Eletroestimulação nervosa transcutânea (TENS) no alívio da dor durante o trabalho de parto: Uma revisão de escopo

Reis, Carla Cristina Silveira dos; Dias, Leandro da Cunha; Carvalho, Lorena Bezerra; Alves Junior, Lourivaldo Bispo; Imoto, Aline Mizusaki

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 44 (02) • Fev 2022 • https://doi.org/10.1055/s-0042-1742290 copiar

Eletroestimulação nervosa transcutânea (TENS) no alívio da dor durante o trabalho de parto: Uma revisão de escopo

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Mapear evidências em saúde sobre a eficácia da terapia por estimulação elétrica nervosa transcutânea (TENS, na sigla em inglês) no alívio da dor durante o parto.

Métodos

Trata-se de uma revisão de escopo nas bases de dados PubMed, LILACS, Cochrane, VHL, PEDRO e SciELO, através dos descritores estimulação eléctrica, transcutânea e trabalho, obstetrícia e os seus sinônimos.

Resultados

Foram identificados 263 estudos, dos quais 54 duplicados foram excluídos. Após a classificação por títulos e resumos, 24 artigos foram selecionados para leitura, restando 6. Os seis estudos avaliaram a redução da dor através da escala visual analógica (EVA).

Conclusão

Os resultados indicam que a utilização de TENS como estratégia não farmacológica para o alívio da dor no parto tem resultados positivos.

Palavras-chave:
estimulação eléctrica nervosa transcutânea; dores de parto; trabalho de parto

Authors and year	Objective	Intervention	Results	Conclusions
Abreu et al. (2010)¹²12 Abreu EA, Santos JD, Ventura PL. Efetividade da eletroestimulação nervosa transcutânea no alívio da dor durante o trabalho de parto: um ensaio clínico controlado. Rev Dor. 2010;11(04): 313-318 cited 2020May 22 [Internet]. Available from http://files.bvs.br/upload/S/1806-0013/2010/v11n4/a1654.pdf http://files.bvs.br/upload/S/1806-0013/2...	To evaluate the effectiveness of TENS in pain relief during labor.	Experimental group: Application of TENS by means of a pair of electrodes at the level of the T10-L1 vertebrae and another pair at the level of S2-S4.Control group: TENS with subliminal stimulus.	TENS provided pain relief in 80% of the cases, assessed by the VAS. There were no cases of pain relief in the control group.	TENS is effective in relieving pain during labor.
Peng et al. (2010)¹³13 Peng T, Li XT, Zhou SF, Xiong Y, Kang Y, Cheng HD. Transcutaneous electrical nerve stimulation on acupoints relieves labor pain: a non-randomized controlled study. Chin J Integr Med. 2010;16 (03):234-238. Doi: 10.1007/s11655-010-0234-9 https://doi.org/10.1007/s11655-010-0234-...	To investigate the effectiveness of TENS to reduce pain in labor when applied to four specific acupuncture points.	Experimental group: Application of TENS in four specific acupuncture points (LI4, PC6, BL19, and BL21).Control group: without any intervention.	There was 68% of pain relief during labor in the group treated with TENS, measured by the VAS	The application of TENS to acupuncture points LI4, PC6, BL19, and BL21 is an effective, noninvasive method for pain control during labor.
Santana et al. (2016)¹⁴14 Santana LS, Gallo RB, Ferreira CH, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. 2016;62 (01):29-34. Doi: 10.1016/j.jphys.2015.11.002 https://doi.org/10.1016/j.jphys.2015.11....	To assess whether TENS relieves pain or changes its location in the first phase of labor and whether TENS delays the request for neuraxial analgesia.	Experimental group: Application of TENS by means of a pair of electrodes at the level of the T10-L1 vertebrae and another pair at the level of S2-S4.Control group: physiotherapist for guidance and answer questions.	TENS reduced pain in the experimental group, assessed by the VAS, but did not change its location or distribution. Pharmacological analgesia was postponed for 5 hours after TENS intervention, compared with the control group.	TENS significantly reduces pain in labor and postpones the need for pharmacological analgesia.
Shahoei et al. (2017)¹⁵15 Shahoei R, Shahghebi S, Rezaei M, Naqshbandi S. The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: A clinical trial. Complement Ther Clin Pract. 2017;28:176-180. Doi: 10.1016/j.ctcp.2017.05.004 https://doi.org/10.1016/j.ctcp.2017.05.0...	To investigate the effect of TENS on labor pain among nulliparous women.	Experimental group: Application of TENS by means of a pair of electrodes at the level of the T10-L1 vertebrae and another pair at the level of S2-S4.Placebo group: TENS off (no electrical stimulus). Control group: no TENS, just routine care and guidance.	TENS provided a significant reduction in pain during labor and also 4 hours later, assessed by the VAS.TENS had no placebo effect.	TENS reduces pain during labor and 4 hours afterwards.
Báez-Suárez et al. (2018)²2 Báez-Suárez A, Martín-Castillo E, García-Andújar J, García-Hernández JA, Quintana-Montesdeoca MP, Loro-Ferrer JF. Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials. 2018;19 (01):652. Doi: 10.1186/s13063-018-3036-2 https://doi.org/10.1186/s13063-018-3036-...	To investigate the effect of pain relief by applying TENS in labor.	Experimental group: Application of TENS by means of a pair of electrodes at the level of the T10-L1 vertebrae and another pair at the level of S2-S4.Placebo group: TENS off (no electrical stimulus).	TENS provided a greater degree of pain relief in the active TENS group than in the placebo TENS group.	TENS is a safe and effective nonpharmacological option for pain relief during labor.
Njogu et al. (2021)¹⁶16 Njogu A, Qin S, Chen Y, Hu L, Luo Y. The effects of transcutaneous electrical nerve stimulation during the first stage of labor: a randomized controlled trial. BMC Pregnancy Childbirth. 2021;21 (01):164-171. Doi: 10.1186/s12884-021-03625-8 https://doi.org/10.1186/s12884-021-03625...	To determine the effects of TENS therapy in the first stage of labor.	Experimental group: Application of TENS by means of a pair of electrodes at the level of the T10-L1 vertebrae and S2-S4, in addition to a pair in each arm.Control group: routine obstetric care.	The experimental group had lower mean pain scale scores than the control group and shorter duration of the active phase of labor.	TENS can be used as a nonpharmacological therapy to reduce pain and shorten the active phase of labor.

