Randomized Controlled Trial Of TEAS With Different Acupoints Combination On Opioids Consumption In Patients Undergoing Off-pump Coronary Artery Bypass Grafting

PurposeCoronary artery disease(CAD)is the primary cause of death in western countries.There are an increase number of CAD patients undergoing surgerical therapy.In American,500,000 patients receive coronary artery bypass surgery per year,which decreases mortality profoundly in severe CAD patients.Off-pump coronary artery bypass grafting(OP-CABG)surgery is performed on beating heart,which can provide benefits for high-risk patients.In Asia area,especially in India,95% coronary artery bypass surgeries are performed without pump.Anesthesia during OP-CABG surgery has the objective of ensuring maximum cardiac protection,maintaining stability of both hemodynamic and cardiac rhythm,and promoting early ambulation in combination with excellent postoperative analgesia.Anesthesiologists should avoid the use of high doses of long-acting opioids,which potentially prolong respiratory depression,mandate ventilatory support,cause hypotension during or after sternotomy resulting in myocardial ischemia and infarction and delay bowel movement recovery.A lot of studies have demonstrated beneficial effects of acupuncture,eg: preventing deep venous thrombosis,promoting blood circulation,protecting immunologic function,attenuating cerebral ischemic injury as well as analgesic and cardiac protective function.Based on Traditional Chinese Medcine(TCM)theory,the most important influencing factors of acupuncture are acupoint specificity and acupoint combination mode.Acupoint specificity has been investigated thoroughly in the last decades.However,acupoint combination mode is an empirical practice and yet to be testified.We conducted this prospective,double-blinded,randomized controlled trial to compare the opioid sparing effect of transcutaneous electric acupoint stimulation(TEAS)between the distal-proximal acupoints combination and regional acupoints combination.MethodsOne hundred and eighty-six adults scheduled for elective OP-CABG surgery were randomized to TEAS 1:1:1 with distal-proximal acupoints combination(LI4 and CV17),regional acupoints combination(CV17 and CV14)and control(non-acupoints,2 cm to the right side of CV17 and CV14)groups during the period from August,2014 through February,2015 at Xijing and Tianjin Chest Hospitals.The TEAS was lasted for 30 minutes before anesthesia by appointed staffs,which were unaware of the study group assignments.Gel electrodes were applied to the skin after cleaned with alcohol pad.The acupoints were then stimulated electrically with an intensity of 7-11 mA and dense-disperse frequency of 2/10 Hz for 30 min before the anesthesia induction,using the Hwato electronic acupuncture treatment instrument(model No.SDZ-V,Suzhou Medical Appliances Co.,Ltd,Suzhou,China).The stimulating intensity was adjusted to maintain a slight twitching of the local muscles based on individual maximum tolerance,indicating the so-called “De-Qi” sensations of heaviness,numbness,and swelling.The primary endpoint was intraoperative sufentanil consumption.Secondary endpoints included perioperative hemodynamics(heart rate,mean arterial pressure and bispectral index),parameter of cardiac function(cardiac output,cardiac index,systemic vascular resistance and pulmonary vascular resistance),duration of mechanic ventilation,length of cardiac care unit(CCU)stay and postoperative hospital stay,incidence and the duration of re-intubation,re-admission to CCU,placement of intra-aortic balloon counter pulsation(IABP)or ventricular assisted device(VAD),postoperative cardiac function(troponin I and inotrope score),overall and systemic incidence of postoperative complications,and all cause mortality by 30 days.ResultsThe cumulative consumption of sufentanil was significantly reduced in the distalproximal acupoints combination group when compared with those in the regional acupoints combination and control groups(255.0 ± 106.1 ug vs 300.4 ± 106.9 ug and 305.9 ± 119.1 ug,P = 0.027).No significant differences among the three groups were found as refer to all of the secondary endpoints.ConclusionTEAS with distal-proximal acupoints combination has better efficacy in reducing intraoperative opioid consumption in patients undergoing OP-CABG surgery.