Transcutaneous electrical nerve stimulation as an adjunct to non-steroidal anti-inflammatory medications for pain management during pleurodesis

Abstract

Aim: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunctive to nonsteroidal
anti-inflammatory drugs (NSAID) for the post-procedural pain in patients who underwent pleurodesis
for pneumothorax.
Methodology: Sixty patients in the age group of 20-60 years, planned for pleurodesis in the operating rooms of our
hospital, were divided into two groups of 30 each. Patients were alternatively assigned to one of the two groups.
In Group I diclofenac sodium 75 mg in 100 ml of normal saline was started IV after the procedure, while TENS
was applied for 45 minutes during this period. In Group II (control group) diclofenac sodium was started after
the procedure, and an apparatus identical to TENS, but which did not deliver any electric current was applied as
placebo. The blood pressure and pulse rate were noted at predefined intervals i.e. immediately after the procedure
and then at 2, 4, 6 and 8 hrs after the procedure. A 0-10 visual analogue scale (VAS) was used to assess pain at regular
intervals. When the VAS score was ≥3, inj. diclofenac sodium 50 mg was repeated intramuscularly.
Results: The systolic blood pressure was comparable in both groups immediately and 2 h after the procedure but
it was significantly less in Group I at 4, 6 and 8 hrs respectively (P<0.05). The pulse rate was comparable in both
groups immediately after, but decreased significantly in Group I at 2 hrs (P<0.05), 4 hrs (P<0.02), 6 hrs (P<0.02)
and 8 hrs (P<0.02) after the procedure. The VAS score was comparable immediately and at 2 h in both groups
(P=NS), but was significantly less in Group I at 4, 6 and 8 hrs after the procedure (P<0.001). The dose of diclofenac
sodium used in Group I was significantly less than in the Group II (P<0.02).
Conclusion: TENS is useful as an adjunctive to NSAIDs for pain relief in pleurodesis and it lead to reduction in
subsequent requirement of NSAIDs. TENS is a valuable strategy to alleviate pain of pleurodesis with no adverse
effects and with a good hemodynamic stability.