Abstract
Background
Liposuction is a common cosmetic surgical procedure, which requires analgesia for postoperative pain. Transcutaneous electrical nerve stimulation (TENS) has been used for postoperative pain relief; however, there is no evidence of its effectiveness in liposuction patients and this is the focus of this paper.
Methods
A prospective, randomized, double-blind, controlled trial was conducted with 42 adult patients who underwent liposuction. Patients were randomly allocated to either the TENS group (active TENS) or control group (sham TENS). All patients received morphine (0.1 mg/kg) and dipyrone 1 g immediately after surgery; TENS was delivered 2 h later. The primary outcome was pain intensity. Secondary outcomes were analgesic requirement, number and types of adverse effects of TENS, quality of pain, treatment success, and patient satisfaction. Postoperative pain was measured using a visual analog scale (VAS) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ).
Results
Patients in the TENS group reported significantly lower pain intensity (P < 0.001, effect size = 0.92) compared with those in the control group. TENS significantly decreased the consumption of analgesics in the postoperative period (P < 0.001). No withdrawals or adverse effects were observed in the TENS group, but 33.3 % of patients in the control group reported drowsiness and nausea. About 95 and 38 % of patients in the TENS and control groups, respectively, were satisfied with the analgesic treatment.
Conclusion
The results indicate that TENS is effective as an adjunct to analgesics for pain relief after liposuction.
Level of Evidence I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Ahern RW (2009) The history of liposuction. Sem Cutan Med Surg 28:208–211
Coleman WP IV, Hendry SL II (2006) Principles of liposuction. Semin Cutan Med Surg 25:138–144
Fisher C, Grahovac TL, Schafer ME, Shippert RD, Marra KG, Rubin JP (2013) Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg 132:351–361
Matarasso A, Hutchinson OH (2001) Liposuction. JAMA 285:266–268
Triana L, Triana C, Barbato C, Zambrano M (2009) Liposuction: 25 years of experience in 26,259 patients using different devices. Aesthet Surg J 29:509–512
Danilla S, Fontbona M, de Valdés VD, Dagnino B, Sorolla JP, Israel G, Searle S, Norambuena H, Cabello R (2013) Analgesic efficacy of lidocaine for suction-assisted lipectomy with tumescent technique under general anesthesia: a randomized, double-masked, controlled trial. Plast Reconstr Surg 132:327–332
Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928
Bonnet F, Marret E (2005) Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 95:52–58
Bonnet F, Marret E (2007) Postoperative pain management and outcome after surgery. Best Pract Res Clin Anaesthesiol 21:99–107
Edwards J, Meseguer F, Faura C, Moore RA, McQuay HJ, Derry S (2010) Single dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev 9:CD003227
Hudcova J, McNicol E, Quah C, Lau J, Carr DB (2006) Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev 4:CD003348
Bjordal JM, Johnson MI, Ljunggreen AE (2003) 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 7:181–188
Araco A, Gravante G, Araco F, Castrì F, Delogu D, Filingeri V, Cervelli V (2006) Postoperative pain after lipoplasty: an underestimated entity or a misdiagnosed complication? Plast Reconstr Surg 118:567–569
Araco A, Gravante G, Araco F, Delogu D, Cervelli V (2007) Comparison of power water-assisted and traditional liposuction: a prospective randomized trial of postoperative pain. Aesthet Plast Surg 31:259–265
Hatef DA, Brown SA, Lipschitz AH, Kenkel JM (2009) Efficacy of lidocaine for pain control in subcutaneous infiltration during liposuction. Aesthet Surg J 29:122–128
Gadsby JG, Flowerdew MW (2007) Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain. Cochrane Database Syst Rev 1:CD000210
Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150:971–979
