Abstract
Background: The transcutaneous electrical nerve stimulation TENS was used following several surgical procedures involving gynecological ones and has shown a successful pain reduction rate. TENS was proposed to enhance recovery after cesarean section CS.
Objective: This systematic review and meta-analysis were conducted to evaluate the clinical effectiveness of Transcutaneous electrical nerve stimulation (TENS) in enhancing recovery after a cesarean section.
Methods: We performed the Meta-analyses using RevMan software. Data were pooled as mean difference (MD) if continuous and risk ratio (RR) if dichotomous, and the 95% confidence interval (CI) as calculated.
Results: This systematic review included 12 RCTs, with a total of 1,116 women studied. The TENS effectively reduced the intensity of pain just by following its application (SMD=-0.61; 95% CI [-0.82, -0.39], P<0.00001), one day after (SMD=-0.25; 95% CI [-0.47, -0.04], P=0.02), and two days after (SMD=-0.27; 95% CI [-0.50, -0.03], P=0.03).
Conclusion: The TENS effectively reduces the pain intensity following its application and after one or two days. TENS has no effect on the cumulative dose of diclofenac. Because of the inadequacy of safety data, we recommend conducting further RCTs.
[1]
Gibbons, L. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a barrier to universal coverage HEALTH SYSTEMS FINANCING. World Health Rep., 2010, 2010, 30.
[2]
Woods, A.; Barbara, C.; Shirley, K.; Joyce, C.; Joan, W.; Joan, R. A cross-sectional analysis of the effect of patient-controlled epidural analgesia versus patient controlled analgesia on postcesarean pain and breastfeeding. J. Obstet. Gynecol. Neonatal Nurs., 2012, 41, 339-346.
[http://dx.doi.org/10.1111/j.1552-6909.2012.01370.x]
[http://dx.doi.org/10.1111/j.1552-6909.2012.01370.x]
[3]
Karlströِm, A.; Engströِm-Olofsson, R.; Norbergh, K. G.; Sjöِling, M.; Hildingsson, I. Postoperative pain after cesarean birth affects breastfeeding and infant care. Journal of obstetric, gynecologic, and neonatal nursing: JOGNN, 2007, 36, 430-440.
[http://dx.doi.org/10.1111/j.1552-6909.2007.00160.x]
[http://dx.doi.org/10.1111/j.1552-6909.2007.00160.x]
[4]
Wrench, I.J.; Sanghera, S.; Pinder, A.; Power, L.; Adams, M.G. Dose response to intrathecal diamorphine for elective caesarean section and compliance with a national audit standard. Int. J. Obstet. Anesth., 2007, 16(1), 17-21.
[http://dx.doi.org/10.1016/j.ijoa.2006.04.015] [PMID: 17125997]
[http://dx.doi.org/10.1016/j.ijoa.2006.04.015] [PMID: 17125997]
[5]
Jones, L.; Othman, M.; Dowswell, T.; Alfirevic, Z.; Gates, S.; Newburn, M.; Jordan, S.; Lavender, T.; Neilson, J.P. Pain management for women in labour: An overview of systematic reviews. Cochrane Database Syst. Rev., 2012, 2012(3)CD009234
[PMID: 22419342]
[PMID: 22419342]
[6]
Rowe-Murray, H.J.; Fisher, J.R.W. Baby friendly hospital practices: Cesarean section is a persistent barrier to early initiation of breastfeeding. Birth, 2002, 29(2), 124-131.
[http://dx.doi.org/10.1046/j.1523-536X.2002.00172.x] [PMID: 12000413]
[http://dx.doi.org/10.1046/j.1523-536X.2002.00172.x] [PMID: 12000413]
[7]
El-Tahan, M.R.; Warda, O.M.; Yasseen, A.M.; Attallah, M.M.; Matter, M.K. A randomized study of the effects of preoperative ketorolac on general anaesthesia for caesarean section. Int. J. Obstet. Anesth., 2007, 16(3), 214-220.
