Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section

Abstract

Objective: The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation (TENS) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section.

Methods: A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group (Group 1) or the TENS group (Group 2), while 100 women who delivered by vaginal route without episiotomy were randomized into the placebo group (Group 3) or the TENS group (Group 4).

Results: The patients in Group 2 had statistically lower visual analog scale (VAS) and verbal numerical scale (VNS) scores than the patients in Group 1 (p?<?0.001 for both). The patients in Group 4 had statistically lower VAS and VNS scores than the patients in Group 3 (p?=?0.022 and p?=?0.005, respectively). The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS (p?=?0.006). The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo (p?=?0.830).

Conclusion: TENS is an effective, reliable, practical and easily available modality of treatment for postpartum pain.     

A comparative study of transcutaneous electrical nerve stimulation (TENS), entonox, pethidine + promazine and lumbar epidural for pain relief in labor

Analgesic effect, labor outcome, safety and consumer satisfaction were compared in 170 primigravid women; 50 using TENS initially for pain relief, 20 using entonox, 50 pethidine + promazine and 50 lumbar epidural. 88% choosing epidural related it fully effective. 90% using entonox, 96% using TENS and 54% given pethidine + promazine found partial relief. 82% of patients given TENS and 80% given pethidine + promazine required additional analgesia. This was also needed by one of the 20 patients choosing entonox. Women using entonox alone had the shortest labors and women using lumbar epidural, the longest. Operative delivery was significantly more common in women receiving lumbar epidural. No significant inter-group differences were noted in cord pH or Apgar scores. Parturients and midwives both gave high consumer satisfaction ratings to all methods--except for pethidine + promazine, whose use must therefore be questioned. The analgesic efficacy of lumbar epidural outweighs any possible side effects. Entonox appears suited to those able to cope with the earlier part of labor, drug-free. Realization of the potential of TENS requires the design of machines specifically to cope with the quality of the pain of labor.     

A pilot randomised controlled trial (RCT) investigating the effectiveness of reflexology for managing pregnancy low back and/or pelvic pain

Many pregnant women with low back and/or pelvic pain (LBPP) use pain medications to manage this pain, much of which is self-prescribed and potentially harmful. Therefore, there is a need to find effective nonpharmacological treatments for the condition. Reflexology has previously been shown to help nonspecific low back pain. Therefore; a pilot RCT was conducted investigating reflexology in the management of pregnancy-LBPP. 90 primiparous women were randomised to either usual care, a reflexology or footbath intervention. Primary outcome measures were; the Pain Visual Analogue Scale (VAS). 64 women completed the RCT; retention rates for the reflexology group were 80%, usual care group 83.33% and footbath group 50%. The reflexology group demonstrated a Clinically Important Change (CIC) in pain frequency (1.64 cm). Results indicate it is feasible to conduct an RCT in this area, although a footbath is an unsuitable sham treatment. Reflexology may help manage pregnancy-LBPP; however a fully powered trial is needed to confirm this.     

The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence

Objective

to assess the effects of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour.

Search methods

studies were identified from a search of the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2008).

Selection criteria

randomised controlled trials comparing women receiving TENS for pain relief in labour vs routine care or placebo devices. All types of TENS machines were included.

Data collection and analysis

two review authors assessed all trials identified by the search strategy, carried out data extraction and assessed risk of bias.

Results

14 studies including 1256 women were included: 11 examined TENS applied to the back, two to acupuncture points and one to the cranium. Overall, there was little difference in satisfaction with pain relief or in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32–0.55). The majority of women using TENS would use it again in a future labour. There was no evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and infants. No adverse events were reported.

Conclusions

there is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact on other outcomes for mothers or infants. The use of TENS at home in early labour has not been evaluated. Although the guidelines of the National Institute for Health and Clinical Excellence recommend that TENS should not be offered to women in labour, women appear to be choosing it and midwives are supporting them in their choice. Given the absence of adverse effects and the limited evidence base, it seems unreasonable to deny women that choice. More robust studies of effectiveness are needed.     

Evaluating the efficacy of lavender aromatherapy on peripheral venous cannulation pain and anxiety: A prospective,randomized study

ObjectiveThis study was designed to evaluate the effectiveness of lavender aromatherapy on pain, anxiety, and level of satisfaction associated with the peripheral venous cannulation (PVC) in patients undergoing surgery.MethodOne hundred and six patients undergoing surgery were randomized to receive aromatherapy with lavender essential oil (the lavender group) or a placebo (the control group) during PVC. The patients' pain, anxiety, and satisfaction scores were measured.ResultsThere was no statistically significantly difference between the groups in terms of demographic data. After cannulation, the pain and anxiety scores (anxiety 2) of the patients in the lavender group were significantly lower than the control group (for p = 0.01 for pain scores; p < 0.001 for anxiety 2 scores). In addition, patient satisfaction was significantly higher in the lavender group than in the control group (p = 0.003).ConclusionLavender aromatherapy had beneficial effects on PVC pain, anxiety, and satisfaction level of patients undergoing surgery.     

