Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20230083-en
Brazilian Journal of Pain
Original Article

Combined ultrasound and electric field stimulations improve pain and functional capacity in immediate cesarean delivery: a randomized clinical trial, double-blind, and placebo-controlled

Terapia combinada de estimulação elétrica por meio do ultrassom melhora a dor e a capacidade funcional no pós-parto imediato de cesariana: ensaio clínico randomizado, duplo-cego e placebo

Thalita Cristina Wolff Bertotti; Rubneide Barreto Silva Gallo; Laysse Candido da Silva; Talita Gnoato Zotz; Natália Boneti Moreira; Raciele Ivandra Guarda Korelo

Downloads: 0
Views: 321

Abstract

BACKGROUND AND OBJECTIVES: Wound complications and pharmacological pain relief methods used at the skin surgical site after cesarean delivery may result in women’s physical and emotional burden. Thus, nonpharmacological treatments must be explored to avoid these complications and side effects on maternal health. The objective of this study was to investigate the effects of Combined Ultrasound and Electric Field Stimulation (CUSEFS) on cicatricial pain and functional capacity in immediate cesarean delivery.
METHODS: This study has a randomized clinical trial, double-blind, and placebo-controlled design. Thirty women (25.7±5.0 years) in immediate postpartum were randomly assigned to three groups: Control (CG, n:9), CUSEFS (TG, n:11), and Placebo (PG, n:10). CUSEFS was performed once for 20 minutes. Cicatricial pain (McGill Pain Questionnaire) and functional capacity (Functional Capacity Check) was assessed at baseline, after the intervention, and after 30 minutes. Cohen’s (d) and Mixed-design analysis of variance were used to compare groups.
RESULTS: Immediately after the intervention, TG showed a decrease in cicatricial pain compared with CG in sensory (d:3.8 to 4.0), affective (d:4.0), and total categories (d:3.9). In functional capacity, TG had less difficulty than CG at walking (d:0.6) and lying down (d:1.1), and PG at rest (d: 0.9).
CONCLUSION: CUSEFS might be a resource for managing cicatricial pain and functional capacity in immediate cesarean delivery. Further studies with longer duration and different CUSEFS doses/parameters are required.

Keywords

Cesarean section, Combined modality therapy, Electric stimulation therapy, Pain, Ultrasonic therapy

Resumo

JUSTIFICATIVA E OBJETIVOS: As complicações na ferida e o uso de métodos farmacológicos de alívio da dor no local cirúrgico após a cesariana podem resultar em sobrecarga física e emocional para a mulher. Assim, tratamentos não farmacológicos devem ser explorados para evitar essas complicações e efeitos adversos à saúde materna. O objetivo deste estudo foi investigar os efeitos da terapia combinada de estimulação elétrica por meio do ultrassom (CUSEFS) na dor cicatricial e na capacidade funcional no pós-parto imediato de cesariana. 
MÉTODOS: Este estudo possui um desenho de ensaio clínico randomizado, duplo-cego e controlado por placebo. Trinta mulheres (25,7±5,0 anos) em pós-parto imediato de cesariana foram distribuídas aleatoriamente em três grupos: Controle (CG, n:9), CUSEFS (TG:11) e Placebo (PG, n:10). O CUSEFS foi realizado uma vez por 20 minutos. A dor cicatricial (Questionário de Dor McGill) e a capacidade funcional (Functional Capacity Check) foram avaliadas no início, após a intervenção e após 30 minutos. As análises de variância de design misto e Cohen (d) foram usadas para comparar os grupos. 
RESULTADOS: Imediatamente após a intervenção, o TG apresentou diminuição na dor cicatricial em relação ao CG nas categorias sensorial (d:3,8 a 4,0), afetiva (d:4,0) e total (d:3,9). Na capacidade funcional, o TG apresentou menor dificuldade que o CG na marcha (d:0,6) e deitado (d:1,1), e que o PG em repouso (d:0,9). 
CONCLUSÃO: O CUSEFS pode ser um recurso para o manejo da dor cicatricial e da capacidade funcional imediatamente após a cesariana. Além disso, são necessários mais estudos com maior duração e diferentes doses/parâmetros de CUSEFS.

Palavras-chave

Cesariana, Dor, Terapia combinada, Terapia por estimulação elétrica, Ultrassom

References

1 Carbonnel M, Brot D, Benedetti C, Kennel T, Murtada R, Revaux A, Ayoubi JM. Risks factors FOR wound complications after cesarean section. J Gynecol Obstet Hum Reprod. 2021;50(7):101987.

2 Komatsu R, Ando K, Flood PD. Factors associated with persistent pain after childbirth: a narrative review. Br J Anaesth. 2020;124(3):e117-30.

3 Villers MS. Reducing cesarean delivery surgical site complications. Obstet Gynecol Clin North Am. 2020;47(3):429-37.

4 Santos PL, Rett M T, Lotti RCB, Moccellin AS, DeSantana JM. A via de parto interfere nas atividades cotidianas no puerpério imediato? ConScientiae Saúde. 2017;15(4):604-11.

5 Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, Mc-Carberg B, Montgomery R, Murphy J, Perkal M F, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: a Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016 Feb;17(2):131-57

6 R Velingkar K, Ramachandra P, V Pai M, Krishna Rao B. Influence of transcutaneous electrical nerve stimulation on pain intensity and functional activities following lower segment cesarean section. Physiother Theory Pract. 2023;39(10):2099-105.

