Effects of Transcutaneous Electrical Acupoint Stimulation on the Postoperative Sleep Quality and Pain of Patients After Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial

Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients: A Report from the Society of Cardiovascular Anesthesiologists

Pain after thoracic surgery is often significant, which can disrupt normal respiratory mechanics and impair the clearance of secretions, thus increasing the risk of postoperative respiratory complications. Poorly controlled acute pain can lead to persistent post-thoracotomy pain and continued opioid use that can affect quality of life. With the increased awareness of opioid-associated adverse effects and recent emphasis on enhanced recovery, opioid-sparing multimodal analgesia has been used widely for acute pain management after thoracic surgery. This practice advisory reviews, evaluates, and summarizes the recent literature related to pharmacological therapies and non-pharmacological therapies used for postoperative pain management after thoracic surgery and offers guidance to providers in making appropriate pain management decisions for their patients.

Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients: Executive Summary: A Report From the Society of Cardiovascular Anesthesiologists

Patients after thoracic surgery experience significant pain that can disrupt normal respiratory mechanics, increase the risk of respiratory complications, and impair recovery. Poorly controlled postoperative pain can develop into persistent postoperative pain. In addition, using opioids for pain control in the thoracic surgical population makes them more susceptible to opioid-related side effects due to their pre-existing comorbidities. The lack of consensus on how to effectively attain pain control after thoracic surgery has resulted in variability in the analgesic regimens utilized by providers across institutions and practices. The overall goal of this practice advisory is to identify opportunities for improvement in the postoperative pain management of thoracic surgical patients and provide guidance to perioperative providers through the provision of evidence-based recommendations.

Intraoperative transcutaneous electrical acupoint stimulation combined with anesthesia to prevent postoperative cognitive dysfunction: A systematic review and meta-analysis

BACKGROUND

Postoperative cognitive dysfunction (POCD) is associated with an increased risk of dementia and may lead to chronic neurodegeneration. The utilization of intraoperative Transcutaneous Electrical Acupoint Stimulation (TEAS) in conjunction with anesthesia is expected to become an effective preventive measure for POCD in clinical practice.

METHODS

We conducted a comprehensive literature review focusing on the use of TEAS in the prevention of POCD during surgical anesthesia. We searched various databases for relevant literature, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The synthesis of data was performed using RevMan version 5.4.

RESULTS

Our meta-analysis incorporated data from 20 Randomized Controlled Trials (RCTs) involving 1549 patients. The findings revealed that intraoperative TEAS significantly reduced the incidence of POCD when compared to the control group [Odds Ratio (OR) 0.29, 95% Confidence Interval (CI) 0.22-0.39, p < 0.00001]. Moreover, patients receiving intraoperative TEAS exhibited a significant increase in MMSE scores (MD 1.21, 95% CI 0.53-1.89, p = 0.0005). Additionally, intraoperative TEAS demonstrated efficacy in reducing the contents of perioperative serum S100β protein (S100β), neuron-specific enolase (NSE), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in patients, and the improvement of these indexes may be the potential mechanism of TEAS in preventing POCD.

CONCLUSION

Our results suggest that intraoperative TEAS combined with anesthesia prevents cognitive dysfunction in the immediate postoperative period, however we need additional evidence of its utility in preventing long-term cognitive dysfunction. We advocate for the broader promotion and application of this approach in clinical surgical settings.

TRIAL REGISTRATION

PROSPERO (CRD42023457910).

Transcutaneous electrical acupoint stimulation reduces postoperative patients' length of stay and hospitalization costs: a systematic review and meta-analysis

OBJECTIVE

To study the effects of transcutaneous electrical acupoint stimulation (TEAS) on length of stay (LOS) and hospitalization costs in postoperative inpatients.

METHODS

Two researchers collectively searched PubMed, Embase, Cochrane Library, China Network Knowledge Infrastructure, and Wanfang Database. The search time was set from the beginning to 25 April 2023, to identify randomized controlled trials articles that met the criteria. Statistical analyses were performed using the Stata software (version 16.0). The risk of bias was assessed using the Cochrane risk-of-bias tool, and publication bias was evaluated using a funnel plot and Egger's test. The quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Thirty-four randomized controlled trials were included. The main results showed that TEAS reduced hospitalization costs [standardized mean difference (SMD)=-1.92; 95% CI: -3.40, -0.43), LOS (SMD=-1.00; 95% CI: -1.30, -0.70) and postoperative LOS (SMD=-0.70; 95% CI: -0.91, -0.49] in postoperative patients. Subgroup analyses further revealed that TEAS was effective in reducing both the overall and postoperative LOS in patients undergoing multiple surgical procedures. It is worth noting that the observed heterogeneity in the results may be attributed to variations in surgical procedures, stimulation frequencies, and stimulation points utilized in different trials.

