{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:57:22Z","timestamp":1771930642683,"version":"3.50.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to systematically evaluate the potential effects of transcutaneous electrical nerve stimulation (TENS) on analgesic consumption, pain relief, and pulmonary function outcomes in patients following coronary artery bypass grafting (CABG).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic literature search was conducted across four core databases\u2014PubMed, Embase, Web of Science, and the Cochrane Library. Methodological quality was evaluated using the Cochrane Risk of Bias (RoB 2.0) tool, and the certainty of evidence was evaluated using the GRADE system. For statistical analysis, standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for continuous variables. Heterogeneity was assessed via the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic (threshold: 50%), with fixed-effects models applied when\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009\u2264\u200950% or random-effects models applied when\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009&amp;gt;\u200950%. Subgroup analyses stratified by intervention duration were performed for outcomes demonstrating significant heterogeneity (\n                      <jats:italic>I\u00b2<\/jats:italic>\n                      \u2009\u2265\u200950%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      First, regarding pain management, TENS demonstrated greater efficacy in postoperative acute pain at rest (within 12\u2005h) than control interventions (SMD\u2009=\u2009\u22121.02, 95% CI: \u22120.23\u20132.28;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.11), albeit with high heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200988.50%). Postoperative chronic pain at rest (5 days) was more pronounced (SMD\u2009=\u2009\u22122.00, 95% CI: \u22124.15\u20130.15;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.07). Second, in terms of pulmonary recovery, TENS significantly improved forced expiratory volume within 1\u2005s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      : SMD\u2009=\u20090.85, 95% CI: 0.43\u20131.26;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.00) but not forced vital capacity (FVC: SMD\u2009=\u2009\u22121.02, 95% CI: \u22120.23\u20132.28;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.11), with heterogeneity levels of 54.00% and 88.50%, respectively. Third, regarding analgesic use, TENS reduced postoperative opioid consumption (SMD\u2009=\u2009\u22124.23, 95% CI: \u22127.31 to \u22121.15;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007), although heterogeneity remained high (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996.20%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The current evidence preliminarily suggests that TENS may reduce postoperative analgesic dependence and modestly improve pulmonary function in patients following CABG; however, it has not demonstrated a statistically significant advantage in pain relief. Given the substantial heterogeneity across studies, these findings should be interpreted with caution. Future large-scale RCTs with standardized protocols are needed to validate these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024594786<\/jats:ext-link>\n                      , PROSPERO CRD42024594786.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1690565","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:44:47Z","timestamp":1770273887000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of transcutaneous electrical nerve stimulation on patients after coronary artery bypass grafting: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Enyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Hospital of Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihe","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Hospital of Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Hospital of Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lulu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Hospital of Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Hospital of Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Second Hospital of Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"E685","DOI":"10.59958\/hsf.8689","article-title":"Evolution and progress of coronary artery bypass grafting: 2025","volume":"28","author":"Alshneikat","year":"2025","journal-title":"Heart Surg Forum"},{"key":"B2","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1055\/a-2624-5607","article-title":"The history of coronary artery disease","volume":"34","author":"Gorton","year":"2025","journal-title":"Int J Angiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"qgaf211","DOI":"10.1093\/postmj\/qgaf211","article-title":"Opioid induced constipation: mechanisms and management","volume":"15","author":"Becker","year":"2025","journal-title":"Postgrad Med J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.neurom.2023.02.085","article-title":"Transcutaneous electric nerve stimulation in animal model studies: from neural mechanisms to biological effects for analgesia","volume":"27","author":"Tavares Oliveira","year":"2024","journal-title":"Neuromodulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"4645","DOI":"10.1080\/09638288.2025.2453640","article-title":"Rehabilitative