Sluka KA, Deacon M, Stibal A, Strissel S, Terpstra A (1999) Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther 289:840–846
Kalra A, Urban MO, Sluka KA (2001) Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). J Pharmacol Exp Ther 298:257–263
Leonard G, Goffaux P, Marchand S (2010) Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone. Pain 151:215–219
Lim AT, Edis G, Kranz H, Mendelson G, Selwood T, Scott DF (1983) Postoperative pain control: contribution of psychological factors and transcutaneous electrical stimulation. Pain 17:179–188
Hamza MA, White PF, Ahmed HE, Ghoname EA (1999) Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anesthesiology 91:1232–1238
Smith CM, Guralnick MS, Gelfand MM, Jeans ME (1986) The effects of transcutaneous electrical nerve stimulation on post-cesarean pain. Pain 27:181–193
DeSantana JM, Santana-Filho VJ, Guerra DR, Sluka KA, Gurgel RQ, da Silva WM Jr (2008) Hypoalgesic effect of the transcutaneous electrical nerve stimulation following inguinal herniorrhaphy: a randomized, controlled trial. J Pain 9:623–629
DeSantana JM, Sluka KA, Lauretti GR (2009) High and low frequency tens reduce postoperative pain intensity after laparoscopic tubal ligation: a randomized controlled trial. Clin J Pain 25:12–19
Freynet A, Falcoz PE (2010) Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interact Cardiovasc Thorac Surg 10:283–288
Pitangui AC, de Sousa L, Gomes FA, Ferreira CH, Nakano AM (2012) High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: a randomized, controlled trial. J Obstet Gynaecol Res 38:980–987
Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299
Pimenta CAM, Teixeira MJ (1997) McGill Pain Questionnaire: adaptation into the Portuguese language. Rev Bras Anestesiol 47:177–186
Oliveira AS, Bermudez CC, Souza RA, Souza CM, Dias EM, Castro CE, Bérzin F (2003) Pain impact on life of patients with temporomandibular disorder. J Appl Oral Sci 11:138–143
Turk DC, Dworkin RH, McDermott MP, Bellamy N, Burke LB, Chandler JM, Cleeland CS, Cowan P, Dimitrova R, Farrar JT, Hertz S, Heyse JF, Iyengar S, Jadad AR, Jay GW, Jermano JA, Katz NP, Manning DC, Martin S, Max MB, McGrath P, McQuay HJ, Quessy S, Rappaport BA, Revicki DA, Rothman M, Stauffer JW, Svensson O, White RE, Witter J (2008) Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. Pain 139:485–493
Benedetti F, Amanzio M, Casadio C, Cavallo A, Cianci R, Giobbe R, Mancuso M, Ruffini E, Maggi G (1997) Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg 63:773–776
Brennum J, Arendt-Nielsen L, Horn A, Secher NH, Jensen TS (1993) Quantitative sensory examination during epidural anaesthesia and analgesia in man: effects of morphine. Pain 52:75–83
Catheline G, Le Guen S, Besson JM (1999) Effects of opioid receptor antagonists on the effects of i.v. morphine on carrageenin evoked c-Fos expression in the superficial dorsal horn of the rat spinal cord. Brain Res 824:105–111
Price DD, Von der Gruen A, Miller J, Rafii A, Price C (1985) A psychophysical analysis of morphine analgesia. Pain 22:261–269
Sluka KA, Judge MA, McColley MM, Reveiz PM, Taylor BM (2000) Low frequency TENS is less effective than high frequency TENS at reducing inflammation-induced hyperalgesia in morphine-tolerant rats. Eur J Pain 4:185–193
Gagliese L, Melzack R (2003) Age-related differences in the qualities but not the intensity of chronic pain. Pain 104:597–608
Léonard G, Cloutier C, Marchand S (2011) Reduced analgesic effect of acupuncture-like TENS but not conventional TENS in opioid-treated patients. J Pain 12:213–221
Compliance with Ethical Requirements
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
da Silva, M.P., Liebano, R.E., Rodrigues, V.A. et al. Transcutaneous Electrical Nerve Stimulation for Pain Relief After Liposuction: A Randomized Controlled Trial. Aesth Plast Surg 39, 262–269 (2015). https://doi.org/10.1007/s00266-015-0451-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-015-0451-6