[http://dx.doi.org/10.1016/j.ijoa.2007.01.012] [PMID: 17459695]
[http://dx.doi.org/10.1016/j.ijoa.2007.01.012] [PMID: 17459695]
[8]
Hepner, D.; Eappen, S. Postoperative analgesia: Systemic and local techniques. In: Chestnut’s obstetric anesthesia principles and practice; Chestnut, D.H., Ed.; Mosby: Philadelphia, 2009; pp. 575-592.
[http://dx.doi.org/10.1016/B978-0-323-05541-3.00027-2]
[http://dx.doi.org/10.1016/B978-0-323-05541-3.00027-2]
[9]
Bateman, B.T.; Franklin, J.M.; Bykov, K.; Avorn, J.; Shrank, W.H.; Brennan, T.A.; Landon, J.E.; Rathmell, J.P.; Huybrechts, K.F.; Fischer, M.A.; Choudhry, N.K. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women. Am. J. Obstet. Gynecol., 2016, 215(3), 353.e1-353.e18.
[http://dx.doi.org/10.1016/j.ajog.2016.03.016] [PMID: 26996986]
[http://dx.doi.org/10.1016/j.ajog.2016.03.016] [PMID: 26996986]
[10]
Elyasi, H.; Heidari, M.; Shahbeigi, S. Comparative effects of indomethacin suppository and pethidine on pain after cesarean section. Pajoohandeh J, 2000, 5, 9-15.
[11]
Committee Opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstet. Gynecol., 2017, 130(2), e81-e94.
[http://dx.doi.org/10.1097/AOG.0000000000002235] [PMID: 28742676]
[http://dx.doi.org/10.1097/AOG.0000000000002235] [PMID: 28742676]
[12]
American College of Obstetricians and Gynecologists’ Committee on Clinical Consensus–Obstetrics. Pharmacologic stepwise multimodal approach for postpartum pain management. Obstet. Gynecol., 2021, 138(3), 507-517.
[http://dx.doi.org/10.1097/AOG.0000000000004517] [PMID: 34412076]
[http://dx.doi.org/10.1097/AOG.0000000000004517] [PMID: 34412076]
[13]
Sean, M.; Coulombe-Lévêque, A.; Vincenot, M.; Martel, M.; Gendron, L.; Marchand, S.; Léonard, G. Transcutaneous electrical nerve stimulation (TENS): towards the development of a clinic-friendly method for the evaluation of excitatory and inhibitory pain mechanisms. Can. J. Pain., 2021, 5(1), 56-65.
[http://dx.doi.org/10.1080/24740527.2020.1862624] [PMID: 34189390]
[http://dx.doi.org/10.1080/24740527.2020.1862624] [PMID: 34189390]
[14]
Sluka, K.A.; Walsh, D. Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. J. Pain, 2003, 4(3), 109-121.
[http://dx.doi.org/10.1054/jpai.2003.434] [PMID: 14622708]
[http://dx.doi.org/10.1054/jpai.2003.434] [PMID: 14622708]
[15]
Johnson, M.I. Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain management in perioperative settings: A critical review. Expert Rev. Neurother., 2017, 17(10), 1013-1027.
[http://dx.doi.org/10.1080/14737175.2017.1364158] [PMID: 28817978]
[http://dx.doi.org/10.1080/14737175.2017.1364158] [PMID: 28817978]
[16]
Sivaramakrishnan, A.; Solomon, J.M.; Manikandan, N. Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial. J. Spinal Cord Med., 2018, 41(4), 397-406.
[http://dx.doi.org/10.1080/10790268.2017.1390930] [PMID: 29067867]
[http://dx.doi.org/10.1080/10790268.2017.1390930] [PMID: 29067867]
[17]
Garshasbi, A.; Behboudi, S. The efect of gum chewing on postoperative ileus afer cesarean section. Proceedings of the Society for Obstetric Anesthesia and Perinatology 42nd Annual Meeting, San Antonio, Tex, USA, 2010.