effects of transcutaneous electric nerve stimulation on limb function in stroke patients: a systematic review and meta-analysis","volume":"47","author":"Song","year":"2025","journal-title":"Disabil Rehabil"},{"key":"B6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s11916-020-0846-1","article-title":"Transcutaneous electrical nerve stimulation in relieving neuropathic pain: basic mechanisms and clinical applications","volume":"24","author":"Mokhtari","year":"2020","journal-title":"Curr Pain Headache Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.jclinepi.2021.02.003","article-title":"Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement","volume":"134","author":"Page","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"B8","first-page":"l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume-title":"Br Med J","author":"Sterne","year":"2019"},{"key":"B9","doi-asserted-by":"publisher","first-page":"Ed000142","DOI":"10.1002\/14651858.Ed000142","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"Br Med J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"Br Med J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"385","DOI":"10.4103\/0019-5154.185700","article-title":"Biostatistics series module 4: comparing groups\u2014categorical variables","volume":"61","author":"Hazra","year":"2016","journal-title":"Indian J Dermatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1152\/japplphysiol.00993.2013","article-title":"Sympathetic ganglion transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery improves femoral blood flow and exercise tolerance","volume":"117","author":"Cipriano","year":"2014","journal-title":"J Appl Physiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/S0031-9406(05)65606-4","article-title":"TENS and pain control after coronary artery bypass surgery","volume":"83","author":"Domtaille","year":"1997","journal-title":"Physiotherapy"},{"key":"B15","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.pmn.2017.10.018","article-title":"Effect of TENS on postoperative pain and pulmonary function in patients undergoing coronary artery bypass surgery","volume":"19","author":"Jahangirifard","year":"2018","journal-title":"Pain Manag Nurs"},{"key":"B16","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1590\/s0102-76382009000400020","article-title":"The role of electroanalgesia in patients undergoing coronary artery bypass surgery","volume":"24","author":"Luchesa","year":"2009","journal-title":"Rev Bras Cir Cardiovasc"},{"key":"B17","doi-asserted-by":"publisher","first-page":"E266","DOI":"10.1532\/HSF98.20081139","article-title":"Comparison of continuous and intermittent transcutaneous electrical nerve stimulation in postoperative pain management after coronary artery bypass grafting: a randomized, placebo-controlled prospective study","volume":"12","author":"Solak","year":"2009","journal-title":"Heart Surg Forum"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.17219\/acem\/159703","article-title":"Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: a systematic review","volume":"32","author":"Szmit","year":"2023","journal-title":"Adv Clin Exp Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1007\/s11121-023-01588-0","article-title":"Developing the opioid rapid response system\u2122 for lay citizen response to the opioid overdose crisis: a randomized controlled trial","volume":"24","author":"Hecht","year":"2023","journal-title":"Prev Sci"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e92668","DOI":"10.7759\/cureus.92668","article-title":"Impact of yoga nidra on heart rate variability in coronary artery disease patients undergoing coronary artery bypass grafting: a comparative study","volume":"17","author":"Antony","year":"2025","journal-title":"Cureus"},{"key":"B21","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1080\/17581869.2025.2529150","article-title":"Effects of transcutaneous electrical nerve stimulation in complex regional pain syndrome: a systematic review","volume":"15","author":"Righi","year":"2025","journal-title":"Pain Manag"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e61","DOI":"10.12771\/emj.2025.00724","article-title":"Two paths, one goal-uniting regional and general anesthesia for optimal surgical care: a narrative review","volume":"48","author":"Kim","year":"2025","journal-title":"Ewha Med J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e65703","DOI":"10.7759\/cureus.65703","article-title":"Evaluating the effectiveness of transcutaneous electrical nerve stimulation for various outcomes in emergency department settings: a systematic review and meta-analysis","volume":"16","author":"Ahmed","year":"2024","journal-title":"Cureus"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2217\/pmt-2016-0030","article-title":"Transcutaneous electrical nerve stimulation: current status of evidence","volume":"7","author":"Johnson","year":"2017","journal-title":"Pain Manag"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1690565\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:56:51Z","timestamp":1771927011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1690565\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":24,"alternative-id":["10.3389\/fcvm.2026.1690565"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1690565","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]},"article-number":"1690565"}}