CONCLUSIONS

TEAS can help postoperative patients reduce their LOS and hospitalization cost. However, considering the bias identified and heterogeneity, the results of this review should be interpreted with caution.

Effects of transcutaneous electrical acupoint stimulation on early postoperative pain and recovery: a comprehensive systematic review and meta-analysis of randomized controlled trials

Background

Previous studies have indicated beneficial outcomes of transcutaneous electrical acupoint stimulation (TEAS), but high-quality and comprehensive meta-analyses are lacking. The aim was to quantitatively analyze the efficacy and safety of perioperative TEAS on postoperative pain and recovery.

Methods

PubMed, Web of Science, EMBASE, and the Cochrane Library were searched through July 2022. Randomized controlled trials (RCTs) that examined the perioperative application of TEAS in adults compared with sham-TEAS and/or non-TEAS were eligible. Cumulative analgesic consumption within 24 h and rest pain scores at 2, 6, 12, and 24 h postoperatively were the two co-primary outcomes.

Results

Seventy-six RCTs (n = 9,665 patients) were included. Patients treated with TEAS experienced a reduction in clinical importance in cumulative analgesic (morphine equivalent) consumption (WMD: -14.60 mg, 97.5% CI: -23.60 to -5.60; p < 0.001) and a reduction in statistical importance in rest pain scores at multiple time points within the first 24 postoperative hours. The secondary outcome analysis also identified clinically significant recovery benefits to TEAS during the first 24 h after surgery. Furthermore, TEAS could effectively reduce opioid-related side effects and did not increase serious side effects.

Conclusion

This article describes current evidence about TEAS intervention on early postoperative pain and recovery. The results support the effectiveness of TEAS, but more high-quality evidence of clinical applicability is also needed.

Systematic review registration

PROSPERO (CRD42021249814).

Efficacy of Zhumian Tang formula granules combined with eszopiclone for the treatment of poor sleep quality: a multi-center, randomized controlled, superiority trial

OBJECTIVE

To evaluate the efficacy and safety of Zhumian Tang formula granules combined with eszopiclone for treating poor sleep quality.

METHODS

This multi-center, dynamic block-randomized, parallel-group superiority clinical trial included 130 patients. The combined treatment group received Zhumian Tang formula granules combined with eszopiclone treatment, and the control group received eszopiclone treatment only. The group allocation ratio was 1∶1. The duration of treatment was 2 weeks. Participants were asked to complete questionnaires before treatment, after 1 week of the intervention, after 2 weeks of the intervention, and at the follow-up on week 3. The primary outcomes were the Pittsburgh Sleep Quality Index (PSQI) score and the total effective rate of treatment. The secondary outcome was the rate of adverse effects.

RESULTS

Compared with the eszopiclone treatment group, the PSQI score of the combined treatment group was significantly lower after 2 weeks of the intervention (6.98 vs 8.26, P < 0.05). However, there was no significant difference in the mean PSQI score after 1 week of the intervention (9.89 vs 9.15, P = 0.124). After the follow-up on week 3, the PSQI score of the combined treatment group remained significantly lower than that of the eszopiclone treatment group (6.12 vs 8.31, P < 0.001). The total effective rates of treatment of the combined group and the eszopiclone group were 36.92% vs 35.38% (Z = 0.033, P = 0.855) after 1 week of the intervention, 83.08% vs 58.46% (Z = 9.519, P < 0.05) after 2 weeks of the intervention, and 83.08% vs 61.54% (Z = 7.530, P < 0.05) and after the follow-up on week 3, respectively. There was no significant difference in the overall rate of adverse reactions between the combined and eszopiclone treatment groups (21.53% vs 31.8%, P = 0.318).