Authors	Participants	Age range	Study methodology	Blinding	Subject allocation	Eligibility criteria
Abreu et al. (2010)¹²12 Abreu EA, Santos JD, Ventura PL. Efetividade da eletroestimulação nervosa transcutânea no alívio da dor durante o trabalho de parto: um ensaio clínico controlado. Rev Dor. 2010;11(04): 313-318 cited 2020May 22 [Internet]. Available from http://files.bvs.br/upload/S/1806-0013/2010/v11n4/a1654.pdf http://files.bvs.br/upload/S/1806-0013/2...	20	18–26	Nonrandomized controlled trial	No	Numeration of medical records (medical records with even endings were allocated to the TENS group, and those with odd endings to the control group)	Parturients between 18 and 30 years old; term pregnancy; active stage of labor; single viable fetus in cephalic presentation.
Peng et al. (2010)¹³13 Peng T, Li XT, Zhou SF, Xiong Y, Kang Y, Cheng HD. Transcutaneous electrical nerve stimulation on acupoints relieves labor pain: a non-randomized controlled study. Chin J Integr Med. 2010;16 (03):234-238. Doi: 10.1007/s11655-010-0234-9 https://doi.org/10.1007/s11655-010-0234-...	305	24–30	Nonrandomized controlled trial	No	Pregnant women who requested analgesia were enrolled in the TENS group and others were assigned to the control group	Pregnant women who dismissed epidural analgesia; term pregnancy; primiparous with singleton; fetal cephalic presentation; active stage of labor; have no obstetric complications.
Santana et al. (2016)¹⁴14 Santana LS, Gallo RB, Ferreira CH, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. 2016;62 (01):29-34. Doi: 10.1016/j.jphys.2015.11.002 https://doi.org/10.1016/j.jphys.2015.11....	46	18–21	Randomized controlled trial	Evaluator	Computer-generated random assignment list	Primiparous women do not have obstetric complications; term pregnancy; single fetus in cephalic position; spontaneous onset of labor; no use of oxytocin or other medications from hospital admission until randomization.
Shahoei et al. (2017)¹⁵15 Shahoei R, Shahghebi S, Rezaei M, Naqshbandi S. The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: A clinical trial. Complement Ther Clin Pract. 2017;28:176-180. Doi: 10.1016/j.ctcp.2017.05.004 https://doi.org/10.1016/j.ctcp.2017.05.0...	90	16–36	Randomized controlled trial	No		Primiparous; single fetus in cephalic position; pregnancy age of 38-42 weeks; active phase of labor; intact membranes.
Báez-Suárez et al. (2018)²2 Báez-Suárez A, Martín-Castillo E, García-Andújar J, García-Hernández JA, Quintana-Montesdeoca MP, Loro-Ferrer JF. Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials. 2018;19 (01):652. Doi: 10.1186/s13063-018-3036-2 https://doi.org/10.1186/s13063-018-3036-...	63	22–35	Randomized controlled trial	Double-blind	Computerized random number generator	Age > 18 years old; women with a low-risk pregnancy; 37–42 weeks gestation age; single fetus.
Njogu et al. (2021)¹⁶16 Njogu A, Qin S, Chen Y, Hu L, Luo Y. The effects of transcutaneous electrical nerve stimulation during the first stage of labor: a randomized controlled trial. BMC Pregnancy Childbirth. 2021;21 (01):164-171. Doi: 10.1186/s12884-021-03625-8 https://doi.org/10.1186/s12884-021-03625...	326	18–29	Randomized controlled trial	Evaluator	Computer-generated list	37–42 weeks gestation age; primipara and multipara with no complications; active stage of labor; single viable fetus in cephalic presentation.

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[1] Address for correspondence
Lourivaldo Bispo Alves Junior, Specialist, Quadra 5 conj D, casa 13, Arapoanga, Planaltina, DF, Brazil (e-mail: lourivaldobispo3@gmail.com).