Clinical Observation On Analgesic Effect Of Different Intensity Transcutaneous Electrical Acupoint Stimulation After Total Knee Arthroplasty

Objective:To observe the therapeutic effect of different intensities of transcutaneous electrical acupoint stimulation on pain after total knee arthroplasty,to explore the optimal intensity of action of transcutaneous electrical acupoint stimulation in the treatment after total knee arthroplasty,and to provide a reference for the selection of parameters for the application of transcutaneous electrical acupoint stimulation after total knee arthroplasty.Methods:According to the inclusion and exclusion criteria 60 Patients who were scheduled to undergo their first unilateral Total Knee Arthroplasty due to knee Osteoarthritis in the Department of joint orthopedics,Affiliated Hospital of Shandong University of Chinese medicine from February 2020 to February 2021 were selected.Patients were randomized according to the random number table method into three groups of 20 patients each,the patients in the three groups were treated with the same surgical and anesthetic protocols,and they were given the same routine treatment postoperatively.Control group:routine postoperative analgesic treatment.Low-intensity TEAS group(Ta group):On the basis of conventional analgesic treatment,low-intensity teas treatment was started on postoperative day 2nd,the intensity at this point was the sensory threshold at the selected acupoint,the minimum value when starting to feel a weak stimulus,until the patient was discharged.High intensity TEAS group(Tb group):The TEAS intensity was the maximum intensity tolerated by the patients,at this time,the current intensity was gradually increased from the sensory threshold until strong tremor and flatulence sensation occurred in the local muscles of the patient,but no tingling was appropriate,and the intensity was adjusted at any time during treatment to maintain maximum stimulation and the rest of the protocol was the same as the Ta group.The VAS scores under resting and rehabilitative exercise,the degree of postoperative swelling of the affected limbs,and the HSS functional scores of the knee joints were recorded on the 2nd,3rd,5th,and 7th postoperative days in the three groups;the total number of pressed PCIA,the number of patients who used additional analgesic drugs and experienced nausea and vomiting,skin pruritus within 7 days were recorded.The data were analyzed by SPSS 22.0.Results:A total of 60 patients were included,20 in each group.There were no significant differences in age,gender,BMI index,and surgical site among the groups(P>0.05),and the data were comparable.1.Visual analogue scale: There were no significant differences in VAS scores between the three groups at rest and in the rehabilitation training condition On the second day after operation(P>0.05).On the 3rd,5th and 7th days after surgery,The decrease in VAS score in the Tb group compared to the control group or Ta groups was statistically significant(P<0.05).The VAS score decreased in the TA group compared with the control group at the same time node,but the difference was not statistically significant(P>0.05).2.The use of PCIA and additional analgesic drugs: The number of pressed PCIA in the three groups was statistically significant in the Ta group compared with the control group,the Tb group compared with the control group or the Ta group(P<0.05).The number of patients who additionally used analgesic drugs decreased in the TB,Ta and control groups in turn,but the difference was not statistically significant(P>0.05)Degree of swelling of the affected limb: There were no significant differences between the three groups in the circumferences contrasts of 10 cm above and 10 cm below the patella on the second postoperative day(P>0.05).The circumference of the affected limb was smaller in the Tb group compared with the control or Ta groups on postoperative days 3rd,5th and 7th,and the difference was statistically significant(P < 0.05).The circumferences of 10 cm above the patella on the fifth postoperative day,10 cm above the patella and 10 cm below the patella on the seventh postoperative day,were smaller in the TA group compared with the control group and the differences were statistically significant(P<0.05).4.Hospital for special surgery knee score: There was no statistically significant difference in HSS scores between the three groups on the second postoperative day(P>0.05).The HSS scores were higher in the Tb group compared with the control group or the Ta group at day 3rd,5th and 7th postoperatively,and the difference was statistically significant(P<0.05);the HSS scores were higher in the Ta group compared with the control group at the same time node,but the difference was not statistically significant(P>0.05).5.Postoperative adverse effects: The number of cases of nausea and vomiting in the Tb group was significantly lower than the control group,and the difference was statistically significant(P<0.05),the number of cases of nausea and vomiting in the Ta group compared with the control group was not statistically significant(P>0.05).the number of patients with pruritus was not statistically significant compared among all groups(P>0.05)Conclusion:Transcutaneous electrical acupoint stimulation has shown remarkable efficacy in the treatment of pain after total knee arthroplasty,being able to effectively control and reduce patients’ VAS scores and reduce the amount of analgesic medication used.It also improves postoperative limb swelling,reduces the incidence of adverse effects,and accelerates postoperative functional recovery.Among the two protocols,high intensity versus low intensity,high intensity transcutaneous acupoint electrical stimulation had better efficacy,manifested as being able to better improve each indicator,which is worthy of clinical promotion.