Entonox and TENS have both been used for the management of patients with surgical wound pain during physiotherapy. A prospective randomised placebo controlled study was performed to compare the efficacy of these two treatments. Thirty-one post-abdominal surgical patients were involved in the study. Each of these patients received, in random order, three respiratory physiotherapy treatment sessions with analgesia: either Entonox via a face mask (Entonox group), para-incisional TENS (TENS group), or TENS applied to the leg (TTL group). Pain was quantified using a visual analogue scale and efficacy of physiotherapy was assessed by peak expiratory flow rate (PEFR). Both variables were measured before, immediately post, and 30 minutes after each treatment in the half-lying position, by the same physiotherapist. Our study showed that TENS and Entonox were both equally effective in pair relief and in improving peak expiratory flow rate in patients after upper abdominal surgery. This improvement was maintained for 30 minutes after treatment. Non-specific factors influenced the assessment of subjective pain relief immediately after physiotherapy treatment, but this effect lasted for less than 30 minutes. However, PEFR was not significantly influenced by pshychological factors. Physiotherapy without analgesia (with placebo TENS) caused a reduction in PEFR and may be detrimental in patients with post-operative wound pain. TENS was free from any side-effects and has sufficient practical advantages to make it the preferred choice of supplementary analgesia during chest physiotherapy.

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