Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) As An Analgesic Intervention for Labor Pain: A Network Meta-analysis of Randomized Controlled Trials

Abstract

Introduction: Epidural analgesia (EA) is the most widely used intervention for the reduction of labor pain; however, it is contra-indicated for patients with spinal deformity or allergy to anesthetics and may be refused by parturients. As a noninvasive and nonnarcotic analgesic intervention, transcutaneous electrical acupoint stimulation (TEAS) has gained increasing attention in recent years. Therefore, we performed a network meta-analysis to compare the efficacy and safety of TEAS and EA as measured by visual analog scale score, the failure rate of natural delivery, adverse events, and Apgar scores.

Methods: Relevant randomized controlled trials (RCTs) from four electronic databases (PubMed, EMBASE, Web of Science, and Cochrane CENTRAL) and clinical trials.gov were searched from inception until September 4, 2022. A random effects model was used during analysis, and outcomes were evaluated as standard mean difference (SMD), odds ratio (OR), and 95% confidence intervals (CrI) using STATA (version SE15.0), R (version 3.6.1), and ADDIS (version 1.16.8) software.

Results: Ten RCTs comprising 1214 parturients were identified by screening. Six RCTs compared TEAS and controls, three compared EA and controls, and one compared TEAS and EA. No heterogeneity was found within the four outcomes. There was no significant difference in any outcomes between interventions or control treatments in terms of SMD, OR, and CrI. Combined with the highest surface under the cumulative ranking curve score, TEAS demonstrated possible better effects in the aspects of analgesic efficacy and safety under certain circumstances.

Conclusions: TEAS may be a potential alternative for parturients as a simple, noninvasive, and non-pharmacological intervention compared with EA in terms of analgesic efficacy and safety for mothers and neonates.

Keywords: Efficacy; Epidural analgesia; Labor pain; Network meta-analysis; Safety; Transcutaneous electrical acupoint stimulation.

Fig. 1

Flow chart of study selection

Fig. 2

Summary of risks of bias

Fig. 3

The evidence network graphs and forest plots of main outcomes. a Visual analog scale score; b failure rate of natural delivery; c adverse events. Network graphs: the size of circle represents sample size; the width of the line is proportional to the number of included RCTs. Forest plots: I² value is used to assess heterogeneity. EA epidural analgesia, TEAS transcutaneous electrical acupoint stimulation, RCT randomized controlled trial, SMD standard mean difference, OR odds ratio, CrI confidence interval

Fig. 4

The evidence network graph and forest plot of Apgar scores. a Evidence network graph; b forest plot