Chen L, Tang J, White P F, Sloninsky A, Wender R H, Naruse R, Kariger R
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA.
Anesth Analg. 1998 Nov;87(5):1129-34.
Transcutaneous electrical nerve stimulation (TENS) has been used as a complementary (supplemental) therapy to opioid analgesics for pain relief after surgery. Simultaneous stimulation at a classical Chinese acupoint site and periincisional dermatomes significantly decreases the postoperative analgesic requirement. This sham-controlled study was designed to assess the relative effectiveness of acupoint versus nonacupoint stimulation on the postoperative hydromorphone (HM) requirement, the incidence of opioid-related side effects, and the overall recovery profile. One hundred women undergoing total abdominal hysterectomy or myomectomy procedures with a standardized general anesthesia were randomly assigned to one of four postoperative analgesic treatment regimens (n = 25 each): Group I = sham-TENS (no electrical current) at the Zusanli (ST36) acupoints, Group II = nonacupoint-TENS at the shoulders, Group III = dermatomal-TENS at the level of the surgical incision, and Group IV = acupoint-TENS at the Zusanli acupoints. The frequency of TENS was set in the standard dense-and-disperse mode of 2/100 Hz. The intensity of stimulation was set at 0 mA for patients in Group I and at 9-12 mA for patients in Groups II, III, and IV. A patient-controlled analgesia (PCA) device programmed to deliver bolus doses of HM 0.2-0.4 mg IV on demand with a minimal lockout interval of 10 min was used to quantify the postoperative opioid analgesic requirement. Standard 100-mm visual analog scales were used to assess pain, as well as sedation, fatigue, and nausea, at specific intervals after surgery. The numbers of PCA demands and delivered bolus doses, requirements for supplemental medication, and any opioid-related side effects were recorded. In the first 24 h postoperatively, the opioid requirements in Groups III and IV were decreased by 37% and 39%, respectively, compared with the control (sham) group and 35% and 38%, respectively, compared with Group II. The duration of PCA usage and the incidences of nausea and dizziness were also significantly decreased in Groups III and IV compared with Groups I and II. We conclude that periincisional dermatomal and Zusanli acupoint stimulation were equally effective in decreasing the postoperative opioid analgesic requirement and in reducing opioid-related side effects. Both of these positions were more effective than the nonacupoint (shoulder) location.
The location of the stimulating electrodes seems to be an important determinant of the efficacy of transcutaneous electrical nerve stimulation in decreasing the need for opioid analgesics in the postoperative period. This study demonstrates that transcutaneous electrical nerve stimulation applied at the dermatomal level of the skin incision is as effective as Zusanli acupoint stimulation, and both were more effective than stimulation at a nonacupoint (shoulder) location.
经皮电刺激神经疗法（TENS）已被用作阿片类镇痛药的辅助（补充）疗法，用于术后止痛。在传统中医穴位和手术切口周围皮节同时进行刺激，可显著降低术后镇痛需求。本项假对照研究旨在评估穴位刺激与非穴位刺激对术后氢吗啡酮（HM）需求、阿片类药物相关副作用发生率及总体恢复情况的相对有效性。100例行全腹子宫切除术或子宫肌瘤切除术并接受标准化全身麻醉的女性被随机分配至四种术后镇痛治疗方案之一（每组n = 25）：第一组 = 在足三里（ST36）穴位进行假TENS（无电流）刺激；第二组 = 在肩部进行非穴位TENS刺激；第三组 = 在手术切口水平进行皮节TENS刺激；第四组 = 在足三里穴位进行穴位TENS刺激。TENS频率设定为标准的疏密波模式，即2/100Hz。第一组患者的刺激强度设定为0mA，第二、三、四组患者的刺激强度设定为9 - 12mA。使用患者自控镇痛（PCA）装置，设定按需静脉注射0.2 - 0.4mg HM的推注剂量，最小锁定时间间隔为10分钟，以量化术后阿片类镇痛药需求。术后特定时间间隔使用标准的100mm视觉模拟量表评估疼痛、镇静、疲劳和恶心情况。记录PCA需求次数、推注剂量、补充药物需求以及任何阿片类药物相关副作用。术后24小时内，与对照组（假刺激组）相比，第三组和第四组的阿片类药物需求量分别降低了37%和39%，与第二组相比分别降低了35%和38%。与第一组和第二组相比，第三组和第四组的PCA使用时间以及恶心和头晕的发生率也显著降低。我们得出结论，手术切口周围皮节和足三里穴位刺激在降低术后阿片类镇痛药需求及减少阿片类药物相关副作用方面同样有效。这两个部位均比非穴位（肩部）部位更有效。
刺激电极的位置似乎是经皮电刺激神经疗法在降低术后阿片类镇痛药需求疗效方面的一个重要决定因素。本研究表明，在皮肤切口的皮节水平进行经皮电刺激神经疗法与足三里穴位刺激效果相同，且两者均比在非穴位（肩部）部位刺激更有效。
