Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format

Download Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format

Post on 07-Apr-2018

215 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

<ul><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 1/32</p><p>TENS FOR PAIN RELIEF IN</p><p>LABOR AND POSTSURGERY</p><p>By :- AIZA ZAKIMPT-Ortho 1st Yr</p><p>Moderator:-Dr.Sohrab A Khan</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 2/32</p><p>TENS-Transcutaneous Electrical</p><p>Nerve Stimulation A simple,non-invasive analgesic technique used</p><p>extensively in health care settings (Johnson1997,Robertson&amp;Spurritt 1998)</p><p> Mainly used for symptomatic management ofacute &amp; chronic pain(Walsh 1997,Woolf &amp;Thompson1994)</p><p> Also claimed to have antiemetic&amp;tissue healingeffects(Walsh1997,Pearl et al1999)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 3/32</p><p>Mechanism of action</p><p> Pain modulation during &amp; after TENS isachieved primarily through two basic</p><p>neurophysiological mechanisms aimed atclosing the spinal gate(Wall&amp;Melzack1994,Walsh 1997,Barr 1999)</p><p> PAIN GATE MECHANISM</p><p> ENDOGENOUS OPIATE SYSTEM(mainlyendorphins,enkephalins,)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 4/32</p><p>Features of TENS devices</p><p> Pulse waveform(fixed)-Monophasic/Biphasic</p><p>(sym/assym) Pulse amplitude (adjustable)</p><p>-1-50mA</p><p> Pulse duration (often fixed)-10 -1000 micro sec</p><p>Pulse frequency(adjustable)-1-250 p.p.s</p><p> Pattern-continuous,burst,</p><p>Modulated</p><p> Channels-single/dual</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 5/32</p><p>TYPES</p><p> Three main modes of TENS found -</p><p>Conventional, Acupuncture-like, Intense</p><p>TENS (Walsh 1997, Woolf &amp;Thompson1994,Vladimir 2008)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 6/32</p><p>Contd..</p><p> Conventional-High frequency low intensity</p><p>amp-10-30 mA Freq-10-200Hz</p><p> AL-TENS-Low frequency high intensityamp-high</p><p> Intense TENS-High freq high intensity</p><p>amp-highest tolerable Freq-200Hz</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 7/32</p><p>Electrodes</p><p> Different shapes &amp; sizes available</p><p> Single channel offer 2 &amp; dual channel offer 4</p><p>electrodes for large vague or multiple areas Electrodes-non sterile carbon silicon,</p><p>reusable/self adhesive/sterile, disposible</p><p>Contd</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 8/32</p><p>Contd..ELECTRODE PLACEMENT</p><p> Over &amp; around painful area</p><p>At spinal nerve roots segmentally relatedto involved dermatome or myotome</p><p> Peripheral nerve</p><p>Related motor points,trigger points or acupuncture points</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 9/32</p><p>Dosimetry</p><p> Mode, Duration &amp; Frequency-Based onpatients comfort</p><p>Scientific literature shows no evidence tosupport the belief that particular modeselection is more efficacious for any givenacute or chronic pathological condition (Leoet al 1986,Johnson et al 1991, Chesterton,Foster et al 2003)</p><p> No correlation between patient, site, cause ofpain &amp; TENS parameters chosen &amp; outcomes</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 10/32</p><p>Contraindications Pacemakers(unless recommended)</p><p> Epilepsy(unless recommended)</p><p> Pregnancy(unless recommended during--First trimester</p><p>-Over the uterus</p><p>Not to be applied over carotid sinus,broken or</p><p>dyaesthetic skin</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 11/32</p><p>TENS IN LABOR</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 12/32</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 13/32</p><p>STAGE 2</p><p> Stage of expulsion or</p><p>stage of delivery</p><p> Start with full cervicaldilation &amp; end with birth of</p><p>baby.</p><p> Duration of contraction-</p><p>30sec-1min.