Clinical Efficacy And Central Mechanism Of Electroacupuncture On Acute Pain After Total Knee Replacemen

Objective1.Using the method of bibliometric analysis,the research progress of acupuncture in the perioperative period of TKA was determined.2.Single blind,randomized and sham-acupuncture controlled trials was conducted to determine the clinical efficacy of electroacupuncture in the treatment of acute pain after TKA,and functional imaging data analysis was used to explore the central mechanism of postoperative analgesia.3.The behavioral score of TKA acute pain rat model was used to determine the efficacy of electroacupuncture analgesia.High-throughput transcriptome sequencing of PAG tissue by RNA-seq technique was used to screen DEGs,to lay a foundation for the exploration of the molecular mechanism of electroacupuncture analgesia postoperative.Methods1.In Chinese,“acupuncture/electro-acupuncture”and “total knee arthroplasty/total knee replacement” are used to search CNKI and WOS databases,and Excle and WOSviewer tools were used to make statistics and visual analysis on the retrieved documents.2.A single blind,randomized,placebo controlled clinical study was conducted.The126 subjects were randomly divided into electro-acupuncture group and artificial acupuncture group.After operation,D3,D4,D5,D6 and D7 were given electroacupuncture and sham-acupuncture analgesia respectively.Preoperative,D2,D3,D4,D5,D6,and D7 NRS scores,PPT values,and use of additional analgesics were recorded.Statistical analysis of AKSS scores,s EMG,m30 s STS,SAS,and SDS scores before and after intervention,and incidence of adverse events.3.40 patients were randomly divided into electro-acupuncture group and pseudoacupuncture group,and were scanned with rs-f MRI before and after the intervention.The ALFF and Re Ho values of the whole brain and the functional connection strength between the whole brain and the midbrain aqueduct were analyzed.4.Twenty-four rats were randomly divided into control group,SA group and EA group to establish acute pain models after TKA.Electroacupuncture,artificial acupuncture and blank control were given to D1 once a day for 5 consecutive days.The pain behavioral performance(50% MWT and cumulative pain score)at different time points before and after the modelling were recorded.After D5 intervention,6 DEGs(Ttr,Aqp1,Trpv 4,Cxcl 10,Igf 2,Twist 1)were selected from EA group and SA group using RT-q PCR to identify the expression of PAG gene in SA group and EA group.Results1.A total of 61 articles were included in the analysis,acupuncture in TKA has not been widely used in the perioperative period,China,Japan,South Korea,Spain,the United States,Chile and Denmark have been studied in this area.Articles in this field were easily published in journals of alternative medicine,acupuncture and moxibustion,comprehensive clinical medicine and traditional Chinese medicine.The main research institutions were Shanghai,Nanjing,Guangzhou and Fujian Universities of Traditional Chinese Medicine.There was no cooperative relationship between each institution and the author.The research direction was to assist analgesia after acupuncture.There was controversy about the analgesic effect of acupuncture in the world.Besides assisting analgesia,acupuncture also includes prevention and treatment of venous thrombosis,postoperative nausea and vomiting and postoperative senile cognitive impairment.Principles of Acupoint Selection Methods of Distal Acupoint Selection Including Wrist and Ankle Acupuncture,Abdominal Acupuncture,Auricular Acupuncture,etc.2.The results of clinical study showed that 120 subjects were included in the final statistics.The NRS scores of EA group were lower than those of D4,D5,D6 and D7 after operation,and the PPT values of D4,D5,D6 and D7 after operation were significantly higher than those of EA group,and the use frequency of additional analgesic drugs in EA group was less than those of EA group(P < 0.05).The AKSS scores,M30 S STS and RMS values of the electroacupuncture group were significantly higher than those of the artificial acupuncture group(P < 0.05),and the SAS and SDS scores were significantly lower after treatment(P < 0.05).3.In the electro-acupuncture group,compared with before and after treatment,the decrease ALFF value was in SMA.L.Decreased Re Ho value were in SMA and INS.R;FC increased in MTG.L,FFG.L,IFGtriang.L,ACG.L,DCG.R and MFG,while FC decreased in STG.R in whole brain and PAG.After treatment,the electroacupuncture group was compared with the sham acupuncture group,increased ALFF values were STG.R,MTG,ITG.R,HIP.R,FFG.L and Po CG.L.While decreased ALFF values were PCUN,DCG.R,PCL.R,SMA and SFGdor.L.The brain regions with increased Reho values were STG.L,MTG,ITG.R,IFGtriang.R,HIP.R and PHG.R;the brain regions with decreased Reho values were PCL.L,DCG.R,SMA.L,SFGdor.R,SFGmed.L,IPL.L and PCUN.L.The brain ares with increased FC to PAG were INS.L,OFClat.,ITG.L,HIP.R,SFGmed.R,MFG.R.The brain ares with decreased FC to PAG were STG.R,SFGdor.L,IPL,SMG.L and ANG.R.4.The results showed that the pain tolerance of electroacupuncture group was 50%higher than that of D2,D3,D4 and D5,and the difference was significant(P < 0.05),and there was no statistical difference between the two groups.The accumulative pain score of electroacupuncture group was significantly lower than that of D2,D3,D4 and D5 in the artificial needle group and control group(P < 0.05).There was no statistical difference between the artificial needle group and control group.RNA-seq analysis showed that there were 354 DEGs,37 up-regulated genes and 317 downregulated genes in EA group and SA group.RT-q PCR results showed that gene Ttr,Aqp 1,Trpv 4,Cxcl 10,Igf 2 and Twist 1 were down-regulated in EA group,which was consistent with the results of RNA-seq assay.Conclusion1.The effect of acupuncture on postoperative analgesia,the choice of acupoints and the time of treatment are controversial,and there is a lack of multi-center,large sample clinical trials and mechanism of action.2.Electroacupuncture at Futu,Zusanli,Yinlingquan and Yanglingquan points can effectively relieve the acute pain,promote the recovery of joint function in early stage and improve the bad mood in perioperative period.3.Electroacupuncture can inhibit the excessively activation of SMA,INS,ACC and PFC,increase the functional connection between the part of the limbic system and the PFC and the PAG,and regulate the neurological downward inhibition of the expression of some pain-causing genes in PAG.In order to achieve the analgesic effect.