Description at bilateral points (LI4–LI11, LR3–ST36, PC6–TE5)
Experimental Description
The day before the surgery, 32 patients undergoing cardiac surgery were randomised into two groups: patients from the treatment group received preoperative EA at bilateral points (LI4–LI11, LR3–ST36, PC6–TE5) for 30 min with alternating frequencies of 3 and 15 Hz. Patients from the control group received sham transcutaneous electrical nerve stimulation (TENS).10 patients were excluded because of hemodynamic and ventilatory instability leaving 13 (10 male) in the treatment group and 9 (4 male) in the control group.
Sample Count
22
Control
Sham
control group(n=9)
Experiment
EA at bilateral points (LI4–LI11, LR3–ST36, PC6–TE5) group(n=13)
Indicator
Fentanyl dosePostoperative pain intensity
Auxiliary Medication
In both groups, patients were given postoperative analgesia in the ICU according to protocol, which consisted of us of PCA pump with continuous injection of 0.4 μg/ kg/h fentanyl dose (0.04 ml/kg/h fentanyl solution 50 ml + physiological saline solution 200 ml) together with the option of 0.3 μg/kg bolus (0.03 ml/kg of the solution) with a minimum 15 min interval between each bolus as well as a total limit of 30 ml in the 4 h period. Neither non-hormonal anti-inflammatory drugs nor local anaesthetic were used.
Stimulation Method
EA
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
EL502
NKL Laboratories, Brusque-SC, Brazil
3/15 Hz
biphasic waveform
individual maximum tolerance
30 min
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
0.25×40 mm
Dong Bang Needle Company, Korea
1-2 cm;2.3 cm(ST36)
Description Patients from Group 1 (treatment) were given preoperative EA (12–18 h prior to the surgery) and postoperative PCA. EA was applied to three pairs of acupuncture points on each side (LI4–LI11, LR3–ST36, PC6–TE5) for 30 min using 4 s alternating frequencies of 3 and 15 Hz. Power was determined according to individual maximum tolerance. The shape of the pulse wave of the EA device is a typical biphasic waveform without galvanic component (initial square wave followed by exponential inverted wave in the second phase). An electrostimulator machine was used (EL502; NKL Laboratories, Brusque-SC, Brazil). De qi (electric shock feeling) was not elicited. Needles were inserted 1–2 cm deep. At ST36 point, insertion depth was 2.3 cm and de qi was elicited by manual stimulation before EA. The needles used were sterile and disposable DongBang (Dong Bang Acupuncture, Korea) 0.25×40 mm.
Anesthesia Method
GA
Clinical Trial Type
random
Adverse Effects
no side effects were reported in the treatment group.
Effector
10 patients were excluded because of hemodynamic and ventilatory instability leaving 13 (10 male) in the treatment group and 9 (4 male) in the control group. The average total doses of fentanyl given were 13.1±2.2 and 16.3±1.6 μg/kg in the treatment and control groups respectively (p<0.002). The doses of patient controlled analgesia were 4.1±2.0 and 6.9±1.7 μg/kg in the treatment and control groups respectively (p<0.003). The number of boluses issued also differed (treatment 13.9±7.0 vs control 24.8±7.0, p<0.002). Pain intensity scores differed between the groups (treatment 2.5±1.1 vs control 4.0±2.0, p<0.04). One patient from the control group experienced drowsiness that justified a change in fentanyl infusion, as decided by the anaesthetist.Preoperative electro-acupuncture in conventional cardiac surgery may reduce the postoperative consumption of fentanyl.
"Randomised, controlled study of preoperative electroacupuncture for postoperative pain control after cardiac surgery."
Abstract
BACKGROUND: This study aims to evaluate the effects of preoperative electroacupuncture (EA) on the need for opioids in the postoperative stage of conventional cardiac surgery. METHODS: A prospective, randomised and controlled study was conducted at Unimed Hospital Centre in Joinville, SC, Brazil. The day before the surgery, 32 patients undergoing cardiac surgery were randomised into two groups: patients from the treatment group received preoperative EA at bilateral points (LI4-LI11, LR3-ST36, PC6-TE5) for 30 min with alternating frequencies of 3 and 15 Hz. Patients from the control group received sham transcutaneous electrical nerve stimulation (TENS). Use of fentanyl during the postoperative period was measured. RESULTS: 10 patients were excluded because of hemodynamic and ventilatory instability leaving 13 (10 male) in the treatment group and 9 (4 male) in the control group. The average total doses of fentanyl given were 13.1+/-2.2 and 16.3+/-1.6 mug/kg in the treatment and control groups respectively (p<0.002). The doses of patient controlled analgesia were 4.1+/-2.0 and 6.9+/-1.7 mug/kg in the treatment and control groups respectively (p<0.003). The number of boluses issued also differed (treatment 13.9+/-7.0 vs control 24.8+/-7.0, p<0.002). Pain intensity scores differed between the groups (treatment 2.5+/-1.1 vs control 4.0+/-2.0, p<0.04). One patient from the control group experienced drowsiness that justified a change in fentanyl infusion, as decided by the anaesthetist. CONCLUSION: Preoperative electro-acupuncture in conventional cardiac surgery may reduce the postoperative consumption of fentanyl."