CONCLUSION

The combination of Zhumian Tang formula granules with eszopiclone was found to be safe and more effective in improving sleep quality than eszopiclone alone. Traditional Chinese medicine can enhance the effectiveness of Western medicine in the treatment of insomnia.

Effects of Acupuncture-Point Stimulation on Perioperative Sleep Disorders: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

Background

Perioperative sleep disorders exert a severe adverse impact on postoperative recovery. Recently, some observational studies reported that acupuncture-point stimulation (APS) provided benefits for promoting perioperative sleep quality. However, the effects of APS on perioperative sleep disorders following general anesthesia have not been thoroughly assessed by any systematic study and meta-analysis. Therefore, we conducted this systematic review and meta-analysis to reveal the effects of APS on perioperative sleep disorders.

Methods

Eight databases (Chinese: CNKI, VIP, CBM, and Wanfang; English: PubMed, Embase, Web of Science, and Cochrane Library) were thoroughly searched to find randomized controlled trials (RCTs) that indicated a link between APS and the occurrence of perioperative sleep disorders. We applied RevMan 5.4 (Cochrane Collaboration) and Stata 16.0 (Stata Corp) to conduct our meta-analysis. In addition, the trial sequential analysis (TSA) tool was utilized to estimate the validity and reliability of the data.

Results

In this study, nine RCTs with 719 patients were conducted. Compared to the control group, APS significantly improved perioperative subjective sleep quality (SMD: -1.36; 95% CI: -1.71 to -1.01; P < 0.00001). Besides, it increased perioperative TST (preoperative period MD = 24.29, 95% CI: 6.4 to 42.18, P = 0.0008; postoperative period MD = 45.86, 95% CI: 30.00 to 61.71, P < 0.00001) and SE (preoperative MD = 3.62, 95% CI: 2.84 to 4.39, P < 0.00001; postoperative MD = 6.43, 95% CI: 0.95 to 11.73, P < 0.00001). The consequence of trial sequential analysis further confirmed the reliability of our meta-analysis results.

Conclusion

According to the currently available evidence, APS could effectively improve perioperative sleep quality and play an essential role in decreasing the incidence of perioperative sleep disorders.

Effect of transcutaneous electrical acupoint stimulation on remifentanil dosage during craniotomy aneurysm clipping: a prospective, randomized controlled study

BACKGROUND

Craniotomy aneurysm clipping is one of the main treatments for intracranial aneurysm (IA). Endotracheal intubation and intraoperative operation may induce dramatic hemodynamic fluctuations and increase the risk of aneurysm rupture. Intraoperative high-dose opioid use is the main measure to reduce the intraoperative stress response, but it increases the incidence of complications such as postoperative vomiting and delayed awakening. Transcutaneous electrical acupoint stimulation (TEAS) stimulates β-endorphin expression levels and reduces opioid requirements. In this study, we aimed to assess the effects of TEAS on remifentanil dosage and oxidative stress (OS) in craniotomy aneurysm clipping.

METHOD

Forty-two patients with craniotomy aneurysm clipping were randomized into two groups: the TEAS group (T group) and the sham TEAS group (S group). "Hegu" (LI4), "Neiguan" (PC6) and "Zusanli" points (ST36) were selected, and a "HANS" percutaneous acupoint electrical stimulator was used for intervention 30 min before anesthesia induction until the end of the operation. The primary outcome was intraoperative remifentanil dosage. The secondary outcomes were intraoperative propofol dosage, mean arterial pressure (MAP) and heart rate (HR) 5 min before the TEAS intervention (T0), 5 min before head holder pinning (T1), immediately after pinning (T2), 5 min before craniotomy (T3), immediately after craniotomy (T4), at craniotomy (T5), and at the end of surgery (T6), as well as serum β-endorphin levels at T1, T2 and T6 and neuron-specific enolase (NSE), S100β, superoxide dismutase (SOD) and malondialdehyde (MDA) levels at T1, T2 and 24 h after surgery (T7).

RESULTS

The dosage of remifentanil in the T group was reduced compared to that in the S group (P < 0.05). At T2, T4 and T5, the MAP and HR in the T group were lower than those in the S group (P < 0.05). At T2 and T7, the levels of NSE, S100β and MDA in group T were lower than those in group S (P < 0.05), while the SOD levels in group T were higher than those in group S (P < 0.05).