Reported treatment strategies for reflexology in cardiac patients and inconsistencies in the location of the heart reflex point: an online survey

BackgroundReflexology texts are inconsistent with regard to the location of the heart point and contradictory with regard to the correct reflexology approach to cardiac patients. We aimed to determine the impact of these inconsistencies on the practice of Association of Reflexologists (AoR) members.MethodOnline survey of AoR members.ResultRespondents' beliefs and practises mirror the inconsistencies in reflexology teaching literature and marked inconsistencies exist in the heart reflex point placement.ConclusionsProfessional clarification around the heart reflex point location and further clinical research is urgently needed to establish the appropriateness of reflexology techniques for cardiac patients.     

椎管内阻滞麻醉与笑气吸入用于分娩镇痛的效果比较

目的　比较椎管内阻滞麻醉和笑气吸入两种方法的分娩镇痛效果和对产妇及新生儿的影响。方法　随机选取 30 0例产妇分为笑气组、椎管内阻滞组和对照组 ,每组各 10 0例。在分娩过程中 ,笑气组给予吸入含 5 0 %笑气与 5 0 %氧气的混合气体 ;椎管内阻滞组给予蛛网膜下腔 +硬膜外腔联合注入芬太尼和布比卡因 ;对照组未给予镇痛药物。并分别观察 3组产妇的镇痛效果、产程时间、分娩方式、产后出血量、产妇桡动脉血及新生儿脐血的血气分析以及新生儿窒息情况。结果　 (1)镇痛效果比较 :椎管内阻滞组镇痛分级 0级为 88例 ,笑气组为 12例 ,对照组为 0例。 3组之间比较 ,差异有极显著性 (P <0 0 1)。 (2 )产程时间比较 :第一产程和总产程时间 ,椎管内阻滞组短于对照组和笑气组 (P <0 0 5 ) ,笑气组与对照组比较 ,差异无显著性 (P >0 0 5 ) ;第二产程时间椎管内阻滞组长于对照组和笑气组 ,但差异无显著性 (P >0 0 5 )。 (3)剖宫产术后出血量比较 :笑气组为 (373± 77)ml,椎管内阻滞组为 (2 5 9± 78)ml,对照组为 (2 39± 89)ml,笑气组与其他两组比较 ,差异有极显著性 (P<0 0 1)。(4)血气分析结果比较 :3组产妇桡动脉血及新生儿脐血血气分析结果各组之间比较 ,差异均无显著性 (P >0 0 5 )。 (5 )分娩方式比较     

Medical abortion with mifepristone and misoprostol: study of the efficacy,somatic tolerance and perception of medical abortion

STUDY DESIGN: This prospective study examined the efficacy and somatic tolerance as well as the perception of the different phases of medical abortion with mifepristone and misoprostol. The subjective influence of counseling and accompanying on perception and psychic sequelae was evaluated. METHOD: The somatic data of the patients who had a medical abortion at Basel University Hospital of Gynecology and Obstetrics from December 1, 1999, to October 31, 2000, were identified in the case records. A questionnaire at the time of the abortion and a structured interview by telephone 6 months later were used to assess the perception of the abortion. RESULTS: Abortion with mifepristone and misoprostol was successful in 95.2% of cases. Counseling and accompanying were considered supportive by 90.4 and 73.7%, respectively. The psychological workup was without problems in 95.5%. CONCLUSION: Medical abortion with mifepristone and misoprostol was successful in 95.2%. Our concept of counseling and accompanying was well received and resulted in an uneventful psychological workup in most cases.     

Transcutaneous electrical nerve stimulation (TENS) for the treatment of primary dysmenorrhea: a randomized crossover comparison with placebo TENS and ibuprofen

In a randomized four-way crossover study, 32 women with primary dysmenorrhea were treated with transcutaneous electrical nerve stimulation (TENS) for two cycles, placebo (sham) TENS for one cycle, or ibuprofen 400 mg four times a day for one cycle. The TENS setting used was 100 pulses per second with 100-microsecond pulse widths. The subjects were allowed to adjust the amplitude to a comfortable level. The pain rescue medication was ibuprofen 400 mg as needed, up to 1600 mg/day. Significantly more subjects who had TENS treatment did not require rescue medication or required less backup ibuprofen at 0-4, 4-8, and 8-12 hours after the onset of dysmenorrhea and starting treatment, as well as during the first 24 hours and for the duration of the menstrual flow, when compared with placebo TENS or ibuprofen-treated cycles (Tukey multiple comparison, P less than .01). Transcutaneous electrical nerve stimulation significantly delayed the need for ibuprofen by an average of 5.9 hours, compared with 0.7 hours when using ibuprofen alone (P less than .05, paired t test). Transcutaneous electrical nerve stimulation alone provided good to excellent subjective pain relief in 42.4% of subjects, compared with 3.2% with placebo TENS, and significantly reduced diarrhea, menstrual flow, clot formation, and fatigue compared with placebo TENS. Transcutaneous electrical nerve stimulation plus less ibuprofen provided pain relief equivalent to that obtained with ibuprofen alone (71 and 75% of the subjects, respectively). We conclude that TENS is a safe, effective, non-medication method for managing primary dysmenorrhea and that TENS plus ibuprofen was the best overall treatment, as indicated by pain relief.     

