Effect Of Transcutaneous Electrical Acupoint Stimulation On Postoperative Pain In Pediatric Orthopedic Surgery With The ERAS Protocol

Objective:This study evaluated the safety and effectiveness of transcutaneous electrical acupoint stimulation（TEAS）on postoperative analgesia in pediatric orthopedic surgery with the enhanced recovery after surgery（ERAS）protocol.Methods:A total of 58 children（3–15 years old）undergoing orthopedic surgery of the lower limb under general anesthesia in the Ethics Committee of the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2022 to October 2022 were randomly allocated into two groups（n=29 each）:transcutaneous electrical acupoint stimulation group（group T）and control group（group C）.The ERAS protocol was used in both groups.In the group T,the bilateral Hegu（LI4）and Neiguan（PC6）acupoints were stimulated starting from 10 min before anesthetic induction until the completion of surgery.In the group C,the electric stimulator was also connected to the participants;however,electrical stimulation was not applied.The severity of pain was assessed using the Faces Pain Scale-Revised（FPS-R）scores at the time of back ward,postoperative 2 h,24 h,and 48 h.The occurrence of emergence agitation assessed using the Pediatric Anesthesia Emergence Delirium（PAED）scale immediately after extubation,10 min after extubation,and before leaving the PACU,with a PAED score of≥10 points defined as emergence agitation.The intraoperative consumption of propofol and remifentanil,time to extubation,time to first press of the patient-controlled intravenous analgesia（PCIA）pump,number of analgesia pump presses in 48 h after surgery,postoperative adverse reactions,and parental satisfaction were examined.Perioperative hemodynamic parameters including mean blood pressure（MAP）and HR measured after entering the operating room（T₀）,before the induction of anesthesia（T₁）,after the induction of anesthesia（T₂）,immediately after intubation（T₃）,at the time of skin incision（T₄）,at the time of skin closure（T₅）,before extubation（T₆）,and immediately after extubation（T₇）.Results:None of the participants had any TEAS-related adverse reactions.In comparison with the group C,FPS-R scores in the group T were significantly decreased at the time of back ward,postoperative 2 h,and 24 h（p<0.05）.The incidence of emergence agitation,intraoperative consumption of remifentanil,and time to extubation were significantly reduced in the group T.Furthermore,the time to first press of the PCIA pump was significantly longer,the number of analgesia pump presses in 48 h after surgery was significantly decreased,the increase in the MAP and HR at T₇was reduced,and parental satisfaction was significantly improved（all p<0.05）.FPS-R score at 48 h postoperatively,intraoperative consumption of propofol,the MAP and HR at T₀ to T₆,and the incidence of postoperative adverse reactions were not significantly different between the two groups（p>0.05）.Conclusion:TEAS may safely and effectively relieve postoperative pain and reduce the consumption of perioperative analgesia in children following orthopedic surgery with the ERAS protocol.The study provides novel evidence for optimizing perioperative analgesia in the ERAS protocol for children.