CONCLUSIONS

The use of TEAS can reduce the dosage of remifentanil and reduce hemodynamic fluctuations during craniotomy aneurysm clipping. It reduces the occurrence of OS and central nervous system damage during surgery and has a certain brain protective effect.

TRIAL REGISTRATION

ChiCTR2100052353. https://www.chictr.org.cn/about.html .

Transcutaneous electrical acupoint stimulation for cancer-related pain management in patients receiving chronic opioid therapy: a randomized clinical trial

PURPOSE

The opioid crisis resulting from its use disorder and overdose poses additional challenges for cancer pain management. The American Society of Clinical Oncology Practice Guideline recommends acupuncture therapy for the management of adult cancer-related pain (CRP), but the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on CRP remains uncertain.

METHODS

This 5-week prospective randomized clinical trial was conducted at 2 hospitals in China, and participants with CRP receiving chronic opioid therapy were randomized 1:1 into two groups between December 2014 and June 2018. The true TEAS group underwent 15 sessions of TEAS treatments over 3 consecutive weeks, while the control group received sham stimulation. The primary outcome was the numerical rating scale (NRS) score in the past 24h at week 3. The secondary outcomes included morphine equivalent daily dose, quality of life and adverse events.

RESULTS

A total of 159 participants were included in the modified intention-to-treat population. The baseline characteristics were similar in both groups. The mean NRS scores were 0.98 points at week 3 in the true TEAS group and 1.41 points in the sham group, with the mean difference between groups of -0.43 points (P < 0.001; OR = 0.68, P < 0.05). The proportion of patients with NRS reduction more than thirty percentage at week 3 was 50.00% in the true TEAS group and 35.44% in the sham group (RD = 0.15, P > 0.05; RR = 1.41, P > 0.05). No significant difference in pain intensity between the two groups was observed during the follow-up period without TEAS intervention (week 4, OR = 0.83, P > 0.05; week 5, OR = 0.83, P > 0.05). The Karnofsky Performance Status value suggested that patients in the true TEAS group experienced an improved quality of life (Between-group differences: week 3, 3.5%, P < 0.05; week 4, 4.6%, P < 0.001; week 5, 5.6%, P < 0.001).

CONCLUSIONS

The 3-week application of TEAS in patients with CRP receiving chronic opioid therapy resulted in a statistically significant reduction in pain scores, but the observed reduction was of uncertain clinical significance. The prolonged analgesic effect of TEAS was not confirmed in this trial.

CLINICALTRIAL

GOV: ChiCTR-TRC-13003803.

Transcutaneous Electrical Acupoint Stimulation Improves Postoperative Sleep Quality in Patients Undergoing Laparoscopic Gastrointestinal Tumor Surgery: A Prospective, Randomized Controlled Trial

INTRODUCTION

This study was conducted to observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the postoperative sleep quality of patients undergoing gastrointestinal tumor surgery and to verify the possible mechanism.

METHODS

Eighty-three patients were allocated to the TEAS or Sham group. Patients in the TEAS group received TEAS treatment (disperse-dense waves; frequency, 2/100 Hz) on bilateral Shenmen (HT7), Neiguan (PC6) and Zusanli (ST36) points for 30 min each time, total three times in the perioperative period. In the Sham group, electrodes were placed; however, no current was given. Sleep quality was assessed on the day before surgery (P1) and the first and third days after surgery (D1 and D3) using the Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS). Postoperative pain was assessed using visual analog scale (VAS) 72 h postoperatively. The incidences of abdominal distension, dizziness, postoperative nausea and vomiting (PONV) and pulmonary complications were recorded. Serum levels of inflammatory cytokines and the expression of key factors of oxidative stress and key molecules of the nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE) signal pathway were measured.

RESULTS

TEAS ameliorated sleep quality at D1 and D3 (PSQI P < 0.05, AIS P < 0.05) and decreased postoperative pain as demonstrated by lower VAS scores compared to the Sham group (P < 0.05). The incidences of abdominal distension and PONV were also lower in the TEAS group. Markers of oxidative stress were increased (P < 0.05), and the serum concentration of interleukin-6 (IL-6) was significantly lower in the TEAS group. The key mediators of the Nrf2/ARE pathway were enhanced after TEAS.

