Efficacy of paravertebral transcutaneous electrical nerve stimulation in perioperative analgesia and enhanced recovery after thoracoscopic lobectomy: a randomized, sham-controlled clinical trial

Abstract Purpose Managing postoperative pain remains a significant challenge in video-assisted thoracoscopic surgery (VATS) lobectomy, where inadequate analgesia impedes recovery and increases chronic pain risk. Transcutaneous electrical nerve stimulation (TENS), as a non-invasive neuromodulatory technique, offers potential perioperative analgesia. Based on this rationale, we investigated whether paravertebral TENS (pTENS) could effectively alleviate pain after VATS lobectomy. Methods Patients undergoing VATS lobectomy were randomized to receive pTENS or sham-pTENS one day before surgery (T0), intraoperatively (T0′), and on postoperative day 1 (POD 1), and POD 2. Electrodes were placed on the paravertebral skin corresponding to the thoracic nerve segments innervating the incision. Electrical stimulation parameters: pulse width 260 μs, pulse rate 80 Hz. The pTENS group received maximum tolerable current, sham-pTENS group received 0 mA. Primary outcomes were pain scores at rest and during coughing in the post-anesthesia care unit (PACU; T1), at 4 h (T2), 24 h (T3), 48 h (T4), and at discharge (T5) after surgery. Secondary outcomes included intraoperative anesthetics use, dosage and bolus times of the patient-controlled intravenous analgesia (PCIA) pump, incidences of postoperative complications, serum IL-6 and Dyn levels, and post-operative quality-of-life scores at 30 (T6) and 100 days (T7). Results Of 62 enrolled patients, 56 completed the study. Numeric Rating Scale scores of postoperative pain were significantly lower in the pTENS group compared to the sham-pTENS group at T2, T3, T4, and T5. Incidences of chronic postsurgical pain decreased significantly in the pTENS group compared to the sham-pTENS group (2/31 vs. 17/31, P < 0.001). Intraoperative remifentanil use was significantly lower in the pTENS group compared to the sham-pTENS group (difference in medians [95% CI], 1.2 (0.385 to 1.802), P = 0.004). Dosage and bolus times of the PCIA pump were significantly lower in the pTENS group on POD 1 and POD 2 ( P < 0.001). The duration of PACU stay (difference in medians [95% CI], 4.29 (1.91 to 6.67), P = 0.004), the time of thoracic drain tube removal (difference in medians [95% CI], 5 (0 to 11), P = 0.044), the time of first intestinal exhaust (difference in medians [95% CI], 2 (0 to 5), P = 0.032), the time of first out-of-bed activity (difference in medians [95% CI], 1.77 (−0.44 to 3.99), P = 0.007) and the time of first urination (difference in medians [95% CI], 1 (1 to 1), P < 0.001) were significantly shorter in the pTENS group. IL-6 levels in the pTENS group were significantly lower compared to the control group at T1 ( P < 0.001) and T4 ( P = 0.039). Compared to the Sham-pTENS group, the serum concentrations of Dyn in the pTENS group were significantly increased at T1, T3 and T4 ( P < 0.001). The mean of Mental Component Summary in the pTENS group were significantly higher compared to the control group both at T6 and T7 ( P < 0.001). Conclusion pTENS is a safe and effective non-pharmacological analgesic therapy in VATS lobectomy because it can relieve acute pain. Trial registration Pre-registered at www.chictr.org on 7th September 2021 (ChiCTR2100050902).