Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, No. 65 Shengli Road, Tangshan, 063000, Hebei, China.
Department of Anesthesiology, The Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chendu, 610000, China.
Urolithiasis. 2019 Jun;47(3):279-287. doi: 10.1007/s00240-018-1056-8. Epub 2018 Mar 20.
Transcutaneous electrical acupoint stimulation (TEAS) is an effective analgesic measure. We studied the analgesic effect of TEAS by applying it alone after ureteroscopic lithotripsy, rather than applying it as a supplementary analgesic measure. Participants (n = 120) scheduled to undergo ureteroscopic holmium laser lithotripsy, were enrolled and randomly assigned into Group T (TEAS n = 60) and Group C (Control, n = 60). The participants in Group T were treated with TEAS for postoperative analgesia. TEAS were implemented on bilateral Shenyu (BL23) and Yinlingquan (SP9) at the time backward and the time at 4, 8, 12 h postoperatively. TEAS was re-implemented three times on the target acupoints for the next 2 days. When TEAS failed to meet the analgesic effect, the participants were given tramadol hydrochloride tablets of 100 mg. Participants of Group C were given tramadol hydrochloride tablets for postoperative analgesia. The primary outcome of VAS scores at the time backward (T), 4 h (T), 12 h (T), 24 h (T), 48 h (T) postoperatively and the amount of remedy for analgesic consumption within 48 h postoperatively were compared. The secondary outcome of adverse reactions and plasma concentrations of serotonin (5-HT) and substance P (SP) at T, T, T, T, T were detected, respectively. The VAS scores at T, T, T, T postoperatively in two groups were lower than T. Compared to group C, the VAS scores at T (3.68 ± 0.68 vs. 4.79 ± 0.82, P = 0.01), T (2.64 ± 0.72 vs. 3.92 ± 0.88, P = 0.03), T (2.21 ± 0.88 vs. 3.38 ± 0.74, P < 0.01) in Group T were lower, and total remedy of analgesic consumption was significantly lower (127.14 ± 28.46 vs. 415.27 ± 86.37, P < 0.01) within 48 h postoperatively. The plasma concentrations of 5-HT in Group T was lower than Group C at T (348.54 ± 138.49 vs. 418.69 ± 124.68, P = 0.03), T (324.28 ± 112.73 vs. 398.52 ± 114.53, P < 0.01), T (309.64 ± 129.09 vs. 388.46 ± 115.36, P = 0.04) postoperatively and concentrations of SP at T (59.38 ± 24.68 vs. 78.93 ± 26.32, P < 0.01), T (49.36 ± 25.55 vs. 66.49 ± 23.57, P = 0.02), T (42.19 ± 24.36 vs. 64.15 ± 28.16, P = 0.04), T (39.26 ± 19.88 vs. 54.64 ± 20.62, P = 0.02) postoperatively were also lower than Group C. Meanwhile, the occurrences of vertigo (6.7 vs. 18.3%, P < 0.01), nausea and vomiting (11.7 vs. 21.7%, P < 0.01), constipation (10.0 vs. 20.0%, P = 0.03) in Group T were also lower. Application of TEAS alone was associated with effective alleviation of postoperative pain, reduction of postoperative analgesics consumption, decrease of plasma concentration of algogenic substance and the incidence of adverse reactions after ureteroscopic lithotripsy.
经皮穴位电刺激（TEAS）是一种有效的镇痛措施。我们研究了单独应用 TEAS 对输尿管镜碎石术后的镇痛效果，而不是将其作为补充镇痛措施。将 120 名计划接受输尿管镜钬激光碎石术的患者纳入并随机分为 T 组（TEAS n=60）和 C 组（对照组 n=60）。T 组患者术后接受 TEAS 镇痛。在术后 4、8、12 小时，在双侧肾俞（BL23）和阴陵泉（SP9）的时间向后和时间进行 TEAS。在接下来的 2 天内，在目标穴位上对 TEAS 进行了 3 次重复。当 TEAS 未能达到镇痛效果时，给予患者盐酸曲马多片 100mg。C 组患者术后给予盐酸曲马多片镇痛。比较两组术后即刻（T）、4 小时（T）、12 小时（T）、24 小时（T）、48 小时（T）的 VAS 评分以及术后 48 小时内镇痛药消耗的补救量。分别检测两组 T、T、T、T、T 时的不良反应和血浆 5-羟色胺（5-HT）和 P 物质（SP）浓度。两组 T、T、T、T 术后的 VAS 评分均低于 T。与 C 组相比，T 时 VAS 评分（3.68±0.68 vs. 4.79±0.82，P=0.01）、T 时 VAS 评分（2.64±0.72 vs. 3.92±0.88，P=0.03）、T 时 VAS 评分（2.21±0.88 vs. 3.38±0.74，P<0.01）较低，术后 48 小时内镇痛药总补救量显著减少（127.14±28.46 vs. 415.27±86.37，P<0.01）。T 时 T 组的 5-HT 血浆浓度低于 C 组（348.54±138.49 vs. 418.69±124.68，P=0.03）、T 时 T 组的 5-HT 血浆浓度低于 C 组（324.28±112.73 vs. 398.52±114.53，P<0.01）、T 时 T 组的 5-HT 血浆浓度低于 C 组（309.64±129.09 vs. 388.46±115.36，P=0.04），SP 血浆浓度在 T 时（59.38±24.68 vs. 78.93±26.32，P<0.01）、T 时（49.36±25.55 vs. 66.49±23.57，P=0.02）、T 时（42.19±24.36 vs. 64.15±28.16，P=0.04）、T 时（39.26±19.88 vs. 54.64±20.62，P=0.02）也低于 C 组。同时，T 组的眩晕发生率（6.7% vs. 18.3%，P<0.01）、恶心呕吐发生率（11.7% vs. 21.7%，P<0.01）、便秘发生率（10.0% vs. 20.0%，P=0.03）也较低。单独应用 TEAS 与术后疼痛有效缓解、术后镇痛药消耗减少、血浆致痛物质浓度降低以及输尿管镜碎石术后不良反应发生率降低有关。
