Pemf Therapy Rapidly Reduces Post-Operative Pain In TRAM Flap Patients

Background: Autologous breast reconstruction utilizing an abdominal donor site can result in significant post-operative pain.  Pulsed electromagnetic field  (PEMF) therapy has been shown to rapidly reduce pain after breast reduction without the cost and side effects of narcotic pain medications, but its efficacy following more complex reconstructive surgeries has not been examined.¹ This study investigates whether PEMF therapy can reduce pain levels and narcotic use after pedicled transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction.

Methods: In this double-blind, randomized, placebo-controlled pilot study, 17 patients undergoing pedicled TRAM flaps received either placebo or PEMF therapy to the abdominal donor site and the breast flap immediately post-op. PEMF therapy, identical to that used for breast reduction¹, was delivered via disposable devices (Ivivi Health Sciences, LLC, San Francisco) in a continuous regimen of 15 min every 2 hours. All patients were given patient-controlled analgesia to take as needed for the first two days post-op, followed by oral pain medications. Pain levels were self-reported on a visual analog scale (VAS), and narcotics were quantified as Percocet equivalents.

Results: Mean VAS scores in the active cohort decreased approximately 3-fold faster (P < 0.01) than those in the sham cohort during the first 24 hours of intermittent PEMF therapy; placebo pain scores were more than 2.5-fold those of active treatment scores at 5 hours post-op (P = 0.009), which persisted to 24 hours post-op (P = 0.021).  Percocet equivalent pill count was approximately 2-fold higher in the placebo group compared to the therapy group for the first 24 hours post-op (P = 0.021). These results are summarized in Figures 1 and 2.

Conclusions: PEMF therapy was effective in rapidly reducing post-operative pain and use of narcotic medications following TRAM flap breast reconstruction. These results are similar to those obtained in a previous study on breast reduction, suggesting that pulsed electromagnetic fields, delivered with disposable and economical devices, can be effective for pain management, not only after smaller procedures, but also for more complex surgeries in which pain can be greater and longer-lasting.

Reference:

1. Rohde C, Chiang A, Adipojou O, Casper D, Pilla AA. "Effects of Pulsed Electromagnetic Fields on IL-1β and Post Operative Pain: A Double-Blind, Placebo-Controlled Pilot Study in Breast Reduction Patients." Plast Reconstr Surg. 2010, 125: 1620-1629.