[18]
Lussos, S.A.; Bader, A.M.; Thornhill, M.L.; Datta, S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia. Reg. Anesth., 1992, 17(3), 126-130.
[PMID: 1606094]
[PMID: 1606094]
[19]
Higgins, J.; Thomas, J.; Chandler, J.; Cumpston, M.; Li, T.; Page, M.J. Welch, VA Cochrane Handbook for Systematic Reviews of Interventions version 6.3; Cochrane, 2022.
[20]
Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; Chou, R.; Glanville, J.; Grimshaw, J.M.; Hróَbjartsson, A.; Lalu, M.M.; Li, T.; Loder, E.W.; Mayo-Wilson, E.; McDonald, S.; McGuinness, L.A.; Stewart, L.A.; Thomas, J.; Tricco, A.C.; Welch, V.A.; Whiting, P.; Moher, D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 372, n71.
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[21]
Higgins, J.P.T.; Thompson, S.G.; Deeks, J.J.; Altman, D.G. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414), 557-560.
[http://dx.doi.org/10.1136/bmj.327.7414.557] [PMID: 12958120]
[http://dx.doi.org/10.1136/bmj.327.7414.557] [PMID: 12958120]
[22]
Kurata, N.B.; Ghatnekar, R.J.; Mercer, E.; Chin, J.M.; Kaneshiro, B.; Yamasato, K.S. Transcutaneous electrical nerve stimulation for post–cesarean birth pain control. Obstet. Gynecol., 2022, 140(2), 174-180.
[http://dx.doi.org/10.1097/AOG.0000000000004798] [PMID: 35852266]
[http://dx.doi.org/10.1097/AOG.0000000000004798] [PMID: 35852266]
[23]
Chen, W.; Liu, C.; Yang, Y.; Tian, L. The effect of transcutaneous electrical nerve stimulation (TENS) on pain control and phenylethanolamine-N-methyltransferase (PNMT) gene expression after cesarean section. Cell. Mol. Biol., 2021, 67(3), 153-157.
[http://dx.doi.org/10.14715/cmb/2021.67.3.23] [PMID: 34933717]
[http://dx.doi.org/10.14715/cmb/2021.67.3.23] [PMID: 34933717]
[24]
Kasapoğlu, I.; Kasapoğlu Aksoy, M.; Çetinkaya Demir, B.; Altan, L. The efficacy of transcutaneous electrical nerve stimulation therapy in pain control after cesarean section delivery associated with uterine contractions and abdominal incision. Turk. J. Phys. Med. Rehabil., 2020, 66(2), 169-175.
[http://dx.doi.org/10.5606/tftrd.2020.3225] [PMID: 32760894]
[http://dx.doi.org/10.5606/tftrd.2020.3225] [PMID: 32760894]
[25]
Li, M.; Xu, F.; Liu, M.; Li, Y.; Zheng, J.; Zhu, Y.; Lin, L.; Chen, J. Effects and mechanisms of transcutaneous electrical acustimulation on postoperative recovery after elective cesarean section. Neuromodulation, 2020, 23(6), 838-846.
[http://dx.doi.org/10.1111/ner.13178] [PMID: 32472663]
[http://dx.doi.org/10.1111/ner.13178] [PMID: 32472663]
[26]
Fatima, N.; Sarfraz, N. Comparison of high versus low transcutaneous electrical nerve stimulation for pain management after caesarean section: A clinical trial. Annals of King Edward Medical University, 2019, 25(2)
[27]
Zhou, D.; Hu, B.; He, S.; Li, X.; Gong, H.; Li, F.; Wang, Q. Transcutaneous electrical acupoint stimulation accelerates the recovery of gastrointestinal function after cesarean section: A randomized controlled trial. Evid. Based Complement. Alternat. Med., 2018, 2018, 1-9.
[http://dx.doi.org/10.1155/2018/7341920] [PMID: 30538764]
[http://dx.doi.org/10.1155/2018/7341920] [PMID: 30538764]
[28]
Alves, E.M.S.; Rabêlo, T.N.; Santos, M.G.R.; Souza, I.G.; Lima, P.A.L.; Santana, L.S. Transcutaneous electric nerve stimulation for post-Cesarean section analgesia. Rev. Dor, 2015, 16(4), 16.
[http://dx.doi.org/10.5935/1806-0013.20150053]
[http://dx.doi.org/10.5935/1806-0013.20150053]
[29]
Kose, S.; Dagistan, T.A.; Hasan, T.; Gulengul, K.; Kanat-Pektas, M.; Mesut, K.; Mehmet, Y. Transcutaneous electrical nerve stimulation (Tens) for pain control after vaginal delivery and cesarean section. J. Matern. Fetal Neonatal Med., 2013, 27(15), 1572-1575.
[30]
Binder, P.; Gustafsson, A.; Uvnäs-Moberg, K.; Nissen, E. Hi-TENS combined with PCA-morphine as post caesarean pain relief. Midwifery, 2011, 27(4), 547-552.
[http://dx.doi.org/10.1016/j.midw.2010.05.002] [PMID: 20615594]
[http://dx.doi.org/10.1016/j.midw.2010.05.002] [PMID: 20615594]
[31]
Jaafarpour, M. The analgesic effect of transcutaneous electrical nerve stimulation (TENS) on caesarean under spinal anaesthesia. J. Clin. Diagn. Res., 2008, 6(3), 815-819.
[32]
Habib, A.S.; Itchon-Ramos, N.; Phillips-Bute, B.G.; Gan, T.J. Transcutaneous acupoint electrical stimulation with the ReliefBand for the prevention of nausea and vomiting during and after cesarean delivery under spinal anesthesia. Anesth. Analg., 2006, 102(2), 581-584.
[http://dx.doi.org/10.1213/01.ane.0000189217.19600.5c] [PMID: 16428565]
[http://dx.doi.org/10.1213/01.ane.0000189217.19600.5c] [PMID: 16428565]
[33]
Smith, C.M.; Guralnick, M.S.; Gelfand, M.M.; Jeans, M.E. The effects of transcutaneous electrical nerve Stimulation on post-cesarean pain. Pain, 1986, 27(2), 181-193.
[http://dx.doi.org/10.1016/0304-3959(86)90209-5] [PMID: 3540813]
[http://dx.doi.org/10.1016/0304-3959(86)90209-5] [PMID: 3540813]
[34]
Zimpel, S.A.; Torloni, M.R.; Porfírio, G.J.; Flumignan, R.L.; da Silva, E.M. Complementary and alternative therapies for post-caesarean pain. Cochrane Database Syst. Rev., 2020, 9(9)CD011216
[PMID: 32871021]
[PMID: 32871021]
[35]
Bjordal, J.M.; Johnson, M.I.; Ljunggreen, A.E. Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain. Eur. J. Pain, 2003, 7(2), 181-188.
[http://dx.doi.org/10.1016/S1090-3801(02)00098-8] [PMID: 12600800]
[http://dx.doi.org/10.1016/S1090-3801(02)00098-8] [PMID: 12600800]
[36]
de Sousa, L.; Gomes-Sponholz, F.A.; Nakano, A.M.S. Transcutaneous electrical nerve stimulation for the relief of post-partum uterine contraction pain during breast-feeding: A randomized clinical trial. J. Obstet. Gynaecol. Res., 2014, 40(5), 1317-1323.
[http://dx.doi.org/10.1111/jog.12345] [PMID: 24750301]
[http://dx.doi.org/10.1111/jog.12345] [PMID: 24750301]
[37]
Veyilmuthu, R.; Govindan, S.; Venugopalan, M.; Panicker, S. Effect of transcutaneous electrical nerve stimulation on labour pain relief among primigravida and multigravida mothers. Int. J. Reprod. Contracept. Obstet. Gynecol., 2017, 6(3), 980.
[http://dx.doi.org/10.18203/2320-1770.ijrcog20170569]
[http://dx.doi.org/10.18203/2320-1770.ijrcog20170569]
