The Clinical Research On Control The Post-hemorrhoidectomy Pain By Transcutaneous Electrical Acupoint Stimulation

Background:With human social and economic developing, great changes have taken place in people’s life style and habits, at the same time, social pressure of people also increased dramatically. Under the influence of the subjective and objective factors, in today’s society, the anus diseases has a multiple and common trend. Although they seldom can threat to people’s life, but they has brought great inconvenience to people’s life, and pain, and sufferings, which seriously affected the quality of life of people.Hemorrhoid is the most common and frequent clinical disease of the anus. According to the data of census found that, the accidence of anorectal diseases is59.1%, in that hemorrhoids is87.25%of all. While mixed hemorrhoids account for80.98%of the number of hemorrhoids above. In recent years, with the understanding to mechanism and the anatomy, physiology and pathology of hemorrhoids has been reached further and further, treatments of hemorrhoids has been thorough and developing. In the treatment of mixed hemorrhoids, the surgical treatment is still the best way to cure mixed hemorrhoid, and part of the main disease in principle required surgery. There are many ways to hemorrhoid surgery, while, in1937, Milligan and Morgan founded the stripping of Internal Ligation, which is still one of the most useful and classical treatments of Ⅲ, Ⅵ mixed hemorrhoids in recent years. A long-term clinical practice has proved that this kind of operation gives a good long-term efficacy and relatively cheap cost of treatment. Since clinical promotion of using this procedure, it has been widely used so far. But postoperative pain is that the most mixed hemorrhoid patients worried about. The pain will not begin gradually reducing until it nearly usually last for5-7days. Postoperative patients with daily life and personal mental health caused great disturbance, seriously affecting the rehabilitation of patients, while increasing the length of hospital stay and costs of treatment. At present, there are many different ways of analgesia, such as taking medicine, hip baths, anal suppositories, applying, local injection of sclerosing agents, Balanced Anaksia, Patient-controlled Analgesia. Otherwise, there is analgesia by physical therapy such as intermediate frequency electrical stimulation and transcutaneous electrical stimulation, etc. But each way has its own advantages and shortcomings. How to sustained relief of pain effectively, is an important issue to improve the patients’ quality of life. Exploring a way which is effective, less side effect and convenient for pain relief after hemorrhoids surgery is the currently important assignment in clinical research. Transcutaneous electrical acupoint stimulation is a new popularity of green therapy in the acupuncture field in recent years. It has the advantages of acupuncture and percutaneous electrical stimulation. Under the guidance of acupuncture and meridian theory, we locate the corresponding acupuncture points accurately and paste electrode piece, by asymmetrical bidirectional waveform of current stimulate acupuncture points, to achieve analgesia treatment. Because the resistance of these special points (acupoints) in skin is low. There has high density input to the central nervous system, to adjust the role of the meridian. This is a kind of combined acupuncture and physical therapy treatment. In the treatment of pain, transcutaneous electrical acupoint stimulation therapy is suitable for clinical application widely, because of wide application range, remarkable analgesic effect, and reuse.Objective: Based on the theory of Traditional Chinese medicinal meridian, use Evidence-Based Medicine to explore the influence and security of the technique of Transcutaneous Electrical Acupoint Stimulation and western medicine that can deal with the pain after the operation of mixed hemorrhoids by chosing scientific research and design, and to find a safe and effective clinical options for the clinical treatment of mixed hemorrhoids anal pain.Methods:From January2012to December2012, in Anorectal of Zhujiang Hospital of Southern Medical University, Suffered with mixed hemorrhoid,80patients undergoing with the operation of Milligan-Morgan Hemorrhoedectomy were divided into Treatment Group (40cases) and Control Group (40cases) randomly. In the Treatment Group,40patients are treated with Transcutaneous Electrical Acupoint Stimulation at the implementation after operation:with the microcomputer low-frequency therapeutic apparatus made by Guangdong Yangcheng Electronics co.,LTD, adopting the two sides of BL30, in which the two pieces of5cm x5cm of electrodes stick the center to point, the therapist increases the stimulus intensity to the maximum tolerance of patient slowly, for30minutes twice each day. If the pain relief is not obvious after treatment, or patients feel pain again, or even harder to bear, the patients could make a choice that taking transcutaneous electrical acupoint stimulation again or take a pill (Tramadol hydrochloride50mg each time). Meanwhile, it would be recorded in the time and frequency of use.In the Control Group,40patients only have50mg Tramadol hydrochloride. If the pain relief is not obvious after treatment, or patients feel pain again, or even harder to bear, the patients could take a pill (Tramadol hydrochloride50mg each time) again. After operation completed, observe the hours of pain evaluation4h,6h,12h,24h,48h,72h. The main Observation indicators are:visual analogue score (VAS), oral portray score method (VRS score4),and the edema of the wound score. The adverse effect and the amount of analgesic drugs were recorded simultaneously. Then all data were analyzed with SPSS.13.0.Results: 1. Main evaluation index:(1) two groups of postoperative anal pain VAS scores comparison, according to a=0.05level,4h,6h,12h,24h,48h,72h after surgery, two groups VAS score, P>0.05, have no statistical significance.(2) two groups of postoperative anal pain score comparison, according to VRS, a=0.05level, at each time point(4h,6h,12h,24h,48h,72h) after operation of two groups of VRS score, P>0.05, two groups have the same distribution and without statistical significance.(3) In the two groups of patients in4h,6h,12h,24h,48h,72h after the surgery of wound edema score comparison, through statistical analysis, P>0.05, the two groups have the same distribution, and no statistical significance.2. Secondary indicators:In the comparison of analgesics use quantity on average of the two groups at each observation period between the two groups, according to a=0.05inspection level, in0～4h、4～6h、24～48h、48～72h after operation,the comparison of analgesics use quantity on average of the two groups, P<0.05, two groups were with different distribution, and it have statistical significance by statistical analysis (P <0.05), the treatment group was superior than control group. In6～12h、12～24h after operation,the comparison of analgesics use quantity on average of the two groups, two groups were with the same distribution, without statistical significance by statistical analysis (P>0.05).3. Security Evaluation Index:according to a=0.05inspection level, comparing the incidence of postoperative adverse events between the two groups, two groups are with different distribution, and it have statistical significance by statistical analysis (P <0.05), the treatment group is superior than control group in safety.Conclusions:1. The technique transcutaneous electrical acupoint stimulation can reduce the mixed hemorrhoid postoperative pain with a certain curative effect. It can reduce the pain intensity, and improve the daily life of patients.2. The technique of transcutaneous electrical acupoint stimulation has so many adventages such as safe, effect, reusable, cheeper, easy to master and implement, that is a good treatment to deal with pain after operation that Milligan-Morgan Hemorrhoedectomy.3. In the most painful stage of the development of hemorrhoid, the treatment can reduce the pain intensity and shorten the time of pain with a good analgesic effect and provide a new clinical choice that worth promoting extensively.