Li Sha, Zheng Man, Wu Wenzhong, Guo Jie, Ji Fangbin, Zheng Zhen
Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, China.
Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, China.
Explore (NY). 2017 Sep-Oct;13(5):313-318. doi: 10.1016/j.explore.2017.06.002. Epub 2017 Jun 30.
Our study aimed to investigate the feasibility and effectiveness of preoperative electroacupuncture (EA), delivered 24hours before surgery, on postoperative nausea and vomiting (PONV) and postoperative pain in patients undergoing gynecologic laparoscopic surgery.
In this randomized controlled trial, 40 patients scheduled for elective gynecologic laparoscopic surgery were randomly assigned to the usual care (UC) group and the EA group (n = 20 each). Both groups received the routine treatment consisting of intravenous dexamethasone (5mg) after induction of anesthesia and intravenous tropisetron (5mg) before the end of the operation. The patients in the EA group received EA at bilateral neiguan (PC6) and zusanli (ST36) within 24hours prior to the surgery. The incidence and severity of PONV and pain were recorded at 6hours, 12hours, and 24hours after the operation. Time to first flatus passage was also recorded. Bonferroni-corrected independent sample t-tests were used to analyze the data.
In the first six hours after surgery, 15% and 20% of the patients experienced postoperative nausea in the EA and the UC groups, respectively. The incidences of postoperative vomiting were 5% for the EA group and 20% for the UC group. PONV reduced to zero over 12hours in both groups and there was no statistically significant difference in PONV between the two groups at any time point. The EA group rated their postoperative pain statistically significantly lower than the UC group did at six hours postoperative (EA: 1.9 ± .8; UC: 2.9 ± .9, P = .001). The two groups did not differ in pain at 12 and 24hours. The EA group had a shorter time to pass first flatus than the UC group did (EA: 20.3hours ± 6.1; UC: 26.4 ± 5.2, P = .002). The common EA-related adverse effects were minor, and did not require medical attention. The patients tolerated the EA treatment well.
It is feasible and safe to deliver one-session EA treatment within 24hours preoperatively to preempt postoperative pain. One-session preoperative EA may also accelerate motility of the gastrointestinal track. Properly powered studies are needed to further test the effectiveness of preoperative EA on PONV.
本研究旨在探讨术前24小时进行电针治疗对妇科腹腔镜手术患者术后恶心呕吐（PONV）及术后疼痛的可行性和有效性。
在这项随机对照试验中，40例计划进行择期妇科腹腔镜手术的患者被随机分为常规护理（UC）组和电针组（每组n = 20）。两组均接受常规治疗，包括麻醉诱导后静脉注射地塞米松（5mg）和手术结束前静脉注射托烷司琼（5mg）。电针组患者在手术前24小时内接受双侧内关（PC6）和足三里（ST36）电针治疗。记录术后6小时、12小时和24小时时PONV和疼痛的发生率及严重程度。同时记录首次排气时间。采用Bonferroni校正的独立样本t检验分析数据。
术后前6小时，电针组和UC组分别有15%和20%的患者出现术后恶心。电针组术后呕吐发生率为5%，UC组为20%。两组在12小时内PONV均降至零，且在任何时间点两组之间的PONV均无统计学显著差异。电针组术后6小时的疼痛评分在统计学上显著低于UC组（电针组：1.9±0.8；UC组：2.9±0.9，P = 0.001）。两组在术后12小时和24小时的疼痛无差异。电针组首次排气时间短于UC组（电针组：20.3小时±6.1；UC组：26.4±5.2，P = 0.002）。常见的与电针相关的不良反应轻微，无需医疗处理。患者对电针治疗耐受性良好。
术前24小时进行单次电针治疗以预防术后疼痛是可行且安全的。术前单次电针治疗还可能加速胃肠道蠕动。需要开展有足够样本量的研究来进一步检验术前电针治疗对PONV的有效性。