CONCLUSION

Perioperative TEAS improved postoperative sleep quality, reduced postoperative pain and alleviated postoperative adverse effects in patients undergoing laparoscopic gastrointestinal tumor surgery resection. This may be associated with activating Nrf2/ARE signal pathway and decreasing its inflammatory actions.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ), ChiCTR2100054971.

Perioperative transcutaneous electrical acupoint stimulations as part of an enhanced recovery after surgery protocol for living donors undergoing nephrectomy: A randomized, controlled clinical trial

Objective

Living kidney donors (LKDs) experience perioperative anxiety. We designed the following study to evaluate the anxiolytic effect of transcutaneous electrical acupoint stimulation (TEAS) during the perioperative period in a group of LKDs undergoing laparotomy nephrectomy.

Methods

LKDs were randomly assigned to either the TEAS or control group. Participants in the TEAS group received 30min of intervention (6-15 mA, 2-100 Hz), at Yintang (EX-HN-3), bilateral Taichong (LR3) and Neiguan (PC6) one day before surgery (D₀), before induction of anesthesia (D₁) and one day after surgery (D₂). The participants in the control group received the same placement of electrodes but without electrical stimulation. Venous blood was collected before each intervention. Anxiety levels and recovery profiles were recorded.

Results

LKDs in the TEAS group had lower anxiety level than those in the control group at D₁, D₂ and three days after surgery (D₃). The percentage differences were: 33.3%, 25.0%, and 22.2%; [95% confidence interval (CI), (-55.1%, -11.6%), (-47.4%, -2.6%), and (-42.3%, -2.2%); P = 0.005, P = 0.034, and P = 0.035; respectively]. LKDs who received TEAS had better sleep quality and short-term recovery profiles than those in the control group. The plasma levels of 5-hydroxytryptamine (5-HT) and melatonin (MT) in the TEAS group were significantly higher than those in the control group at D₁ and D₂ (5-HT: P = 0.001, and P < 0.001; MT: P = 0.006, and P = 0.001). At the 3-month follow up, fewer LKDs in the TEAS group had incisional pain when compared to the control group (P = 0.032).

Conclusions

Perioperative TEAS decreased perioperative anxiety and facilitated postoperative recovery in the LKDs, and potential decreased the development of chronic pain. Trial Registration: Registered at ChiCTR2000029891, http://www.chictr.org.cn/listbycreater.aspx.

A Systematic Review and Meta-Analysis Protocol to Establish How Common Clinical Acupoint Stimulation-Related Therapies Should Be Used for Managing Insomnia

Background

Many studies have now investigated the effects of common clinical acupoint stimulation-related therapies (ASRTs) following the meridian theory of traditional Chinese medicine for the management of insomnia. However, ASRT choice is currently based on personal clinical experience or patient preference. This study will review the common ASRTs reported in clinical trials and analyze their efficacy and safety for managing insomnia with or without co-morbidities.

Methods

English and Chinese databases will be thoroughly searched, and other potentially eligible trials will be obtained by reviewing reference lists of identified studies and previous reviews. Only randomized controlled trials (RCTs) of common clinical ASRTs to manage insomnia published in peer-reviewed journals will be considered. Sleep quality questionnaires or indices will be considered as the main outcome, while the secondary outcomes will include sleep parameters, daytime dysfunction, quality of life, and adverse effects. Two reviewers will independently investigate eligible RCTs, extract information, analyze their methodological quality, and employ Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria to evaluate the strength of the evidence. The treatment impact of various ASRTs will be calculated using meta-analysis techniques, and the degree of study heterogeneity will be assessed using Cochrane's Q and I-squared statistics. Subgroup and sensitivity analyses will be used to evaluate the reliability of the results.

Results

Our systematic review and meta-analysis will present up-to-date evidence on: 1) which common clinical ASRTs are beneficial for the management of insomnia; and 2) whether the effects of common clinical ASRTs on insomnia vary depending on clinical, participant, and treatment characteristics.

Conclusion

The results of our review should help decision-makers make educated choices regarding evidence-based non-pharmacological management options for insomnia.

Study Registration

The International Platform of Registered Systematic Review and Meta-analysis (INPLASY), record INPLASY2021120137.

