Department of Anesthesiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Acupuncture, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Acupunct Med. 2022 Oct;40(5):415-424. doi: 10.1177/09645284221076517. Epub 2022 Mar 1.
We aimed to evaluate the effectiveness and safety of preoperative electroacupuncture (EA) on the incidence of postoperative nausea and vomiting (PONV), and severity of postoperative pain, in gynecological patients undergoing laparoscopic surgery. The effects of EA administered at different preoperative time points were compared.
A total of 413 patients undergoing elective laparoscopic gynecological surgery were randomly allocated into 4 groups receiving EA the day before surgery (Group Pre, n = 103), 30 min before (Group 30, n = 104) or both (Group Comb, n = 103), or usual care alone (Group Usual, n = 103). All acupuncture groups had usual care. The incidence of PONV and pain at 24 h were primary outcomes. Secondary outcomes included the severity of postoperative nausea, vomiting and pain, requirement for antiemetic medication and quality of recovery (QoR)-15 scores after surgery.
There were significant differences between the four groups in nausea and vomiting incidence (0-24 h), postoperative antiemetic use (0-48 h), and postoperative pain (0-6 h), with the EA groups recording the lowest levels. Regarding primary outcomes, incidence of nausea and vomiting at 6-24 h was 28/11/18/11% (p = 0.003) 23/5/8/9% (p < 0.001), respectively, for Groups Usual/Pre/30/Comb. Accordingly, EA reduced the incidence of nausea and vomiting at 6-24 h by 61/34/60% and 79/65/61% for Groups Pre/30/Comb, respectively. Regarding secondary outcomes, incidence of nausea and vomiting at 0-6 h was 20/9/11/7% (p = 0.013) and 17/7/9/6% (p = 0.021), respectively, for Groups Usual/Pre/30/Comb. Rescue antiemetics at 0-6 h were required by 18/4/11/4% (p = 0.001) in Groups Usual/Pre/30/Comb. The mean numerical rating scale (NRS) pain score (0-10) at 0-6 h was significantly different between groups (2.45/1.89/2.01/1.97 for Groups Usual/Pre/30/Comb, p = 0.024). There were no significant differences between the three EA-treated groups.
In gynecological patients undergoing laparoscopic surgery and treated with multimodal antiemetic methods, one session of preoperative EA may be a safe adjunctive treatment for PONV prophylaxis. Optimal timing of EA requires further verification.
ChiCTR-INR-16010035 (Chinese Clinical Trial Registry).
评价术前电针（EA）对妇科腹腔镜手术患者术后恶心呕吐（PONV）发生率和术后疼痛严重程度的影响，并比较不同术前时间点给予 EA 的效果。
共纳入 413 例行择期腹腔镜妇科手术的患者，随机分为术前 1 天（Pre 组，n = 103）、术前 30 分钟（30 组，n = 104）、同时（Comb 组，n = 103）或常规护理（Usual 组，n = 103）组接受 EA。所有针刺组均接受常规护理。PONV 发生率和术后 24 小时疼痛为主要结局。次要结局包括术后恶心、呕吐和疼痛的严重程度、术后恶心呕吐防治药物的需求以及术后恢复质量（QoR）-15 评分。
四组患者在恶心呕吐发生率（0-24 小时）、术后止吐药使用（0-48 小时）和术后疼痛（0-6 小时）方面存在显著差异，EA 组的水平最低。关于主要结局，6-24 小时恶心呕吐的发生率分别为 28/11/18/11%（p = 0.003）和 23/5/8/9%（p < 0.001），分别为 Usual/Pre/30/Comb 组。因此，EA 分别使 Pre/30/Comb 组 6-24 小时恶心呕吐的发生率降低了 61/34/60%和 79/65/61%。关于次要结局，0-6 小时恶心呕吐的发生率分别为 20/9/11/7%（p = 0.013）和 17/7/9/6%（p = 0.021），分别为 Usual/Pre/30/Comb 组。0-6 小时需要急救止吐药的比例分别为 18/4/11/4%（p = 0.001）。0-6 小时的平均数字评定量表（NRS）疼痛评分（0-10）在各组之间有显著差异（分别为 2.45/1.89/2.01/1.97，p = 0.024）。三组 EA 治疗组之间无显著差异。
在接受多模式止吐治疗的行腹腔镜妇科手术的患者中，单次术前 EA 可能是一种安全的 PONV 预防辅助治疗方法。EA 的最佳时机还需要进一步验证。
ChiCTR-INR-16010035（中国临床试验注册中心）。
