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Abstract
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Background and Aims Effective postoperative pain management is a pivotal determinant of recovery following orthopedic surgery. While opioids have traditionally been used for this purpose, their side effects have prompted the search for alternative methods.Transcranial direct current stimulation (tDCS) has emerged as a promising modality for opioid-sparing and pain reduction. To this end, we conducted a meta-analysis to assess the relative efficacy of active tDCS compared to sham tDCS in patients undergoing orthopedic procedures.
Methods PubMed, EMBASE, Scopus, and Cochrane were searched for randomized controlled trials (RCTs) comparing active versus sham tDCS in the postoperative period of orthopedic surgery. We assessed outcomes such as opioid consumption, and pain scores. We used RevMan 5.4 for statistical analyses and evaluated the risk of bias using the RoB-2 tool.
Results Active tDCS was associated with significantly lower opioid consumption (Mean Difference -2.43; 95% CI -4.09 to -0.77; p<0.004; I2 = 69%; 4RCTs; 180 patients; figure 1) and lower pain scores (Standard Mean Difference -0.33; 95% CI -0.33 to -0.03; p<0.03; I2 = 0%; 4 RCTs; 191 patients; figure 2) when compared to sham tDCS.
Opioid consumption was lower for the tDCS group when compared to the sham group
Pain scores favoured the tDCS group
Conclusions The findings of our meta-analysis suggest that transcranial direct current stimulation (tDCS) holds promise as an adjunctive therapy to opioid-based pain management during the postoperative phase of orthopedic procedures. tDCS has demonstrated potential advantages, such as diminishing opioid consumption and decreasing pain intensity.