Description Zhongwan (RN12) and bilateral acupoints Tianshu (ST25), Zusanli (ST36), and Shangjuxu (ST37)
Experimental Description
A total of 249 patients were randomly assigned to treatment groups.
Sample Count
249
Age
≥18
Control
Sham
sham acupuncture group(n=124)
Experiment
electroacupuncture group(n=125)
Indicator
Time of first defecationTime of first flatusFirst tolerance of semiliquid dietFirst tolerance of solid foodFirst ambulationVisual analog scale(VAS)Postoperative Nausea and Vomiting(PONV)Length of postoperative hospital stayReadmission rate within 30 days after dischargePostoperative complications
Auxiliary Medication
ERAS protocol (the preventive use of antibiotics, perioperative multimodal analgesia, avoidance of opioid use, early removal of urinary catheter and nasogastric tubes, early mobilization, nutritional support, and others).
Stimulation Method
EA
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
HANS-200A
Nanjing Jisheng Medical Technology Co., Ltd., Nanjing, Jiangsu, China
2/100 Hz
alternating
adjusted to trigger slight vibration of the needle handles
30 min
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
0.30×40 mm or 0.25×30 mm
Hwato disposable acupuncture needle; Suzhou, Jiangsu, China
-
Description The stimulation frequency was 2 per 100 Hz, and the intensity was adjusted to trigger slight vibration of the needle handles.
Anesthesia Method
GA
Clinical Trial Type
A Multicenter, Randomized Clinical Trial
Adverse Effects
Eight acupuncture-related AEs (6%) in the EA group and 7 AEs (6%) in the SA group were reported (Table 4). Treatment-related AEs were mild and transient. Three patients withdrew from the study because of AEs (1 patient in the EA group and 1 patient in the SA group) because of pain, and 1 patient withdrew because of residual needling sensation after needle removal. There were no serious AEs in either group.
Effector
Results of this randomized clinical trial demonstrated that in patients undergoing laparoscopic surgery for colorectal cancer with the ERAS protocol, EA shortened the duration of POI and decreased the risk for prolonged POI compared with SA. EA may be considered as an adjunct to the ERAS protocol to promote gastrointestinal function recovery and prevent prolonged POI after surgery.
"Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer: A Multicenter, Randomized Clinical Trial."
Abstract
IMPORTANCE: Despite the adoption of the optimized Enhanced Recovery After Surgery (ERAS) protocol, postoperative ileus (POI) severely impairs recovery after colorectal resection and increases the burden on the health care system. OBJECTIVE: To assess the efficacy of electroacupuncture (EA) in reducing the duration of POI with the ERAS protocol. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized, sham-controlled trial was conducted in China from October 12, 2020, through October 17, 2021. There was a 1:1 allocation using the dynamic block random method, and analyses were by intention to treat. Patients 18 years or older undergoing laparoscopic resection of colorectal cancer for the first time were randomly assigned to treatment group by a central system. INTERVENTIONS: Patients were randomly assigned to 4 sessions of EA or sham electroacupuncture (SA) after surgery. All patients were treated within the ERAS protocol. MAIN OUTCOMES AND MEASURES: The primary outcome was the time to first defecation. Secondary outcomes included other patient-reported outcome measures, length of postoperative hospital stay, readmission rate within 30 days, and incidence of postoperative complications and adverse events. RESULTS: A total of 249 patients were randomly assigned to treatment groups. After the exclusion of 1 patient because of a diagnosis of intestinal tuberculosis, 248 patients (mean [SD] age, 60.2 [11.4] years; 153 men [61.7%]) were included in the analyses. The median (IQR) time to first defecation was 76.4 (67.6-96.8) hours in the EA group and 90.0 (73.6-100.3) hours in the SA group (mean difference, -8.76; 95% CI, -15.80 to -1.73; P = .003). In the EA group compared with the SA group, the time to first flatus (median [IQR], 44.3 [37.0-58.2] hours vs 58.9 [48.2-67.4] hours; P < .001) and the tolerability of semiliquid diet (median [IQR], 105.8 [87.0-120.3] hours vs 116.5 [92.0-137.0] hours; P = .01) and solid food (median [IQR], 181.8 [149.5-211.4] hours vs 190.3 [165.0-228.5] hours; P = .01) were significantly decreased. Prolonged POI occurred in 13 of 125 patients (10%) in the EA group vs 25 of 123 patients (20%) in the SA group (risk ratio [RR], 0.51; 95% CI, 0.27-0.95; P = .03). Other secondary outcomes were not different between groups. There were no severe adverse events. CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial demonstrated that in patients undergoing laparoscopic surgery for colorectal cancer with the ERAS protocol, EA shortened the duration of POI and decreased the risk for prolonged POI compared with SA. EA may be considered as an adjunct to the ERAS protocol to promote gastrointestinal function recovery and prevent prolonged POI after surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2000038444."
Souce
JAMA Surg. 2023 Jan 1;158(1):20-27. doi: 10.1001/jamasurg.2022.5674.