</p><p> Gap between the</p><p>contraction-</p><p>5-10min</p><p> Stage lasts for 1-2 hrs</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 14/32</p><p>STAGE 3</p><p> Placental stage</p><p> From birth of baby to</p><p>expulsion of afterbirths</p><p>{placenta, umblical cord &amp;</p><p>membranes}</p><p>Shortest stage 5-30 min</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 15/32</p><p>TENS in labor pain</p><p> Effectiveness of TENS for relief of pelvic &amp; backpain associated with 1st&amp;2nd stages of labor wasfirst evaluated by Augustinsson &amp; colleagues in1977.</p><p> Pain is successfully controlled by applying TENSPara spinally at T10-L1 &amp; S2-S4 levels during</p><p>1st&amp;2nd stage of labor respectively.</p><p> There are specially designed obstetric TENSdevices which have dual channels &amp; boost</p><p>control button/trigger switch for contraction pain</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 16/32</p><p>Electrodes position &amp; characteristics of</p><p>TENS when used in labor pain</p><p> 1st stage labor-Electrodes positioned to</p><p>target afferents active during distensionof cervix &amp; lower uterine segment</p><p> 2nd stage-Electrodes positioned totarget afferents active during distensionof pelvis &amp; perineum</p><p> Between contractions-low intensity/low</p><p>frequency (burst-2 bursts per sec) During contractions-high intensity/high</p><p>frequency (continuous-80-100 Hz)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 17/32</p><p>contd..</p><p> Researches show that patients acceptence ofTENS as an adjunctive treatment for paincontrol is high</p><p> No adverse/side effects have been noted</p><p>among mothers or babies Researchers have concluded that TENS is an</p><p>effective, non pharmacological, non invasive,adjuvant pain relief modality in early stages of</p><p>labor Contd</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 18/32</p><p>Advantages</p><p>Advantages of TENS over conventionalanalgesic methods used during labor includethe administration of a safe, non invasive,readily reversible analgesia that does not</p><p>affect the vital functions of mother &amp; childduring or immediately following delivery.</p><p>It has also been reported that TENS</p><p>facilitated the mothers ability to concentrate onbreathing &amp; relaxation techniques (Grim, LC,Morey 1985)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 19/32</p><p>Disadvantage</p><p>Using TENS during foetal monitoring leads tointerference secondary to electrical signalgenerated by TENS device.</p><p>This inconvenience can be avoided by temporarilylowering the TENS amplitude or turning off the</p><p>device during fetal monitoring or using specialfilter developed to suppress stimulus artifact fromTENS unit,so that fetal monitering notaffected(Bundsen &amp; Ericson)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 20/32</p><p> Cluett E in 1994 in his review concluded that TENS</p><p>and ENTONOX (drug) are both equally effective in</p><p>females having short labors and needed no other form</p><p>of analgesia.(CHIA et al 1990)</p><p> Kaplan et al concluded that TENS is a effective non</p><p>pharmacological,non invasive adjuvant pain relief</p><p>modality for use in labor and delivery and it also</p><p>reduces the duration of first stage of labor and amountof analgesic intake with no adverse effects.</p><p>Contd</p><p>Evidences:-</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 21/32</p><p>Contd</p><p> V.Span et al 2006 concluded that it lowers pain butthere is no change in patients request for epiduralanasthesia.</p><p> Dowswell et al 2009 in their review concluded thatthere is only limited evidence that TENS reduces painin labor and it does not seem to have any effect (eitherpositive or negative) on other outcomes for mothersand babies.The use of TENS at home in early labor</p><p>have not been evaluated.</p><p> Also concluded that TENS is widely available inhospital settings only and women should have choiceof using it in labor pain.