tens for pain relief in labor and post surgery (2) nw 2003 format

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    TENS FOR PAIN RELIEF IN

    LABOR AND POSTSURGERY

    By :- AIZA ZAKIMPT-Ortho 1st Yr

    Moderator:-Dr.Sohrab A Khan

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    TENS-Transcutaneous Electrical

    Nerve Stimulation A simple,non-invasive analgesic technique used

    extensively in health care settings (Johnson1997,Robertson&Spurritt 1998)

    Mainly used for symptomatic management ofacute & chronic pain(Walsh 1997,Woolf &Thompson1994)

    Also claimed to have antiemetic&tissue healingeffects(Walsh1997,Pearl et al1999)

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    Mechanism of action

    Pain modulation during & after TENS isachieved primarily through two basic

    neurophysiological mechanisms aimed atclosing the spinal gate(Wall&Melzack1994,Walsh 1997,Barr 1999)

    PAIN GATE MECHANISM

    ENDOGENOUS OPIATE SYSTEM(mainlyendorphins,enkephalins,)

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    Features of TENS devices

    Pulse waveform(fixed)-Monophasic/Biphasic

    (sym/assym) Pulse amplitude (adjustable)

    -1-50mA

    Pulse duration (often fixed)-10 -1000 micro sec

    Pulse frequency(adjustable)-1-250 p.p.s

    Pattern-continuous,burst,

    Modulated

    Channels-single/dual

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    TYPES

    Three main modes of TENS found -

    Conventional, Acupuncture-like, Intense

    TENS (Walsh 1997, Woolf &Thompson1994,Vladimir 2008)

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    Contd..

    Conventional-High frequency low intensity

    amp-10-30 mA Freq-10-200Hz

    AL-TENS-Low frequency high intensityamp-high

    Intense TENS-High freq high intensity

    amp-highest tolerable Freq-200Hz

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    Electrodes

    Different shapes & sizes available

    Single channel offer 2 & dual channel offer 4

    electrodes for large vague or multiple areas Electrodes-non sterile carbon silicon,

    reusable/self adhesive/sterile, disposible

    Contd

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    Contd..ELECTRODE PLACEMENT

    Over & around painful area

    At spinal nerve roots segmentally relatedto involved dermatome or myotome

    Peripheral nerve

    Related motor points,trigger points or acupuncture points

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    Dosimetry

    Mode, Duration & Frequency-Based onpatients comfort

    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)

    No correlation between patient, site, cause ofpain & TENS parameters chosen & outcomes

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    Contraindications Pacemakers(unless recommended)

    Epilepsy(unless recommended)

    Pregnancy(unless recommended during--First trimester

    -Over the uterus

    Not to be applied over carotid sinus,broken or

    dyaesthetic skin

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    TENS IN LABOR

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    STAGE 2

    Stage of expulsion or

    stage of delivery

    Start with full cervicaldilation & end with birth of

    baby.

    Duration of contraction-

    30sec-1min.

    Gap between the

    contraction-

    5-10min

    Stage lasts for 1-2 hrs

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    STAGE 3

    Placental stage

    From birth of baby to

    expulsion of afterbirths

    {placenta, umblical cord &

    membranes}

    Shortest stage 5-30 min

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    TENS in labor pain

    Effectiveness of TENS for relief of pelvic & backpain associated with 1st&2nd stages of labor wasfirst evaluated by Augustinsson & colleagues in1977.

    Pain is successfully controlled by applying TENSPara spinally at T10-L1 & S2-S4 levels during

    1st&2nd stage of labor respectively.

    There are specially designed obstetric TENSdevices which have dual channels & boost

    control button/trigger switch for contraction pain

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    Electrodes position & characteristics of

    TENS when used in labor pain

    1st stage labor-Electrodes positioned to

    target afferents active during distensionof cervix & lower uterine segment

    2nd stage-Electrodes positioned totarget afferents active during distensionof pelvis & perineum

    Between contractions-low intensity/low

    frequency (burst-2 bursts per sec) During contractions-high intensity/high

    frequency (continuous-80-100 Hz)

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    contd..

    Researches show that patients acceptence ofTENS as an adjunctive treatment for paincontrol is high

    No adverse/side effects have been noted

    among mothers or babies Researchers have concluded that TENS is an

    effective, non pharmacological, non invasive,adjuvant pain relief modality in early stages of

    labor Contd

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    Advantages

    Advantages of TENS over conventionalanalgesic methods used during labor includethe administration of a safe, non invasive,readily reversible analgesia that does not

    affect the vital functions of mother & childduring or immediately following delivery.

    It has also been reported that TENS

    facilitated the mothers ability to concentrate onbreathing & relaxation techniques (Grim, LC,Morey 1985)

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    Disadvantage

    Using TENS during foetal monitoring leads tointerference secondary to electrical signalgenerated by TENS device.

    This inconvenience can be avoided by temporarilylowering the TENS amplitude or turning off the

    device during fetal monitoring or using specialfilter developed to suppress stimulus artifact fromTENS unit,so that fetal monitering notaffected(Bundsen & Ericson)

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    Cluett E in 1994 in his review concluded that TENS

    and ENTONOX (drug) are both equally effective in

    females having short labors and needed no other form

    of analgesia.(CHIA et al 1990)

    Kaplan et al concluded that TENS is a effective non

    pharmacological,non invasive adjuvant pain relief

    modality for use in labor and delivery and it also

    reduces the duration of first stage of labor and amountof analgesic intake with no adverse effects.

    Contd

    Evidences:-

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    Contd

    V.Span et al 2006 concluded that it lowers pain butthere is no change in patients request for epiduralanasthesia.

    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

    have not been evaluated.

    Also concluded that TENS is widely available inhospital settings only and women should have choiceof using it in labor pain.

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    TENS for post surgical painrelief

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    TENS FOR POST-SURGICAL

    PAIN RELIEF Hymes et al(1974) were the first to report

    success of conventional TENS for acute painresulting from surgery using sterile electrodes

    paraincisionally Potentially,TENS can relieve pain & reduce

    consumption of opioid&non opioid medication &associated adverse effects including

    drowsiness,ileus,respiratorydepression&gastrointestinal upset &improvesrespiratory function(Ali 1981,Benedetti et el1997,Chiu et al 1999)

    Contd

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    Investigators have evaluated the analgesic

    effects of TENS in patients who underwentcholecystectomies or other abdominal surgery,

    thoracotomies, leminectomies & other types of

    orthopaedic & gynaecological surgery

    (Ali et al,Navarthanam et al, Liu et al, Schuster

    et al, Solomon et al, Richardson et al, Pike,

    Smith,Issenmman, De Santana et al 2009,

    Erdogan et al 2005, Bjordal et al 2003, Navaro2000)

  • 8/4/2019 Tens for Pain

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