| Background:Gastric cancer and colorectal cancer are among the top five cancers worldwide in terms of incidence,ranking third and fifth,respectively.They are also the second and fourth leading causes of cancer-related deaths,respectively,and have a significant impact on human health.Early surgical resection is the main treatment for gastrointestinal cancer,but gastrointestinal cancer surgery is highly traumatic and can elicit strong stress reactions,often leading to related complications after surgery.Postoperative sleep disturbances(PSD)is a clinical syndrome in which patients experience sleep-wake rhythm disorders after surgery,leading to decreased sleep quality or abnormal behavior during sleep.Sleep disorders can increase the risk of delirium,increase pain sensitivity,cause intermittent hypoxemia,immune function inhibition,more stress reactions,and adverse cardiovascular events,severely affecting the patient’s postoperative recovery.Transcutaneous electrical acupoint stimulation(TEAS)as an alternative treatment for traditional acupuncture has the advantages of non-invasion and safety,and is increasingly widely used in clinical practice.Objective:This study aims to observe the effects of using TEAS during the perioperative period on postoperative pain,sleep,and stress response in patients undergoing laparoscopic surgery for gastrointestinal cancer,and to explore its possible mechanisms.Methods:Patients who met the inclusion criteria were randomly divided into TEAS group with 43 cases and Sham group with 45 cases.All patients underwent general anesthesia for laparoscopic surgery of gastric or colorectal cancer.In the TEAS group,TEAS was applied to bilateral Neiguan(PC6),Hegu(LI4),and Zusanli(ST36)acupoints using a transcutaneous nerve electrical stimulator with electrodes attached to these acupoints above.The stimulation was delivered with a sparse and dense wave of 2/100 Hz,with a current intensity of 6-15 mA,and the optimal intensity was adjusted to keep the local muscles twitching slightly,depending on the patient’s tolerance,for 30 minutes on the night before surgery,the night of the surgery and the first night after surgery.In the Sham group,the electrodes were attached to the same acupoints at the same time points,and the same stimulation parameters were used,but the stimulation was not applied.The duration of the stimulation was also 30 minutes.Both groups of patients were evaluated using the Athens Insomnia Scale(AIS)and Pittsburgh Sleep Quality Index(PSQI)on the day before surgery(P1),the first day after surgery(D1),and the third day after surgery(D3).Peripheral blood samples were collected to measure the levels of nuclear factor E2-related factor 2(Nrf2),cortisol(COR),glutathione peroxidase 3(GPX3)and superoxide dismutase(SOD)on P1,0.5h after surgery(D0),D1 and D3.Peripheral blood samples were obtained for the purpose of quantifying the levels of interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-a(TNF-α)on P1,D1,D3 and the fifth day after surgery(D5).The scores of the visual analog scale(VAS)were documented 24,48,and 72 hours following the surgical procedure,as well as the cumulative dose of additional analgesics given within 72 hours after surgery,the occurrence of dizziness,abdominal distension,nausea,vomiting,and pulmonary complications within 72 hours after surgery.Results:Compared with the Sham group,perioperative TEAS improved the quality of sleep on D1 and D3,and the differences were statistically significant(PSQI P<0.05,AIS P<0.05).At 24,48,and 72 hours post-surgery,the TEAS group exhibited significantly lower activity VAS scores compared to the Sham group(P<0.05).However,there were no statistically significant differences observed in the rest VAS scores between the two groups(P>0.05).The plasma IL-6 levels in the TEAS group were significantly decreased on D1,D3 and D5,the differences were statistically significant(P<0.05),while serum levels of TNF-α and IL-10 in the two groups increased after surgery on D1 and D3,and returned to the preoperative levels on D5,but there were no significant differences between the two groups(P>0.05).The occurrence of nausea,vomiting,and abdominal swelling 72h following surgery were significantly lower in the TEAS group than in the Sham group,with statistical significance(P<0.05).In comparison to the Sham group,the levels of oxidative stress markers Nrf2,GPX3 and SOD in the peripheral blood were higher in the TEAS group on D1 and D3,while COR in the peripheral blood were lower,and these differences were statistically significant(P<0.05).The key mediators of the Nr(?)2/ARE pathway were enhanced after TEAS application.Conclusions:Perioperative TEAS improved postoperative sleep quality,reduced postoperative pain,and alleviated postoperative adverse effects in patients undergoing laparoscopic gastrointestinal cancer surgery resection.This may be associated with activating Nrf2/ARE signal pathway and decreasing its inflammatory actions. |
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