Pain Clinical Trial
Official title:
Transcutaneous Electric Nerve Stimulation (TENS) for Pain Relief During Extracorporeal Shock-wave Lithotripsy (ESWL)
This study evaluates pain relief during extracorporeal shock-wave Lithotripsy by using transcutaneous electrical nerve stimulation (TENS) and comparing it with fentanyl which is a narcotic analgesic. Half of the participants will receive a primary fentanyl dose together with TENS application, another half will receive a primary fentanyl dose. All patients will receive fentanyl increments if they still complained of pain.
The ideal anesthesia technique for ESWL must provide good analgesia, sufficient sedation, and
rapid recovery with minimal side effects. Opioids are commonly used analgesics during ESWL.
Fentanyl is a potent synthetic narcotic, which has rapid onset and a short duration of
action, it offers an acceptable analgesia during ESWL but has a noticeable respiratory
depression.
Transcutaneous electrical nerve stimulation (TENS) is a method in which low voltage
electrical impulses transmit through electrodes attached to the skin over a painful area. It
is usually used to relieve a variety of painful conditions. A TENS unit contains electrical
signal generator, a battery in addition to a set of electrodes. The TENS is small,
programmable and the generator can deliver stimuli with different current intensities, pulse
rates and pulse width.
The mechanism of analgesia by TENS has been explained by many theories. the gate control
theory by Melzack and Wall, stated that "when an electrical current is applied to a painful
area, transmission of pain through small diameter fibers is inhibited by the activity of the
large diameter, fast-conducting proprioceptive sensory fibers, closing the gate to the pain
perception to the brain". Another mechanism suggested is activation of descending inhibitory
pathway, via release of endogenous opioids.
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