7 Zimpel SA, Torloni MR, Porfírio GJ, Flumignan RL, da Silva EM. Complementary and alternative therapies for post-caesarean pain. Cochrane Database Syst Rev. 2020;9(9):CD011216.

8 Lee JY, Min DJ, Kim W, Bin BH, Kim K, Cho EG. Non-pharmacological high-intensity ultrasound treatment of human dermal fibroblasts to accelerate wound healing. Sci Rep. 2021;11(1):2465.

9 Hearne CLJ, Patton D, Moore ZE, Wilson P, Gillen C, O’Connor T. Effectiveness of combined modulated ultrasound and electric current stimulation to treat diabetic foot ulcers. J Wound Care. 2022;31(1):12-20.

10 Sangtong K, Chupinijrobkob C, Putthakumnerd W, Kuptniratsaikul V. Does adding transcutaneous electrical nerve stimulation to therapeutic ultrasound affect pain or function in people with osteoarthritis of the knee? A randomized controlled trial. Clin Rehabil. 2019;33(7):1197-205.

11 Moretti FA, Marcondes FB, Provenza JR, Fukuda TY, de Vasconcelos RA, Roizenblatt S. Combined therapy (Ultrasound and Interferential Current) in patients with fibromyalgia: once or twice in a week? combined therapy in fibromyalgia. Physiother Res Int. 2012;17(3):142-9.

12 Korelo RIG, Kryczyk M, Garcia C, Naliwaiko K, Fernandes LC. Wound healing treatment by high frequency ultrasound, microcurrent, and combined therapy modifies the immune response in rats. Braz J Phys Ther. 2016;20(2):133-41.

13 Ennis WJ, Lee C, Gellada K, Corbiere T F, Koh TJ. Advanced technologies to improve wound healing: electrical stimulation, vibration therapy, and ultrasound—what is the evidence? Plast Reconstr Surg. 2016;138:94S-104S.

14 Kim ED, Won YH, Park SH, Seo JH, Kim DS, Ko MH, Kim GW. Efficacy and safety of a stimulator using low-intensity pulsed ultrasound combined with transcutaneous electrical nerve stimulation in patients with painful knee osteoarthritis. Pain Res Manag. 2019;16;2019:7964897.

15 Thomson G, Feeley C, Moran VH, Downe S, Oladapo OT. Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review. Reprod Health. 2019;16(1):71.

16 Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63:834-40.

17 Lima LEA, Bezerra AJR, Hazime FA. High and low frequency transcutaneous electrical nerve stimulation in post-cesarean pain intensity. Fisioter Pesqui. 2014;21(3):243-8.

18 Menezes Costa Lda C, Maher CG, McAuley JH, Hancock MJ, de Melo Oliveira W, Azevedo DC, Freitas Pozzi LM, Pereira AR, Costa LO. The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain. J Clin Epidemiol. 2011;64(8):903-12

19 Pitangui ACR, de Sousa L, Gomes FA, Ferreira CHJ, Nakano AMS. High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: A randomized, controlled trial: High-frequency TENS in post-episiotomy. J Obstet Gynaecol Res. 2012;38(7):980-7.

20 Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin. 2017;35(1):107-24.

21 Bishop DG, Gibbs M W, Dyer RA. Post-caesarean delivery analgesia in resource-limited settings: a narrative review. Int J Obstet Anesth. 2019;40:119-27.

22 Elboim-Gabyzon M, Andrawus Najjar S, Shtarker H. Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: a double-blinded, randomized trial. Clin Interv Aging. 2019;14:1841-50.

23 Chen W, Liu C, Yang Y, Tian L. The effect of transcutaneous electrical nerve stimulation (TENS) on pain control and phenylethanolamine-N-methyltransferase (PNMT) gene expression after cesarean section. Cell Mol Biol. 2021;67(3):153-7.

24 Lusher J, Djatmika C. Living with a non-healing caesarean section wound: A mini-review. Int Wound J. 2020;17(4):1094-6.

25 Makker PGS, Koh CE, Solomon MJ, Steffens D. Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta-analysis. ANZ J Surg. 2022;92(7-8):1658-67.

26 Saldanha M, Hopp MS, Wagner LE, Flores BDC, Pinto K P, Fischer NC, Reuter EMB, Cardoso EM, Dannuey M, Paiva DN. Análise comparativa da força muscular respiratória, força de preensão palmar e capacidade funcional entre puérperas de parto cesárea e em nuligestas. Cinergis. 2017;18:358-62.

27 Hafliðadóttir SH, Juhl CB, Nielsen SM, Henriksen M, Harris IA, Bliddal H, Christensen R. Placebo response and effect in randomized clinical trials: meta-research with focus on contextual effects. Trials. 2021 Jul 26;22(1):493.

28 Benedetti F, Piedimonte A. The neurobiological underpinnings of placebo and nocebo effects. Semin Arthritis Rheum. 2019;49(3):S18-21.

29 Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. Int J Womens Health. 2017;9:81-8.

30 Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L, Nelson G, Wilson RD. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). AmJ Obstet Gynecol. 2019;221(3):247. e1-247.e9.
 


Submitted date:
04/28/2023

Accepted date:
09/29/2023

65a6e1aca953957958185a44 brjp Articles

BrJP

Share this page
Page Sections