Cholecystectomy, Laparoscopic;Laparoscopic Gynecological Surgery
Acupoint
Acupoint
Code
Neiguan
PC6
Hegu
LI4
Side
Description Hegu (LI4) and Neiguan (P6)
Experimental Description
From July 2012 to October 2013, 380 patients scheduled for laparoscopic surgery under general anesthesia were randomly assigned to receive sham TEAS (group SSS), preoperative TEAS (group TSS), preoperative TEAS combined with intraoperative TEAS (group TTS) or preoperative TEAS combined with post-operative TEAS (group TST) (n=95 each group).
Sample Count
380
Age
18-70
Control
Sham
sham TEAS (group SSS)(n=95)
Experiment
preoperative TEAS (group TSS)(n=95);preoperative TEAS combined with intraoperative TEAS (group TTS)(n=95);preoperative TEAS combined with post-operative TEAS (group TST)(n=95)
Indicator
Visual analog scale(VAS)Intraoperative propofol and opioid consumptionPostoperative Nausea and Vomiting(PONV)Supplementary analgesic and antiemetic requirementsExtubation timeLength of stay in PACUTime of first flatusTime of first defecationPatient satisfaction
Auxiliary Medication
No premedication was administered. During the operation, standardized mon- itoring and bispectral index were applied. Anesthesia was induced with propofol 2.0 to 4.0 mg/kg and sufentanil 0.5 to 1.0 ug/kg, and rocuronium 0.6 mg/kg was administered to provide neuromuscular blockade for tracheal intubation. Anesthesia was maintained with adjusted propofol and remifentanil infusion to maintain the bispectral index 40 to 50. Propofol and remifentanil infusion were continued until skin suturing was completed. To evaluate the anesthetic consumption, opioids were converted to morphine using the following equivalencies: 0.01 mg of sufentanil = 0.1 mg of remifentanil = 10 mg of morphine. No local anesthetic was used before skin incision or after conclusion of the procedure. According to our clinical routine postoperative analgesia scheme, all patients received intravenous flurbiprofenaxetil 50 mg at the end of surgery, and intravenous flurbiprofenaxetil 50 mg was supplemented if the analgesia was inadequate (VAS ≥ 4) or if patients required analgesics within 48 hours. All patients were also given tropisetron 5 mg at the end of surgery, and additional 5 mg was given intravenously as rescue, if vomiting occurred or if persistent nausea was reported for 2 hours.
Stimulation Method
TEAS
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
sparse-dense wave
at a maximum current tolerated but subnoxious to the patient.
30 min
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
-
-
-
Description TEAS was achieved by a battery-powered unit named HANS Acupoint Nerve Stimulator (HANS-200A, Nanjing Jisheng Medical Technology Company, Nanjing, China), which sent electrical impulses through 2 pairs of rubber electrodes (4 × 4 cm) attached to participant’s bilateral acupoints. Patients in the TEAS treatment groups received an alternating dense and disperse stimulation, where the 2 Hz (0.6 ms pulse width) stimulation is alternated with 100 Hz stimulation (0.2 ms pulse width) automatically in every 3 seconds, 9,13,18 at a maximum current tolerated but subnoxious to the patient.Each treatment lasted 30 minutes in each perioperative period. For sham TEAS, patients were stimulated with the minimal current that the patient could feel, with the same alternating frequency as described above, for 5 minutes, and the electrodes were applied to the same acupoints as in the study group and were retained in situ for 30 minutes.
Anesthesia Method
AAA
Clinical Trial Type
randomized controlled trial
Adverse Effects
No side effect related to TEAS was observed during the postoperative 48 hours.
Effector
At postoperative 6 hours, the activity pain intensity was significantly lower in groups TTS and TST compared with groups SSS and TSS (P<0.001). At postoperative 24 and 48 hours, activity pain intensity decreased in group TST compared with both groups SSS and TSS (P<0.001). The supplemental analgesic requirement was less in group TST compared with group SSS. There was no significant difference in intraoperative anesthetic consumption, postoperative nausea and vomiting and time of the first postoperative flatus or defecation among the 4 groups. The patient satisfactory rate was higher in groups TSS, TTS, and TST compared with group SSS. No side effect related to TEAS was observed during the postoperative 48 hours. Combination of preoperative TEAS with intraoperative or postoperative TEAS, rather than preoperative TEAS alone, is an effective and safe adjunctive for management of postoperative pain following laparoscopic surgery.
Perioperative Transcutaneous Electrical Acupoint Stimulation for Postoperative Pain Relief Following Laparoscopic Surgery: A Randomized Controlled Trial.
Abstract
OBJECTIVES: This trial was conducted to assess the influence of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain intensity and the optimal time of TEAS application during perioperative period in patients undergoing laparoscopic surgery. METHODS: From July 2012 to October 2013, 380 patients scheduled for laparoscopic surgery under general anesthesia were randomly assigned to receive sham TEAS (group SSS), preoperative TEAS (group TSS), preoperative TEAS combined with intraoperative TEAS (group TTS) or preoperative TEAS combined with postoperative TEAS (group TST) (n=95 each group). Primary outcomes included resting and activity pain intensity evaluated by visual analog scale at 1, 6, 24, and 48 hours after surgery. RESULTS: At postoperative 6 hours, the activity pain intensity was significantly lower in groups TTS and TST compared with groups SSS and TSS (P<0.001). At postoperative 24 and 48 hours, activity pain intensity decreased in group TST compared with both groups SSS and TSS (P<0.001). The supplemental analgesic requirement was less in group TST compared with group SSS. There was no significant difference in intraoperative anesthetic consumption, postoperative nausea and vomiting and time of the first postoperative flatus or defecation among the 4 groups. The patient satisfactory rate was higher in groups TSS, TTS, and TST compared with group SSS. No side effect related to TEAS was observed during the postoperative 48 hours. DISCUSSION: Combination of preoperative TEAS with intraoperative or postoperative TEAS, rather than preoperative TEAS alone, is an effective and safe adjunctive for management of postoperative pain following laparoscopic surgery."
