Description bilaterally at two groups of distal acupoints: one group consisted of Hegu (LI4) and Neiguan (PC6), the other contained Zusanli (ST36) and Shangjuxu (ST37; Fig. 1)
Experimental Description
A total of 280 patients undergoing abdominal surgery were stratified by type of surgery (i.e., gastric or colorectal surgery) and randomly allocated into the TEAS group (group T) or the sham group (group S). Patients in group T received TEAS at LI4, PC6, ST36 and ST37. Patients in group S received pseudo-TEAS at sham acupoints. The stimulation was given from 30 min before anesthesia until the end of surgery. The same treatment was performed at 9 am on the 1st, 2nd and 3rd days after surgery, until the recovery of flatus in patients.
Sample Count
280
Age
18-70
Control
Sham
sham group(n=140)
Experiment
TEAS group(n=140)
Indicator
AgeGenderHeightWeightComorbiditiesHistory of abdominal surgeryIntraoperative infusion volumeDuration of anesthesiaDuration of surgeryTime to the first bowel motionTime of first flatusFirst ambulationThe level of perioperative plasma SPOccurrence rate of PGDVisual analog scale(VAS)Postoperative Nausea and Vomiting(PONV)Duration of hospital stayCost of hospitalization
Auxiliary Medication
Patients received general anesthesia intravenously, as determined by the chief anesthesiologist. Postoperative analgesia measures included an intravenous analgesic pump that dispensed 250 mg sufentanil in 250 mL saline. If the VAS score was ≥ 4 points, 50 mg flubiprofen (intravenously guttae) was given. The occurrence of nausea and vomiting was also recorded.
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
Thes timulation intensity was adjusted in accordance with the maximal level tolerated by each patient.
The stimulation (real or sham) lasted from 30 min before surgery until the endof the operation.
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
-
-
-
Description They were connected to two guide wires, which were attached to a HANS acupoint nerve stimulator (HANS-200A, Nanjing Jisheng Medical Technology Co., Ltd., China; Fig. 2); each patient required 8 electrodes. Stimulation was delivered with a disperse-dense wave, 2 and 100 Hz in frequency, alternating every 3s.The wave widths were 2Hz for 0.6ms and 100Hz for 0.2ms, and the waveform was complete symmetric biphasic pulse. The stimulation intensity was adjusted in accordance with the maximal level tolerated by each patient. TEAS application began before operation. The stimula- tion (real or sham) lasted from 30 min before surgery until the end of the operation. At 9:00 am on the 1st, 2nd and 3rd days after surgery, the same acupuncturist that attended the patients during their operation performed the same acupuncture manipulation (real or sham) that they had received during surgery. Each session lasted for 30 min until the flatus of patient recovered.
Anesthesia Method
AAA
Clinical Trial Type
a single-center study
Contraindications
Surgical incision or scar near the acupoints of Hegu (LI4),Neiguan (PC6), Zusanli (ST36) and Shangjuxu (ST37); local skininfection at study acupoints; nerve damage in upper or lowerlimbs; a history of spinal surgery
Effector
The time to first bowel motion, first flatus and first ambulation in group T was much shorter than that in group S (P < 0.01). In patients undergoing colorectal surgery, the concentration of SP was lower in group T than in group S on the third day after the operation (P < 0.05). The average incidence of PGD in all patients was 25%, and the frequency of PGD was significantly lower in group T than in group S (18.6% vs. 31.4%, respectively; P < 0.05). TEAS treatment (odds ratio = 0.498; 95% confidence interval: 0.232–0.786) and type of surgery were relevant factors for the development of PGD. Postoperative pain score and PONV occurrence were significantly lower in group T (P < 0.01). Postoperative hospitalization days and the resulting cost to patients were greatly reduced in the TEAS group (P < 0.01). Perioperative TEAS was able to promote the recovery of postoperative gastrointestinal func- tion, reduce the incidence of PGD and PONV. The concentration of SP was decreased by TEAS treatment, which indicates that the brain-gut axis may play a role in how TEAS regulates gastrointestinal function.
Perioperative transcutaneous electrical acupoint stimulation for improving postoperative gastrointestinal function: A randomized controlled trial.
Abstract
BACKGROUND: Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications in patients undergoing major abdominal surgery. Acupuncture has been used widely in gastrointestinal diseases due to its effectiveness and minimally invasive nature. OBJECTIVE: This study evaluated the efficacy of using transcutaneous electrical acupoint stimulation (TEAS) during the surgery and postoperative recovery in patients with gastric and colorectal surgery for improving postoperative gastrointestinal function. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: A total of 280 patients undergoing abdominal surgery were stratified by type of surgery (i.e., gastric or colorectal surgery) and randomly allocated into the TEAS group (group T) or the sham group (group S). Patients in group T received TEAS at LI4, PC6, ST36 and ST37. Patients in group S received pseudo-TEAS at sham acupoints. The stimulation was given from 30 min before anesthesia until the end of surgery. The same treatment was performed at 9 am on the 1st, 2nd and 3rd days after surgery, until the recovery of flatus in patients. MAIN OUTCOME MEASURES: The primary outcome was the time to the first bowel motion, as detected by auscultation. The secondary outcomes included the first flatus and ambulation time, changes of perioperative substance P (SP), incidence of PGD, postoperative pain, postoperative nausea and vomiting (PONV) and some economic indicators. RESULTS: The time to first bowel motion, first flatus and first ambulation in group T was much shorter than that in group S (P < 0.01). In patients undergoing colorectal surgery, the concentration of SP was lower in group T than in group S on the third day after the operation (P < 0.05). The average incidence of PGD in all patients was 25%, and the frequency of PGD was significantly lower in group T than in group S (18.6% vs. 31.4%, respectively; P < 0.05). TEAS treatment (odds ratio = 0.498; 95% confidence interval: 0.232-0.786) and type of surgery were relevant factors for the development of PGD. Postoperative pain score and PONV occurrence were significantly lower in group T (P < 0.01). Postoperative hospitalization days and the resulting cost to patients were greatly reduced in the TEAS group (P < 0.01). CONCLUSION: Perioperative TEAS was able to promote the recovery of postoperative gastrointestinal function, reduce the incidence of PGD and PONV. The concentration of SP was decreased by TEAS treatment, which indicates that the brain-gut axis may play a role in how TEAS regulates gastrointestinal function. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900023263."
