Preoperative Transcutaneous Electrical Acupoint Stimulation Improves The Postoperative Quality Of Recovery After Gynecological Laparoscopic Surgery

Objective There were many problems such as pain, nausea, vomiting after gynecological laparoscopic surgery. Transcutaneous electrical acupoint stimulation is a technology of acupuncture, with the advantages of sedation, analgesia and preventing operative nausea and vomiting. However, whether transcutaneous electrical acupoint stimulation improves the postoperative quality of recovery(Qo R) was unknown. The assay is to assess the effects of preoperative transcutaneous electric acupoint stimulation(TEAS) on the quality of recovery after gynecological laparoscopic surgery.Methods Seventy-four patients with American Society of Anesthesiologists(ASA) physical statusⅠorⅡ, aged 18~60 year, planed for elective gynecological laparoscopic surgery, were randomly distributed into 2 groups with thirty-seven patients in each group: control group(group C) and transcutaneous electric acupoint stimulation group(group TEAS). Patients in both group were administered with midazolam 30 min ahead of induction of anesthesia. Patients in group TEAS was treated with electrical stimulation on acupoints on bilateral Hegu(LI4), Neiguan(PC6), Zusanli(ST36) and Sanyinjiao(SP6) for 30 min. Transcutaneous electric acupoint stimulation were performed with a dense-disperse frequency of 2/10 Hz. The optimal intensity was adjusted according to individual maximum tolerance. However, in the control group, the patients were connected to the same device on the above acupoints, but electronic stimulation was not applied. Tracheal intubation was performed in later intravenous injection of sufentanil, propofol and cisatracurium. Anesthesia was maintained with sevoflurane 2%-3% in accordance with hemodynamic changes and aiming to a bispectral index(BIS) of 40~60. All patients were taken effective analgesia measures by patient controlled intravenous analgesia(PCIA) pump after surgery. The primary outcome was observed on the quality of recovery, which was assessed on 24 h after surgery using a 40-item questionnaire(Qo R-40). Secondary outcomes included postoperative analgesia and other medical conditions affecting the quality of recovery. The former were evaluated on postoperative pain scores assessed using Visual Analogue Scale(VAS) in 0.5, 1, 2, 4, 8 and 24 hour after surgery, the average VAS and maximum VAS in 24 hour, cumulated pressing numbers and effective pressing numbers in 24 hour, and time of first rescue analgesia. The latter included the incidence of side effect such as dizzy, nausea and vomiting, first time of exsufflation, duration of PACU stay and patient’s satisfaction in 24 hour.Results Compared with group C, Qo R-40 scores on 24 h after surgery was significantly increased(176.5 vs. 164.8; P<0.001), the emotional state, physical comfort, psychological support and pain was increased(P<0.05) in TEAS group. However, there were no significant difference in the physical independence item between group TEAS and group C(P>0.05). Compared with group C, there was better analgesia on the group TEAS, as the VAS on 2, 4, 8, 24 h after operation were lower, time of first rescue analgesia was shortened, the average VAS and maximum VAS were decreased, and cumulated effective pressing numbers was decreased(P<0.05). Compared with group C, within 24 h after operation, the incidence of dizzy, postoperative nausea and vomiting was reduced, residence time of PACU stay was shortened, and patient’s satisfaction in 24 h was decreased in TEAS group(P<0.05).Conclusion Preoperative TEAS on bilateral Hegu(LI4), Neiguan(PC6), Zusanli(ST36) and Sanyinjiao(SP6) for 30 minutes enhances quality of recovery, improves postoperative analgesia and patient’s satisfaction, and alleviates postoperative side effects after general anesthesia for gynecological laparoscopic surgery, such as dizzy, nausea and vomiting.