Pain research & management
Efficacy and Safety of Perioperative Transcranial Electrical Stimulation for Postoperative Pain and Related Outcomes: A Systematic Review and Meta-Analysis With Trial Sequential and Subgroup Analyses
By Liu Z, Zhang Y, Li Y and 7 others.
Abstract
Objectives
Transcranial electrical stimulation (tES) is a neuromodulation technique that can serve as an adjuvant tool during the perioperative period. With emerging randomized controlled trials (RCTs) supporting its efficacy across various surgical procedures, synthesis of current evidence and evaluation of its potential for postoperative analgesia in elective-surgery patients and related outcomes are urgently needed.
Materials and methods
We initially searched PubMed, the Cochrane Library, MEDLINE, and Embase for RCTs investigating perioperative tES in patients undergoing elective surgery. The search period covered from the inception of each database to September 2025, and an updated search for newly published studies was conducted in September 2026. We analyzed the outcomes, including postoperative pain scores, opioid consumption, quality of recovery, incidence of postoperative delirium, and adverse events. The Cochrane Risk of Bias 2 (RoB 2) tool was used to evaluate the risk of bias in included studies. Sensitivity and publication bias analyses were performed. Exploratory subgroup analysis and meta-regression were performed to identify sources of heterogeneity. We also analyzed outlier studies. Trial sequential analysis (TSA) was further performed to evaluate the robustness of evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence.