Transcutaneous Electric Nerve Stimulation (TENS) for pain relief during Extracorporeal Shock-Wave Lithotripsy (ESWL)

Abstract

Background: Anesthesia for ESWL must provide good analgesia, rapid recovery with least side effects. Opioids are commonly used analgesics during ESWL, but are not devoid of side effects. TENS is a non-pharmacological, non-invasive analgesic technique, which has been recommended for pain control in many clinical settings. Methods: Sixty patients scheduled for ESWL were randomly assigned to group-A (30 patients): received IV fentanyl 1µg/Kg with the application of conventional TENS. Group-B (30 patients) received IV fentanyl 1µg/Kg. IV increments of 20 µg of fentanyl were given if VAS was≥3 in both groups. Fentanyl consumption, discharge time, adverse effects, and satisfaction score for patients were compared. Results: VAS was lower among group-A than group-B throughout the procedure but that was statistically non-significant. There was significantly lower fentanyl consumption in group-A compared to group-B (P-value < 0.001). Discharge time was significantly shorter among group-A (36.2 ± 0.6 min) than group-B (47.2 ± 0.8 min). Adverse effects were significantly less frequent in group-A compared to group-B. Incidences of O 2 desaturation, nausea and vomiting were higher in group-B compared to group-A. Patients' satisfaction was significantly higher among group-A than among group-B. Conclusion: TENS is an effective and safe practice in controlling pain during ESWL, it decreases fentanyl consumption and its side effects, with greater patients' satisfaction. It decreases discharged time compared to fentanyl so it is ideal for outpatient procedures. ARTICLE HISTORY

Effect of acupressure on pain intensity and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: a randomized double-blind sham-controlled clinical trial

“…Nociceptive effects are associated with increased blood pressure, respiratory rate, and heart rate [ 34 ]. Pain during ESWL increases the risk of kidney hematoma with increased blood pressure [ 7 ]. Our study revealed significant effects of acupressure on patients' systolic blood pressure during the peak of shockwave energy, which is not consistent with the study of Düzel et al [ 34 ].…”

“…However, this method inherently causes significant pain; thus, pain relief is recommended for patients during the procedure [ 6 ]. Severe pain might limit the opportunity for applying sufficient energy doses, leading to additional movement and increased respiration rates [ 7 ]. Additionally, acute pain may increase the risk of kidney hematoma following stone fragmentation due to increased blood pressure [ 1 ].…”

Manajemen Nyeri Pasca Operasi : Tinjauan Pustaka

“…Penggunaan alternatif (untuk pasien yang refrakter terhadap penggunaan konvensional yaitu menggunakan TENS frekuensi rendah: stimulus dengan lebar pulsa >200 mikrodetik dan frekuensi <10 Hz (selama 5-15 menit). Perhatian dilakukan bahwa efek stimulasi frekuensi rendah setidaknya sebagian dibalik oleh nalokson yang menunjukkan peran opioid endogen (Shoukry & Al-Ansary, 2019).…”