Efficacy and safety of transcutaneous electrical acupoints stimulation for preoperative anxiety in thoracoscopic surgery: study protocol for a randomised controlled trial

INTRODUCTION

Preoperative anxiety occurs at a very high rate in patients undergoing video-assisted thoracoscopic surgery (VATS). Moreover, it will result in poor mental state, more analgesic consumptions, rehabilitation delay and extra hospitalisation costs. Transcutaneous electrical acupoints stimulation (TEAS) is a convenient intervention for pain control and anxiety reduction. Nevertheless, TEAS efficacy of preoperative anxiety in VATS is unknown.

METHODS AND ANALYSIS

This single-centre randomised sham-controlled trial will be conducted in cardiothoracic surgery department of the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine in China. A total of 92 eligible participants with pulmonary nodules (size ≥8 mm) who are arranged for VATS will be randomly assigned to a TEAS group and a sham TEAS (STEAS) group in a 1:1 ratio. Daily TEAS/STEAS intervention will be administered starting on 3 days before the VATS and continued once per day for three consecutive days. The primary outcome will be the generalised anxiety disorder scale score change between the day before surgery with the baseline. The secondary outcomes will include serum concentrations of 5-hydroxytryptamine, norepinephrine and gamma-aminobutyric acid, intraoperative anaesthetic consumption, time to postoperative chest tube removal, postoperative pain, and length of postoperative hospital stay. The adverse events will be recorded for safety evaluation. All data in this trial will be analysed by the SPSS V.21.0 statistical software package.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine (approval number: 2021-023). The results of this study will be distributed through peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04895852.

Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block on Postoperative Recovery in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery: A Randomized Controlled Trial

INTRODUCTION

This study assessed the influence of transcutaneous electrical acupoint stimulation (TEAS) combined with transversus abdominis plane block (TAPB) on the recovery of elderly patients undergoing laparoscopic gastric cancer surgery.

METHODS

Ninety patients (age ≥ 60 years) undergoing laparoscopic gastric cancer surgery were randomly divided into general anesthesia group (group G), TAPB group (group NG), and TEAS combined with TAPB group (group NTG). Patients in the NTG group received TEAS at PC6, LI4, and ST36 acupoints and TAPB. Patients in the NG group received TAPB. The quality of recovery (QoR) was assessed using the QoR-15 questionnaire. The percentages of T lymphocyte subsets were determined. Consumption of anesthetics, extubation time, visual analog scale (VAS) scores, time of first postoperative ambulation and flatus, and postoperative adverse events were also recorded.

RESULTS

QoR-15 scores on postoperative day (POD) 3 and POD 7 were higher in the NTG group than in the G and NG groups (P < 0.05). On POD 1 and POD 3, the percentages of CD3⁺ and CD4⁺ T cells and the CD4⁺/CD8⁺ ratio were higher and the percentage of CD8⁺ T cells was lower in the NTG group than in the G and NG groups (P < 0.05). Remifentanil consumption, and the incidence of postoperative nausea and vomiting (PONV) were lower and extubation time and time of first postoperative flatus were shorter in the NTG group than in the G and NG groups (P < 0.05). Compared with the G group, the VAS scores on POD 1 were lower in the NG group and those on POD 2 were lower in the NTG group (P < 0.05).

CONCLUSION

The combination of TEAS and TAPB ameliorated postoperative pain, improved immune and gastrointestinal function, reduced the incidence of PONV, and effectively promoted postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2100042119).

Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials

Objective

This meta-analysis aims to evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) in treating post-operative pain.

Methods

This meta-analysis was registered in PROSPERO (CRD42021286753). We searched PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs) about TEAS in treating postoperative pain that were published before November 2021. The primary outcome was visual analogue scale (VAS) within 24 h after surgery. The secondary outcomes included postoperative opioid analgesic drug consumption and the occurrence of adverse reactions within the postoperative 24–72 h. Adverse reactions included dizziness, nausea, and vomiting. Continuous variables were analyzed using mean difference (MDs) or standardized mean difference (SMDs) and 95% CIs. Relative risk (RR) and 95% CI were used for dichotomous data. The data were pooled and analyzed by RevMan 5.4 and STATA15.0 software.

