| BackgroundPostoperative nausea and vomiting(PONV)is a common complication for patients under general anesthesia after surgery.The incidence of PONV ranges from 40-90% after general anesthesia.Despite advances in anesthetics and postoperative care,the incidence of PONV ranges from 30-50% after general anesthesia within 24 hours,and in a subset of high-risk patients,the PONV rate can reach to 70-80%.Although PONV is self-limited,it not only causes intense discomfort to patients,and can result in dehydration,electrolyte imbalance,and even life threatening airway complications.Persistent PONV also increases intra-abdominal pressure and incision tension,and even leads to rupture of the infection,which can prolong patient hospital stay,reduce patient satisfaction,increase patient costs and their family burden.Acupuncture is an important part of traditional Chinese medicine.Electric acupuncture(EA)is a technique combining electronic technology and traditional acupuncture.Electric acupuncture has been proved effective in several studies recently,such as reducing the consumption of anesthetics,reducing the postoperative complications and relieving acute pain.Electric acupuncture is also proved to be effective for PONV,but we don’t know which is better-the combined acupoints or single acupoint.However,the non-uniform operation procedure including the method of acupoints combinations one of the problems during the clinical application of electric acupuncture.According to the retrieving of the relative literatures,more researchers prefer to combined acupoints rather than single acupoint although the latter is also effective.It is still unclearly whether the effect of dual acupoints stimulation is better than single one.In order to compare the efficiency of this and provide reliable evidence for doctors,we designed this study.ObjectiveThe purpose of this study was to evaluate the effects of single acupoint(Neiguan,PC6)or two acupoints combination(Neiguan,PC6 and Zusanli,ST36)stimulated with transcutaneous electrical acupoint stimulation(TEAS)for PONV in gynecological patients undergoing laparoscopic operation.MethodsThe patients scheduled for elective gynecological laparoscopic operation under general anesthesia were included.They were randomly assigned to receiving single acupoint(PC6 or ST36)TEAS,dual acupoints(PC6 and ST36)TEAS or sham acupuncture from 30 minutes before anesthesia induction to the end of the operation.The primary endpoint was the incidence of PONV within 24 hours after operation(it was recorded at the time point of 30 minutes,2 hours,6 hours and 24 hours respectively.)Secondary endpoints included visual analogue score(VAS)at four different time points,the level of 5-hydroxy tryptamine(5-HT),dopamine and gastrin,antiemetics used and other complications(such as dizziness,pruritus,respiratory depression)within 24 hours,quality of recovery-15(QoR-15)score after 24 hours and hospitalization.ResultsTwo hundred and sixty eight patients were enrolled from Jan 2016 to Jul 2016.Two hundred and fifty six patients completed the trial(64 in dual acupoints group,65 in PC6 group,63 in ST36 group and 64 in sham group).The incidence of PONV in dual acupoints group(D group),PC6 group(P group),ST36 group(S group)and control group(C group)was 23.4%(15),32.3%(21),39.7%(25)and 82.8%(53),respectively.The incidence of PONV was significant lower in D group,P group and S group than in C group(P<0.001).However,there was no significant difference for the incidence of PONV in D group compared to P group and S group(P>0.05).Before operation,the concentration of 5-hydroxy tryptamine dopamine and gastrin was already the same in the four groups.After surgery,the concentration of 5-hydroxy tryptamine and dopamine was higher than before surgery in group D,group P and group S.But there was no difference in the concentration of gastrin.In group C,there was no difference in the concentration of 5-hydroxy tryptamine dopamine and gastrin before and after operation.Compared to C group,pain was relieved and complication was decreased in other three groups(P<0.05).But there was no significant difference between D group and P group or S group(P>0.05).QoR-15 score after operation and the need for antiemetic rescue medication within 24 hours after operation and hospital stay were similar in the four groups.ConclusionIn this study,we found that dual acupoints TEAS and single acupoint TEAS(PC6 or ST36)were both effective in PONV prophylaxis and pain relief in gynecological patients undergoing laparoscopic surgery compared to control group.But dual acupoints TEAS and single acupoint TEAS had the same effect on patient.The effect of acupuncture could be related to the concentration of 5-hydroxy tryptamine,dopamine and gastrin in serum. |
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