ABSTRACT
BACKGROUND: Transcutaneous electrical acupoint stimulation (TEAS) exerts good analgesic effect, but its effectiveness and safety in analgesia after total knee arthroplasty have not been reported.OBJECTIVE: To evaluate the analgesic effect of TEAS at the auricular Shenmen (H 7) point in patients undergoing total knee arthroplasty.METHODS: Forty ASA Ⅰ-Ⅲ patients scheduled for total knee arthroplasty under general anesthesia combined with femoral nerve block were enrolled and randomly divided into experimental and control groups (n=20 per group). The patients in the experimental group received TEAS at auricular Shenmen (H 7) point before anesthesia, 8, 16, 36, and 56 hours postoperatively for 30 minutes. The patients in the control group received same method with the experimental group, but without electrical stimulation. Ultrasound-guided continuous femoral nerve blockade was performed before induction, followed by tracheal tube was inserted and the patients were mechanically ventilated. The patients received patient-controlled continuous femoral nerve analgesia after surgery for 72 hours. The Visual Analogue Scale scores and the quadriceps maximum voluntary isometric contraction were recorded at postoperative 6, 12, 24, 48 and 72 hours. The consumption of ropivacaine and tramadol hydrochloride was recorded. Additionally, the incidence of adverse reactions was recorded.RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores in the experimental group were significantly lower than those in the control group at postoperative 48 and 72 hours (P < 0.05). (2) The quadriceps maximum voluntary isometric contraction in the control group was significantly lower than that in the experimental group at each time point (P < 0.05). (3) The consumption of ropivacaine in the control group ((495.7±39.4) mL) was significantly more than that in the experimental group ((394.5±27.1) mL) (P < 0.05). Seven cases in the control group and one case in the experimental group received the injection of tramadol hydrochloride (P < 0.05). (4) Nausea and vomiting occurred in six cases in the control group and one case in the experimental group, and dizziness only occurred in four cases in the control group (P < 0.05). (5) To conclude, TEAS at the auricular Shenmen (H 7) point can improve the pain after total knee arthroplasty, reduce the consumption of ropivacaine and tramadol hydrochloride, and maintain quadriceps strength.
ABSTRACT
<p><b>OBJECTIVE</b>To discuss the clinical therapeutic effects of electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) on the analgesic effect of thoracic perioperative stage and its effect mechanism.</p><p><b>METHODS</b>Sixty cases of esophageal cancer with elective radical resection under general anesthesia were divided into an observation group and a control group according to the operation sequence, 30 cases in each one. In the control group, the general anesthesia was simply applied and sufentanil was administered for patient controlled intravenous analgesia (PCIA) after operation. In the observation group, on the basis of the scheme as the control group, the electroacupuncture was used at Neimadian (Extra) and Neiguan (PC 6) 30 min before anesthesia induction and after operation, with continuous wave, tolerable intensity, lasting for 30 min. Separately, before acupuncture (T1) and 2h (T2), 12h (T3), 24h (T4) and 48h (T5) after operation, the plasma β-endorphin (β-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E(PGE) were determined. During operation, under the same state (from 50 to 60) of bispectrum of EEG (BIS), the intraoperative anesthetic dose was recorded. Using visual analogue scale (VAS), the pain degree was evaluated at T2, T3, T4 and T5 separately and the grade assessment of the therapeutic effects and safety were recorded at each time point.</p><p><b>RESULTS</b>①The total dosage of sufentanil in the observation group was less than that in the control group[(1.83±0.56) mg vs (2.54±0.62) mg,<0.05]. ②VAS scores at T2, T3 and T4 in the patients of the observation group were all lower than those in the control group (all<0.05). ③The levels of plasma β-EP at T3, T4 and T5 in the observation group were increased significantly as compared with those in the control group (all<0.05) and the levels of plasma 5-HT and PGEat T2, T3 and T4 were reduced significantly as compared with those in the control group (all<0.05). ④ The excellent analgesia rates 2h、12h and 24h after operation in the observation group were better than those in the control group (all<0.05). ⑤The rate of the A grade safety in the observation group was higher than that in the control group (<0.05).</p><p><b>CONCLUSIONS</b>Electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) provides the safe and effective postoperative anesthesia of thoracic surgery and reduces the dosage of analgesics during the operation, which is possibly related to the increase of endogenous β-EP and the inhibition on the release of 5-HT and PGE.</p>