Results

Seventeen trials with 1375 participants were included. The current results suggested that application of TEAS showed obvious superiority in reducing VAS scores (SMD = −1.51, 95% CI = −2.20∼−0.82, I2 = 96%). Subgroup analysis was performed according to open surgery and minimally invasive surgery. VAS scores were decreased after surgery at 24 h (SMD = −0.84, 95% CI = −1.07∼−0.6, I2 = 96%; SMD = −0.88, 95% CI = −1.02∼−0.75, I2 = 96%). The incidence of postoperative dizziness and nausea and vomiting was significantly lower in the TEAS group within postoperative 24–72 h (RR = 0.48, 95% CI = 0.34∼0.68, I2 = 0%; RR = 0.66, 95% CI = 0.44∼1.01, I2 = 69%; and RR = 0.49, 95% CI = 0.24∼1.00, I2 = 51%). Postoperative opioid analgesics were also reduced in the TEAS group within 72 h after surgery (SMD = −2.10, 95% CI = −3.37∼−0.82, I2 = 96%).

Conclusions

TEAS can reduce postoperative pain as well as the incidence of dizziness, nausea, and vomiting and the number of analgesics used after surgery. TEAS is a reasonable modality to incorporate into a multimodal management approach for postoperative pain.

The efficacy and safety of acupuncture assisted anesthesia (AAA) for postoperative pain of thoracoscopy: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Enhanced recovery after surgery suggests the use of multimodal analgesia to optimize the perioperative pain management scheme. At present, studies have shown that the application of acupuncture combined anesthesia in thoracoscopy has achieved good curative effect. However, there is no relevant systematic evaluation. Our study is the first meta-analysis of the effectiveness and safety of acupuncture combined anesthesia in pain management after thoracoscopy, in order to provide strong evidence for clinical support.

METHODS

A comprehensive and systematic literature searching will mainly perform on 7 electronic databases (PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data, Chinese Biomedical Database) from their inception up to November 30, 2021. We will also search for ongoing or unpublished studies from other websites (eg, PROSPERO, ClinicalTrials.gov, Chinese Clinical Trial Registry) and do manual retrieval for potential gray literature. Only the relevant randomized controlled trials published in English or Chinese were included. Two independent investigators will independently complete literature selection, assessment of risk bias, and data extraction, the disagreements will be discussed with the third party for final decisions. The primary outcome measures: visual analog scale, intraoperative anesthetic dosage, and the consumption of postoperative analgesics. The secondary outcome measures: Pittsburgh Sleep Quality Index, the total sleep time after operation, residence time in the anesthesia recovery room, the duration of hospitalization, and the incidence of adverse reactions and serious events. Assessment of bias risk will follow the Cochrane risk of bias tool. Data processing will be conducted by Stata 15.0 software.

RESULTS

We will evaluate the efficacy and safety of acupuncture assisted anesthesia for postoperative pain after thoracoscopy based on randomized controlled trials.

CONCLUSION

This study can provide more comprehensive and strong evidence whether acupuncture assisted anesthesia is efficacy and safe for postoperative pain in thoracoscopy.

REGISTRATION

The research has been registered and approved on the INPLASY website. The registration number is INPLASY 2021120129.

Transcutaneous Electrical Acupoint Stimulation for the Prevention of Postoperative Cognitive Dysfunction: A Systematic Review and Meta-Analysis

Background: No specific treatment is available for postoperative cognitive dysfunction (POCD). Recently, interest in the prevention of POCD during the perioperative period has increased. Although some studies suggest that transcutaneous electrical acupoint stimulation (TEAS) may be beneficial, the relevant evidence remains uncertain. Objective: To evaluate the preventive effects of TEAS on POCD. Methods: Seven databases including PubMed, EMBASE, CENTRAL, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang Database, and Chinese Biomedical Literature Database (CBM) were electronically searched up to April 2021. Two reviewers independently selected the studies, collected data, and assessed the risks of bias and grading of recommendations, assessment, development, and evaluations certainty of the evidence. A meta-analysis of the incidence of POCD, cognitive function score, pain, adverse reactions, and length of hospital stay after surgery was also performed. Results: Twenty-nine randomized controlled trials with 1,994 participants were included. The results of the meta-analysis showed that the TEAS group has a significantly lower incidence of POCD compared with the control group on postoperative days 1 [OR = 0.33 (95%CI: 0.23, 0.47); p < 0.001, I ² = 0%, moderate certainty], 3 [OR = 0.38 (95%CI: 0.29, 0.50); p < 0.001, I ² = 0%, low certainty], and 7 [OR = 0.51 (95%CI: 0.32, 0.81); p = 0.005, I ² = 0%, low certainty] but not on day 5 (p > 0.05, low certainty). Moreover, TEAS improved the Mini-Mental State Examination scores on postoperative days 1, 3, and 7 [MD = 2.44 (95%CI: 1.61, 3.27); p < 0.001, I ² = 93%, low certainty]; [MD = 2.07 (95%CI: 1.53, 2.62); p < 0.001, I ² = 87%, low certainty]; and [MD = 0.49 (95%CI: 0.18, 0.79); p = 0.002, I ² = 21%, low certainty], respectively, but not on day 5 (p > 0.05, very low certainty). TEAS promoted a postoperative analgesic effect within 24 h after surgery. Furthermore, patients receiving TEAS showed a lower incidence of postoperative nausea and vomiting and a shorter hospital stay. Conclusions: Limited evidence suggests that the application of TEAS in the perioperative period is associated with a reduced POCD rate and a protected early postoperative cognitive function.

Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Analgesic Requirement in Patients Undergoing Inguinal Hernia Repair: A Randomized, Placebo-Controlled Study

Given the rising rate of opioid-related adverse drug events during postsurgical pain management, a nonpharmacologic therapy that could decrease analgesic medication requirements would be of immense value. We designed a prospective, placebo-and-randomized controlled trial to assess the clinical effect of transcutaneous acupoint electrical stimulation (TEAS) on the postoperative patient-controlled analgesia (PCA) requirement for morphine, as well as side effects and recovery profile after inguinal hernia repair. Seventy-one subjects undergoing inguinal hernia repair with a standardized anesthetic technique were randomly assigned to one of three analgesic treatment regimens: PCA + TEAS (n = 24); PCA + sham-TEAS (no electrical stimulation) (n = 24), and PCA only (n = 23). The postoperative PCA requirement, pain scores, opioid-related side effects, and blood cortisol levels were recorded. TEAS treatment resulted in a twofold decrease in the analgesic requirement and decreased pain level reported by the patients. In addition, a significant reduction of cortisol level was reported in the TEAS group at 24 h postoperatively compared to the sham and control groups. We conclude that TEAS is a safe and effective option for reducing analgesic consumption and postoperative pain following inguinal hernia repair.

Effects of Intravenous Anesthetics vs Inhaled Anesthetics on Early Postoperative Sleep Quality and Complications of Patients After Laparoscopic Surgery Under General Anesthesia

OBJECTIVE

Decreased postoperative sleep quality remains a serious problem in surgical settings at present. The purpose of our study was to compare the effect of propofol vs sevoflurane on early postoperative sleep quality and complications of patients receiving laparoscopic surgery after general anesthesia.

METHODS

Seventy-four patients undergoing selective laparoscopic surgery under general anesthesia were randomly assigned to the propofol group or sevoflurane group. The wireless portable sleep monitor (WPSM) is used to collect sleep quality on the night before surgery (sleep preop 1), the first night after surgery (sleep POD 1), and the third night after surgery (sleep POD 3). Record the subjective sleep quality and dreaming state during the operation. The perioperative hemodynamics, postoperative sleep and complications were also evaluated.

RESULTS

Compared with Sleep preop 1, patients showed lower sleep efficiency, Stable sleep and Unstable sleep during Sleep POD 1 and Sleep POD 3. In addition, compared with the propofol group, the proportion of REM sleep in the sevoflurane group was much higher during Sleep POD 1 and Sleep POD 3, and the incidence of dreaming was also higher in the sevoflurane group. Patients in the propofol group had better pain relief at 2, 4, and 6 hours after surgery. And the incidence of postoperative nausea and vomiting and dizziness in the sevoflurane group was significantly higher than that in the propofol group.

CONCLUSION

The degree of postoperative sleep efficiency was better on Sleep POD1 and Sleep POD3; the incidence of postoperative nausea and vomiting, and dizziness was lower; and postoperative pain was slighter when the operation was performed under propofol anesthesia compared with patients in the sevoflurane group. Propofol should be considered a better choice during the operation to promote the patient's postoperative sleep quality, relieve postoperative pain and improve the incidence of postoperative dizziness and nausea and vomiting.