经皮穴位电刺激可减少鼻窦切开术中瑞芬太尼的用量并减轻术后副作用：一项前瞻性、随机、安慰剂对照试验。

Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial.

机构信息

Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.

Department of Anesthesiology, School of Medicine, Stony Brook University, New York, NY 11794-8480, USA.

出版信息

Br J Anaesth. 2014 Jun;112(6):1075-82. doi: 10.1093/bja/aeu001. Epub 2014 Feb 26.

DOI:10.1093/bja/aeu001

PMID:24576720

Abstract

BACKGROUND

Although opioids are widely used as analgesics in general anaesthesia, they have unpleasant side-effects and can delay postoperative recovery. Acupuncture and related techniques are effective for acute and chronic pain, and reduces some side-effects. We assessed the effect of transcutaneous electric acupoint stimulation (TEAS) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects.

METHODS

Sixty patients undergoing sinusotomy were randomly assigned to TEAS or control group. TEAS consisted of 30 min of stimulation (6-9 mA, 2/10 Hz) on the Hegu (LI4), Neiguan (PC6), and Zusanli (ST36) before anaesthesia. The patients in the control group had the electrodes applied, but received no stimulation. Bispectral index was used to monitor the depth of anaesthesia. Perioperative haemodynamics were recorded, and peripheral blood samples were collected to measure the levels of mediators of surgical stress. The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anaesthesia-related side-effects.

RESULTS

Patients in the TEAS group required 39% less remifentanil during surgery than controls [0.0907 (SD 0.026) μg kg(-1) min(-1) vs 0.051 (0.018) μg kg(-1) min(-1)]. There were no differences in intra-operative haemodynamics or surgical stress between groups. However, the time to extubation and recall in the control group was 16.8 (6.8) min and 23.0 (5.0) min, respectively, significantly longer than that in the TEAS group (P<0.01). TEAS also decreased the incidence of dizziness and pruritus within the first 24 h after surgery (P<0.01).

CONCLUSION

The use of TEAS significantly reduced intra-operative remifentanil consumption and alleviated postoperative side-effects in patients undergoing sinusotomy.

CLINICAL TRIAL REGISTRATION

The trial was registered at clinicaltrials.gov (NCT01700855).

摘要

背景

尽管阿片类药物在全身麻醉中被广泛用作镇痛药，但它们具有令人不快的副作用，并可能延迟术后恢复。针灸和相关技术对急性和慢性疼痛有效，并减少一些副作用。我们评估了经皮电穴位刺激（TEAS）对术中瑞芬太尼消耗和麻醉相关副作用发生率的影响。

方法

60 例接受鼻窦切开术的患者被随机分为 TEAS 组或对照组。TEAS 组在麻醉前进行 30 分钟刺激（6-9 mA，2/10 Hz），刺激穴位为合谷（LI4）、内关（PC6）和足三里（ST36）。对照组患者应用电极，但不接受刺激。双谱指数用于监测麻醉深度。记录围手术期血流动力学，并采集外周血样测量手术应激介质水平。主要终点是术中瑞芬太尼消耗，次要终点是恢复质量和麻醉相关副作用。

结果

TEAS 组患者术中瑞芬太尼消耗比对照组少 39%[0.0907（SD 0.026）μg kg(-1) min(-1)比 0.051（0.018）μg kg(-1) min(-1)]。两组术中血流动力学或手术应激无差异。然而，对照组拔管时间和回忆时间分别为 16.8（6.8）分钟和 23.0（5.0）分钟，明显长于 TEAS 组（P<0.01）。TEAS 还降低了术后 24 小时内头晕和瘙痒的发生率（P<0.01）。