Högskolan i Skövde

Objectives:  to examine effectiveness and overall opiate consumption between high-sensory transcutaneous  electrical  nerve  stimulation  (Hi-TENS)  combined  with  patient-controlled  analgesia  with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. Design:  randomised, controlled study. Setting:  a county hospital in south-west Sweden. Participants:  42 multiparous women. Measurements and findings:  participants were randomly assigned and connected to patient-controlled analgesia  with  morphine  alone  or  in  combination  with  Hi-TENS  apparatus.  Levels  of  morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption  of  morphine  differed  significantly  between  the  groups:  morphine  with  TENS  was 16.2+/-12.6 mg and morphine alone was 33.1+/-20.9 mg (p = 0.007). Assessment of pain relief showed no  significant  difference.  Sedation  differed  significantly  between  the  groups  (p = 0.045),  especially between three and 12 hours post partum (p = 0.011). Key conclusions and implications for practice:  pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.