Comparison of Transcutaneous Electrical Nerve Stimulation and Lidocaine on Episiotomy Complication in Primiparous Women: A Randomized Clinical Trial

Maryam Rezaeyan, Mehrnaz Geranmayeh, Ashraf Direkvand‑Moghadam


Introduction: Transcutaneous electrical nerve stimulation (TENS) through the skin is a nonpharmacological method of pain relief. The present study aimed to compare TENS and lidocaine on episiotomy complication in primiparous women.

Material and Methods: In a randomized, controlled clinical trial, 80 participants were included from March to July 2011 at the antenatal clinic and postdelivery ward in the Social Security Organization Hospital, Khorramabad, Lorestan, Iran. Data were collected using a demographic questionnaire, visual analog scale and redness, edema, ecchymosis, discharge, and approximation scales. The participants were randomized into two groups with equal number of participants. All participants received 5 cc of local infiltration of 1% lidocaine before episiotomy, and TENS electrodes were placed on He Gu and Shenmen points during the
crowning of fetal head. The TENS group received TENS with 100; 250 µs, the output range of 15–20 mm amplifier from crowning of first stage of labor to the end of the episiotomy repairing. The lidocaine group received 10 cc of local infiltration of 1% lidocaine before episiotomy repair while did not receive TENS electrodes. The pain intensity during and after episiotomy repair was recorded.

 Results: TENS and lidocaine have similar effects on pain relief at the episiotomy cutting, the start of the episiotomy repair, and at end of the episiotomy repair; however, the pain relief of both the interventions was different during the episiotomy repair. The effect of TENS in reducing edema was statistically significant (P = 0.001).

 Conclusions: TENS and lidocaine are effective for the episiotomy complications during and after episiotomy repair.


Analgesia; episiotomy pain relief; Iran; transcutaneous electrical nerve stimulation); visual analog scale

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Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp JJ, Lohr K. Outcomes of routine episiotomy: A systematic review. JAMA 2005;293:2141‑8.

Dodd JM, Hedayati H, Pearce E, Hotham N, Crowther CA. Rectal analgesia for the relief of perineal pain after childbirth: A randomised controlled trial of diclofenac suppositories. BJOG 2004;111:1059‑64. 3. Pietras J, Taiwo BF. Episiotomy in modern obstetrics‑‑Necessity versus malpractice. Adv Clin Exp Med 2012;21:545‑50.

Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: A randomized trial. J Midwifery Womens Health 2005;50:365‑72.

Chang SR, Chen KH, Lin HH, Chao YM, Lai YH. Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study. International J Nursing Studies 2011;48:409-18.

Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams obstetrics. 24th ed. New York: McGraw‑Hill; 2014. p. 551.

Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev 2009;CD007214.

Sjolund BH, Eriksson MB. The influence of naloxone on analgesia produced by peripheral conditioning stimulation. Brain Res 1979;173:295‑301.

Radhakrishnan R, Sluka KA. Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation‑Induced antihyperalgesia. J Pain 2005;6:673‑80.

Tashani O, Johnson M. Transcutaneous Electrical Nerve Stimulation (TENS) A Possible Aid for Pain Relief in Developing Countries? Libyan J Med 2009;4:62‑5.

Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: A randomized double blind placebo–controlled trial. Pain 2007;127:214‑20.

Direkvand‑Moghadam A, Khosravi A. The impact of a novel herbal Shirazi Thymus Vulgaris on primary dysmenorrhea in comparison to the classical chemical Ibuprofen. J Res Med Sci 2012;17:668‑70.

Liu XL, Tan JY, Molassiotis A, Suen LK, Shi Y. Acupuncturepoint stimulation for postoperative pain control: A systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2015;2015:657809.

Kaplan B, Rabinerson D, Parado J. Krieser RU, Neri A. Transcutaneous electrical nerve stimulation (TENS) as a pain‑relief device in obstetrics and gynecology. Clin Exp Obestet Gynecol 1997;24:123‑9.

Hil PD. Psychometric properties of the REEDA. J Nurs Midwifery 1990;35:162‑5.

Pazandeh F, Savadzadeh SH, Faraz Mojab H, Alavi Majd H. Effects of Chamomile Essence on Episiotomy Healing in Primiparous Women. J Ardabil Univ Med Sci 2009;8:364‑70.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short‑Form McGill Pain Questionnaire (SF‑MPQ), Chronic Pain Grade Scale (CPGS), Short Form‑36 Bodily Pain Scale (SF‑36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res 2011;63:S240–52.

Fadaizadeh L, Emami H, Samii K. Comparison of Visual Analogue Scale and Faces Rating Scale in Measuring Acute Postoperative Pain. Arch Iranian Med 2009;12:73‑5.

Direkvand‑Moghadam A, Rezaeian M. Increased intravenous hydration of nulliparas in labor. Int J Gynaecol Obstet 2012;118:213‑5.

William CA. Molecular mechanisms of gating and drug block of sodium channels. Sodium Channels and Neuronal Hyperexcitability. Novartis Foundation Symposia; 2001. p. 206‑25.

Thomson PD, Melmon KL, Richardson JA, Cohn K, Steinbrunn W, Cudihee R, et al. Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann Intern Med 1973;78:499‑508.

Pitangui AC, Araujo RC, Bezerra MJ, Ribeiro CO, Nakano AM. Low and high‑frequency TENS in post‑episiotomy pain relief: A randomized, double‑blind clinical trial. Braz J Phys Ther 2014;18:72‑8.

Hajiamini Z, Masoud SN, Ebadi A, Mahboubh A, Matin AA. Comparing the effects of ice massage and acupressure on labor pain reduction. Complement Ther Clin Pract 2012;18:169‑72.

Son SJ, Kim H, Seeley MK, Feland JB, Hopkins JT. Effects of transcutaneous electrical nerve stimulation on quadriceps function in individuals with experimental knee pain. Scand J Med Sci Sports 2015 [Epub ahead of print].

Cherian JJ, Harrison PE, Benjamin SA, Bhave A, Harwin SF, Mont MA. Do the Effects of Transcutaneous Electrical Nerve Stimulation on Knee Osteoarthritis Pain and Function Last? J Knee Surg 2015 [Epub ahead of print].

Youssef T, Youssef M, Thabet W, Lotfy A, Shaat R, Abd‑Elrazek E, et al. Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure. Int J Surg 2015;22:143‑8.

Cho SH, Lee H, Ernst E. Acupuncture for pain relief in labour: A systematic review and meta‑analysis. BJOG 2010;117:907‑20.

Can HO, Saruhan A. Evaluation of the effects of ice massage applied to large intestine 4 (hegu) on postpartum pain during the active phase of labor. Iran J Nurs Midwifery Res 2015;20:129‑38.

Freynet A, Falcoz P. Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interact Cardiovasc Thorac Surg 2010;10:283‑8.


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