</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 22/32</p><p>TENS for post surgical painrelief</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 23/32</p><p>TENS FOR POST-SURGICAL</p><p>PAIN RELIEF Hymes et al(1974) were the first to report</p><p>success of conventional TENS for acute painresulting from surgery using sterile electrodes</p><p>paraincisionally Potentially,TENS can relieve pain &amp; reduce</p><p>consumption of opioid&amp;non opioid medication &amp;associated adverse effects including</p><p>drowsiness,ileus,respiratorydepression&amp;gastrointestinal upset &amp;improvesrespiratory function(Ali 1981,Benedetti et el1997,Chiu et al 1999)</p><p>Contd</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 24/32</p><p> Investigators have evaluated the analgesic</p><p>effects of TENS in patients who underwentcholecystectomies or other abdominal surgery,</p><p>thoracotomies, leminectomies &amp; other types of</p><p>orthopaedic &amp; gynaecological surgery</p><p>(Ali et al,Navarthanam et al, Liu et al, Schuster</p><p>et al, Solomon et al, Richardson et al, Pike,</p><p>Smith,Issenmman, De Santana et al 2009,</p><p>Erdogan et al 2005, Bjordal et al 2003, Navaro2000)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 25/32</p><p> Several investigators examined effect of</p><p>postoperative TENS applied for brief periods oftime, rather than on continuous 24 hour basis</p><p>(Stratton et al, Liu at al 1985))</p><p> Warfield,Stein &amp; Frank in their study concluded</p><p>that patients receiving TENS had lower pain</p><p>level, had shorter stays in ICU &amp; tolerated chest</p><p>physical therapy more comfortably.But nosignificant difference in groups taking narcotics</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 26/32</p><p>Contd</p><p> Patient receiving TENS also showed early</p><p>mobility,fewer incidences of postoperativepulmonary complications (Warfield,Stein &amp;Frank1985)</p><p> Benedetti et al (1997) has shown that TENS was</p><p>effective for mild to moderate pain associated withthoracic surgical procedures but ineffective forsevere pain</p><p>It can be used as an adjunct to other medicationswhen pain is moderate &amp;can be the only paintherapy when pain is mild</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 27/32</p><p>Contd</p><p>In a study it was also noted TENS is mosteffective for managing pain in drug navepatients i.e patients who have not usednarcotic medication for more than 2 wks in 6months prior to surgery.This finding implies</p><p>that lack of effectiveness of TENS in patientswith chronic pain may be due to history of significant prescription drugintake(Solomon,Long 1980)</p><p>Contd..</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 28/32</p><p> Erdogan M et al, 2005 recommended</p><p>routine use of TENS after concludingthatTENS reduced opioid intake, improved</p><p>respiratory func &amp; had no side effects</p><p> (Bjordal et al, 2003) TENS administered</p><p>with strong subnoxious intensity over</p><p>wound area (1-8 Hz AL-TENS or 25-150</p><p>Hz) significantly reduced analgesic intakefor post-op pain</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 29/32</p><p>Contd</p><p> For successful use of TENS, patients should</p><p>be carefully evaluated preoperatively &amp; any</p><p>history of narcotic use should be noted</p><p> They should be introduced to the TENS</p><p>treatment protocol preoperatively whenever</p><p>possible, to determine optimal electrode</p><p>placement sites&amp; stimulus parameters&amp; to</p><p>allay patients apprehension associated with</p><p>electrical stimulation</p><p>Contd </p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 30/32</p><p>Contd..</p><p> Ongoing staff education &amp; training&amp;development of protocols are critical to</p><p>the successful implementation of </p><p>postoperative pain management programincorporating TENS (Smith, LaFlamme</p><p>1980)</p><p> Consideration of each patients response</p><p>to,&amp; tolerance of, electrical stimulation iscritically important to the successful</p><p>application of TENS</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 31/32</p><p>Contd</p><p>For post surgical pain,a highfrequency,long pulse duration combinedwith a comfortable intensity, withoutmuscle contraction has been reported toproduce the greatest pain relief (Ho et al1987,Manheimer &amp; Lampe 1984).However</p><p>low frequencies have also found to beeffective (De Santana et al 2009,Bjordal etal 2003)</p></li><li><p>8/4/2019 Tens for Pain Relief in Labor and Post Surgery (2) Nw 2003 Format</p><p> 32/32</p><p>Thank You</p></li></ul>

Recommended

View more >