| Background:Catheter related bladder discomfort is one of the common complications after general anesthesia,which refers to a series of discomfort symptoms after indwelling catheter,mainly manifested as a feeling of swelling in the suprapubic area as well as bladder irritation symptoms,including urgent urination,frequent urination and urine pain,usually accompanied by restlessness and limb activity.CRBD is one of the main problems affecting perioperative comfort and satisfaction of patients,but there is no ideal intervention at present.Objective:To investigate whether transcutaneous electrical acupoint stimulation can prevent postoperative CRBD in male patients undergoing ureteroscopic lithotripsy under general anesthesia.Methods:Our study was registered at Chinese Clinical Trial Registry and approved by the medical ethics committee.From January 2019 to May 2019,60 male patients?aged 18-70 years,BMI:18-30kg/m2,ASA:I-IIIgrade?with ureteroscopic lithotripsy under general anesthesia in the General Hospital of Northern Theater Command of the Chinese People's Liberation Army were selected.They were divided into TEAS group and control group using the random series produced by Excel 2010,with 30 patients in each group.The patients were established with upper limb venous access,monitoring ECG,SPO2,NIBP and bispectral index.Before anesthesia induction,patients in TEAS group were treated with transcutaneous electrical acupoint stimulation at Zhongji?CV3?,Guanyuan?CV4?,Zusanli?ST36?and Sanyinjiao?SP6?.The position of acupoint is referred to the national standard"name and location of acupoints"?GB/T12346-2006?.TEAS would last 30 minutes at density wave?2-15Hz?and stimulation intensity is the maximum intensity that the subjects could tolerate?about 6-10 m A?.In control group,electrodes were attached to the same acupuncture points and connected to the electro-acupuncture device,but no electrical stimulation was given,the anesthesia induction also started after 30 minutes.The anesthesia protocol of both groups was total intravenous anesthesia with propofol and remifentanil target controlled infusion.The depth of anesthesia was adjusted according to the surgical stimulation and hemodynamic parameters during the operation.Stop pumping anesthetics at the end of the operation,pull out the laryngeal mask when the patient wakes up and then transfer it to PACU.The amount of propofol and remifentanil consumption as well as the data of monitoring indicators were recorded.The duration of operation,anesthesia,recovery and PACU stay of the two groups were collected.The patients were followed up at 5minutes after awakening,1,2 and 6 hours after surgery,including the severity of CRBD,visual analog pain score and complications such as nausea and vomiting,dizziness and headache.The data was statistically analyzed with SPSS 25.0 software,and when P<0.05 the difference was statistically significant.Results:A total of 60 subjects were included in this study,3 of whom were excluded because of changing the surgery into percutaneous nephrolithotripsy intraoperatively.Finally,29 cases in TEAS group and 28 in control group completed the study.The difference was not statistically significant compared to the general condition of the two groups of subjects.The incidence of CRBD in TEAS group was grade 0 in 7 cases?24%?,grade 1 in 13 cases?45%?,grade 2 in 7 cases?24%?,grade 3 in 2 cases?7%?.In control group,there were grade 0 in 3 cases?11%?,grade 1 in 8 cases?28%?,grade 2in 14 cases?50%?and grade 3 in 3 cases?11%?.The incidence of grade 2 and above?moderate and severe?CRBD in TEAS group?31%?was significantly lower than that in control group?61%??P=0.025?.The dosage of remifentanil was 275.7±76.4ug in TEAS group while 353.4±55.9ug in control group and the dosage of remifentanil in TEAS group was significantly decreased?P<0.001?.There was no significant difference in the consumption of propofol between the two groups.Compared with T0,the mean arterial pressure and heart rate decreased at T2 in both groups,and the decrease of MAP in control group was significantly higher than that in TEAS group at T2 and T3?P<0.05?.The changes of hemodynamic indexes in TEAS group were more stable than those in control group.There was no significant difference in BIS value between the two groups at each time point.The VAS score of TEAS group decreased significantly at 1 h and 2 h after operation?P<0.05?.There was no significant difference in duration of operation,anesthesia,recovery and PACU stay as well as postoperative anesthesia related complications between the two groups.Conclusion:TEAS at Guanyuan,Zhongji,Zusanli and Sanyinjiao points for 30min before anesthesia induction can effectively prevent CRBD after ureteroscopic lithotripsy under general anesthesia and reduce the consumption of remifentanil.It can also stabilize hemodynamic fluctuation during operation and relieve postoperative pain. |
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