, compared with the
control (sham) group and 35% and 38%, respectively, compared with Grou
p II. The duration of PCA usage and the incidences of nausea and dizzi
ness were also significantly de creased in Groups III and IV compared
with Groups I and II. We conclude that periincisional dermatomal and Z
usanli acupoint stimulation were equally effective in decreasing the p
ostoperative opioid analgesic requirement and in reducing opioid-relat
ed side effects. Both of these positions were more effective than the
nonacupoint (shoulder) location. Implications: The location of the sti
mulating electrodes seems to be an important determinant of the effica
cy of transcutaneous electrical nerve stimulation in decreasing the ne
ed for opioid analgesics in the postoperative period. This study demon
strates that transcutaneous electrical nerve stimulation applied at th
e dermatomal level of the skin incision is as effective as Zusanli acu
point stimulation, and both were more effective than stimulation at a
nonacupoint (shoulder) location.