Prospective randomized study comparing the efficacy and tolerance of clindamycin-gentamycin versus metronidazole-gentamycin in acute utero-adnexal infections in hospitalized patients

The efficacy and safety of two antibiotic combination (clindamycin + gentamycin [C + G] versus metronidazole + gentamycin [M + G]) have been compared in 45 in-patients suffering from pelvic inflammatory disease in a clinical prospective randomized trial. The rates of clinical and bacteriological recovery reached respectively 85.7% and 71.4% for C + G group compared to 83.3% and 78.6% for M + G group (no significant differences). Side effects (vomiting, gastralgia and vaginal mycosis) developed in four occasions in each group. The most frequently isolated organisms were chlamydiae, E. coli and Neisseria gonorrheae (around 50% of overall isolated organisms). Due to the lack of significant differences between the two antibiotic combinations, the final choice will depend on potential risks generated by these products.     

Intravenous prostaglandin F2 for therapeutic abortion: the efficacy and tolerance of three dosage schedules

To determine the most optimal procedure for use of prostaglandins (PGs) clinically for abortion, the abortifacient efficacy and complications of 3 types of intravenous PGF2 alpha schedules were compared over 18 hours. 17 healthy women from 7-20 weeks gestation were infused with PGF2 alpha for therapeutic abortion. The subjects were divided into 3 groups: 1 receiving a constant infusion beginning at 25 mcgm/minute increasing to 200 mcgm up to the maximum FDA dose; the second receiving progressive doses at specified times until the patient developed 350 Montevideo units (MU) of uterine activity; and the third receiving 25 mcgm/minute for 1/2 hour followed by maintenance at 50 mcgm/minute until abortion. All patients aborted with the low-dosage schedule and there were fewer complications. No difference in uterine contractility was seen among subjects receiving the 3 dosage schedules or between those patients aborting and those who failed to abort.     

Multicenter study of the efficacy,cycle control and tolerability of a phasic desogestrel-containing oral contraceptive

Objective To investigate the efficacy, cycle control and tolerability of a phasic oral contraceptive containing ethinylestradiol 35/30/30 μg and desogestrel 50/100/150 μg.

Methods A multicenter study was conducted involving 2070 healthy, fertile women, who received study treatment for six treatment cycles.

Results Most of the participants (79%) had previously been using an alternative oral contraceptive. In 10 408 treatment cycles, two women became pregnant while on treatment (Pearl index, 0.25). The incidence of irregular bleeding was 10% before treatment, rising to 27% at cycle 1, and decreasing to 11% by cycle 6. Irregular bleeding was mainly due to spotting rather than breakthrough bleeding and the incidence of breakthrough bleeding remained below 2.2% for most of the study period. Only 1.8% of women withdrew due to bleeding irregularities. First-time oral contraceptive users initially experienced more irregular bleeding than switchers but these differences lessened over time. The most common adverse events during treatment were headache, breast tenderness and nausea. The incidence of these adverse events fell to below pretreatment levels with continued use.

Conclusion The phasic preparation was effective and well tolerated.     

A concept analysis: the effect of reflexology on homeostasis to establish and maintain lactation

The focus of this paper is to consider whether reflexology can have an effect on homeostasis to establish and maintain lactation. This complementary therapy encompasses the theory of holism to nurture the whole body, mind and spirit (Crane 1997). Parents experience many stressful emotions when their baby is admitted to a neonatal intensive care unit (NICU), which in turn can affect the body, mind and spirit, often contributing to the reduction of lactation for the mother. This paper will utilize a concept analysis approach (Chinn & Jacobs 1987) to provide a focus and sense of direction to the discussion and exploration of the topic.     

Pregnancy-induced morphologic changes in lymphocytes; an experimental study on materno-fetal tolerance in the rat.

Morphological changes in lymphocyte nucleoli were examined in the course of pregnancy in rats. Small amounts of lymphocytes became activated, most of them producing micronucleoli. These findings show the same changes as found in the course of pregnancy in women. Subcutaneous administration of human placental eluate to non-pregnant rats induced a low degree of activation and high micronucleoli formation, dependent on the dose of placental antigen. Repeated administration of increasing doses of placental eluate revealed almost the same morphological changes in lymphocyte nucleoli as seen in normal pregnancy. This is considered an experimental verification that the morphological changes in lymphocyte nucleoli during pregnancy are due to permanent and gradually increasing doses of foreign antigen.