Accelerative Effects of Transcutaneous Electrical Acustimulation on Postoperative Recovery After Thoracolumbar Vertebral Fracture Associated With Suppressed Sympathetic Activity and Interleukin-6.

OBJECTIVES

Gastrointestinal (GI) disturbance is a frequent complication in patients with thoracolumbar vertebral fracture (TVF). Transcutaneous electrical acustimulation (TEA) has been reported to effectively accelerate postoperative GI function recovery after abdominal surgery. This study aimed to investigate the effects of TEA on postoperative recovery and the associated mechanisms.

MATERIALS AND METHODS

A total of 81 patients with TVF who underwent elective posterior pedicle screw fixation surgery were randomized to receive TEA or sham-TEA. TEA at ST36 or sham-TEA at nonacupoints was performed for one hour twice daily, from 24 hours before surgery to postoperative day (POD) 3. The effects were then assessed in the form of a diary at different time points.

RESULTS

Compared with sham-TEA, TEA attenuated postoperative impairments associated with lower GI motility, including a reduction in time to defecation by 27.2% (p = 0.002 vs sham-TEA), time to first flatus by 17.2% (p = 0.027), an increase in the Bristol stool score (p = 0.014), and the number of spontaneous bowel movement (p = 0.009). TEA also relieved other GI symptoms including abdominal bloating on POD1 and POD4 (p < 0.001 and p = 0.001, respectively), straining during defecation (p < 0.001), and sensation of anorectal blockage during defecation (p = 0.02). Moreover, TEA reduced the visual analog scale wound pain score on POD1 (p = 0.026), POD2 (p < 0.001), and POD3 (p < 0.001), increased vagal activity, and decreased sympathetic activity (p < 0.001), in addition to suppressing the serum level of norepinephrine on both POD1 (p = 0.047) and POD4 (p = 0.036). TEA caused a higher decrease from POD1 to POD4 in serum interleukin-6 (p = 0.011, vs sham-TEA). The use of TEA was an independent predictor of shortened time to first defecation.

CONCLUSION

Noninvasive TEA at ST36, in comparison with sham-TEA, is effective in promoting postoperative recovery in patients with TVF by enhancing vagal and suppressing sympathetic activities.

CLINICAL TRIAL REGISTRATION

The study was retrospectively registered on www.chictr.org.cn (Chinese Clinical Trial Registry ChiCTR2300078195).