Transcutaneous Electric Nerve Stimulation Clinical Trial
Official title:
Randomized Controlled Trial of Transcutaneous Electrical Nerve Stimulation for Pain Relief During Transvaginal Oocyte Retrieval Using Conscious Sedation
This randomized double-blinded control trial aims to compare the pain levels experienced by the women using the standard conscious sedation and those who had transcutaneous electrical nerve stimulation (TENS) in addition to conscious sedation. The hypothesis is that there will be less pain in women with both conscious sedation and TENS.
Women who are indicated to undergo IVF in our center will be assessed for eligibility for the
study. Written consent will be obtained from those who agreed to join the study.
Eligible women recruited will be randomized according to a computer-generated randomization
list prepared by a designated research staff into one of the two groups on the day of oocyte
retrieval
1. Patient with both conscious sedation and active TENS
2. Patient with conscious sedation and placebo TENS
Blinding Both the women and the physician performing the procedure will be blinded from the
group allocation.
Checking of effectiveness of blinding will be done by asking the patient and the physician
after the procedure as to which group they think the women is in.
The procedure Women will receive ovarian stimulation according to the departmental Standard
Operating Procedures. Ovarian stimulation will be monitored by ultrasound. Human chorionic
gonadotrophin or an agonist (decapeptyl) will be given when the dominant follicle is at least
18mm and there are three more follicles of at least 16mm. Oocyte retrieval will then be
arranged 36 hours later.
Prior to oocyte retrieval, two sets of self-adhesive electrodes will be placed on the women
back on each side of the spine at T10 to S4 level. Instructions on how to titrate the TENS
amplitude to the desired level that gives a strong non-painful electrical paraesthesia will
be given to the women by the research nurse who is unaware of the group allocation. TENS
therapy will start 5 minutes before the procedure and stop 5 minutes after the removal of
oocyte aspiration needle. The TENS machine used in the study will be the Endomed 482 that
delivers biphasic pulsed currents using pulse duration of 400 µs and pulse frequencies
between 80-100 pulses s−. The women in the treatment group will be given a TENS machine with
electrodes emitting impulses while those in the placebo group will be given a TENS machine
with electrodes that is not emitting any impulses.
The woman lies on the operative bed in a lithotomy position. 25mg Pethidine and 5mg Diazepam
will be given intravenously. The blood pressure and pulse of the woman are checked after the
drug administration and the oxygen saturation is monitored continuously throughout the
procedure. 10ml 1% lignocaine is injected to the paracervical region by the operating surgeon
with a 21-gauge needle after cleansing the vagina and cervix with chlorhexidine. Under
transvaginal ultrasound guidance, a 16-gauge ovum aspiration needle is introduced. Aspiration
of follicles is performed with a suction pressure of 100 mmHg.
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