Background: Labor analgesia remains the center of interest for both obstetricians and women. The safety of the traditional pharmacologic analgesics remains questionable due to their potential fetal and maternal compli...Background: Labor analgesia remains the center of interest for both obstetricians and women. The safety of the traditional pharmacologic analgesics remains questionable due to their potential fetal and maternal complications. Therefore, several non-pharmacological modalities were evaluated for their safety and efficacy to relieve labor pain. Among these methods, transcutaneous nerve stimulation (TENS) gained much concern due to ease of use, low cost and high capacity for women self-titration. The study aims to investigate the efficacy of TENS in reducing labor pain associated with vaginal deliveries, and to determine the factors controlling the response to TENS. Methods: The study was a randomized, controlled clinical trial. A total of 390 women candidates for vaginal delivery were randomly allocated to 3 groups of intervention: paracetamol infusion, TENS, and intramuscular pethidine (130 women per group). The primary endpoint was pain intensity assessed on 10-point VAS scale and women satisfaction. Secondary endpoints included maternal or fetal complications. Results: VAS scores recorded during vaginal deliveries demonstrated a statistically significant reduction in TENS group compared to paracetamol at 15, 30 minutes, 1 and 2 hours, while pethidine arm demonstrated lower scores than TENS group (p < 0.001). The intermediate analgesic efficacy of TENS was preserved when evaluating episiotomy related pain scores. Analysis of differences between good and poor responders to TENS indicated that weight, BMI, education level and the stimulation characteristics were statistically different between the two subgroups (p < 0.001). Adverse maternal and fetal outcomes in TENS arm were comparable to paracetamol and significantly less than pethidine. Conclusion: TENS is a reliable labor pain analgesic with comparable efficacy and superior safety relative to pethidine. Clinicians should personalize TENS therapy according to women’s BMI and education level for optimized pain control.展开更多
文摘Background: Labor analgesia remains the center of interest for both obstetricians and women. The safety of the traditional pharmacologic analgesics remains questionable due to their potential fetal and maternal complications. Therefore, several non-pharmacological modalities were evaluated for their safety and efficacy to relieve labor pain. Among these methods, transcutaneous nerve stimulation (TENS) gained much concern due to ease of use, low cost and high capacity for women self-titration. The study aims to investigate the efficacy of TENS in reducing labor pain associated with vaginal deliveries, and to determine the factors controlling the response to TENS. Methods: The study was a randomized, controlled clinical trial. A total of 390 women candidates for vaginal delivery were randomly allocated to 3 groups of intervention: paracetamol infusion, TENS, and intramuscular pethidine (130 women per group). The primary endpoint was pain intensity assessed on 10-point VAS scale and women satisfaction. Secondary endpoints included maternal or fetal complications. Results: VAS scores recorded during vaginal deliveries demonstrated a statistically significant reduction in TENS group compared to paracetamol at 15, 30 minutes, 1 and 2 hours, while pethidine arm demonstrated lower scores than TENS group (p < 0.001). The intermediate analgesic efficacy of TENS was preserved when evaluating episiotomy related pain scores. Analysis of differences between good and poor responders to TENS indicated that weight, BMI, education level and the stimulation characteristics were statistically different between the two subgroups (p < 0.001). Adverse maternal and fetal outcomes in TENS arm were comparable to paracetamol and significantly less than pethidine. Conclusion: TENS is a reliable labor pain analgesic with comparable efficacy and superior safety relative to pethidine. Clinicians should personalize TENS therapy according to women’s BMI and education level for optimized pain control.
