Abstract
This prospective randomized study aims to evaluate the feasibility and cost-effectiveness of combining transcranial direct current stimulation (tDCS) with patient controlled intravenous morphine analgesia (PCA-IV) as part of multimodal analgesia after thoracotomy. Patients assigned to the active treatment group (a-tDCS, n = 27) received tDCS over the left primary motor cortex for five days, whereas patients assigned to the control group (sham-tDCS, n = 28) received sham tDCS stimulations. All patients received postoperative PCA-IV morphine. For cost-effectiveness analysis we used data about total amount of PCA-IV morphine and maximum visual analog pain scale with cough (VASP-Cmax). Direct costs of hospitalization were assumed as equal for both groups. Cost-effectiveness analysis was performed with the incremental cost-effectiveness ratio (ICER), expressed as the incremental cost (RSD or US$) per incremental gain in mm of VASP-Cmax reduction. Calculated ICER was 510.87 RSD per VASP-Cmax 1 mm reduction. Conversion on USA market (USA data 1.325 US$ for 1 mg of morphine) revealed ICER of 189.08 US$ or 18960.39 RSD/1 VASP-Cmax 1 mm reduction. Cost-effectiveness expressed through ICER showed significant reduction of PCA-IV morphine costs in the tDCS group. Further investigation of tDCS benefits with regards to reduction of postoperative pain treatment costs should also include the long-term benefits of reduced morphine use.
Highlights
The efficacy of transcranial direct current stimulation as an adjuvant nonpharmacological method to conventional regional or systemic analgesia for acute postoperative pain was investigatedInt
Published studies on transcranial direct current stimulation (tDCS) efficacy for postoperative pain management tended to focus on opioid consumption and pain intensity, but there was no attempt to explore the cost-effectiveness of tDCS use for acute postoperative pain management
This study aimed to evaluate the cost-effectiveness of combining tDCS with intravenous morphine patient controlled analgesia (PCA) for the management of acute post-thoracotomy pain
Summary
The efficacy of transcranial direct current stimulation (tDCS) as an adjuvant nonpharmacological method to conventional regional or systemic analgesia for acute postoperative pain was investigatedInt. Res. Public Health 2020, 17, 816 in seven studies [1,2,3,4,5,6,7]. Public Health 2020, 17, 816 in seven studies [1,2,3,4,5,6,7] This was a proof-of-concept clinical trial attempting to explore the impact of tDCS combined with patient controlled intravenous morphine analgesia (PCA-IV) on analgesic use and post-thoracotomy pain. Published studies on tDCS efficacy for postoperative pain management tended to focus on opioid consumption and pain intensity, but there was no attempt to explore the cost-effectiveness of tDCS use for acute postoperative pain management
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