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NEEDLELESS TRANSCUTANEOUS ELECTRICAL ACUSTIMULATION ACCELERATES POST-SURGICAL RECOVERY MEDIATED VIA AUTONOMIC MECHANISMS IN PATIENTS WITH GASTROINTESTINAL CANCERS
Bo Zhang*1,2, Gang Ma1,3, Pingping Hu4, Mingyuan Zhang5, Kehui Tong5, Feng Xu4, Liang Zhu2, Jiande Chen1,6
1Ningbo Pace Translational Medical Research Center, Beilun, Ningbo, zhejiang, China; 2 Division of Gastroenterology, Changzheng Hospital affiliated to Second Military Medical University, Shanghai, Shanghai, Shanghai, China; 3Division of Gastroenterology, Huai’an first people’s Hospital, Nanjing Medical University,, China, Huai an, Jiangsu, China; 4Division of Gastroenterology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Beilun, Ningbo, zhejiang, China; 5Gastroenterology surgical department, Yinzhou Hospital Afliated to Medical School of Ningbo University, Ningbo, China, Ningbo, zhejiang, China; 6Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, , Baltimore, MD
BACKGROUND: Functional gastrointestinal disturbance usually occurs after abdominal surgery for cancers, and is accompanied by increased rate of complications as well as length of hospital stays. Most often, symptoms of postoperative ileus last for 4-5 days without special medical treatments. This study was designed 1) to evaluate the efficacy of transcutaneous electroacupuncture(TEA) at Zusanli(ST36) and Neiguan(PC6) in reducing the duration of postoperative ileus and hospital stays after major abdominal surgery for gastrointestinal cancer; 2) to investigate the mechanisms involving autonomic function.
METHODS: Thirty two patients (Eight Female, twenty four Male, mean age 65.4± 10.2) scheduled for abdominal surgery for gastrointestinal cancers were randomized into two groups: TEA (n=16) and sham-TEA (n=16). TEA was performed via acupoints ST36 and PC6 twice daily each lasting 1 hr from postoperative day 1 to day 3. Sham-TEA was the same except for the use of non-acupoints. Previously used stimulation parameters known to improve gastrointestinal motility were used. Time to defecation was selected as the primary outcome. Secondary outcomes included time to ambulation, time to flatus, time to resume diet, length of hospital stay, visual analogue scale (VAS) pain score, as well as autonomic functions assessed from spectral analysis of heart rat variability (HRV).
Results: 1) Compared to sham-TEA, TEA shortened time to defecation (73.1±16.8 h vs. 102.1±43.7 h; P=0.016), time to first passing of flatus (53.7±18.2 h vs. 76.6±24.3 h; P=0.005), time to resume diet (4.7±2.3 days vs. 6.5±2.1 days, P=0.034) and length of hospital stays (22.4±4.5 days vs. 31.2±14.4 days; P=0.035). 2) TEA markedly reduced the VAS pain score on the postoperative Day 2 (1.4±1.5 vs 3.3±2.3; P=0.006) and Day 3 (1.1±1.3 vs 2.9±1.9; P=0.004) in comparison with sham-TEA. 3) Surgery significantly increased sympathovagal ratio (LF/HF) and decreased vagal activity (HF); whereas, post-surgically the surgery-induced alteration in these autonomic functions gradually returned to normal. However the recovery in these functions was faster with TEA than sham-TEA. From post-operative day 1 to day 4, the LF/HF was reduced by 0.96±0.59 with TEA but only 0.25±1.00 with sham-TEA (P=0.018), and the HF as increased by 0.17±0.11 with TEA and 0.04±0.11 with sham-TEA (P= 0.003).
CONCLUSIONS: Needleless TEA shortens duration of postoperative ileus, time to flatus, time to resume diet, and the length of hospital stay. Additionally, treatment of TEA also alleviates post-surgical pain in patients undergoing abdominal surgery for gastrointestinal surgeries. These effects seem to be mediated via the improvement in autonomic functions with TEA.
Table 1. Outcome Measures of TEA Versus Sham-TEA Groups
| | TEA(n=16) | Sham-TEA(n=16) | P value | | Time to first passing flatus, h | 53.7±18.2 | 76.6±24.3 | 0.005 | | Time to defecation, h | 73.1±16.8 | 102.1±43.7 | 0.016 | | Time to resume diet, days | 4.7±2.3 | 6.5±2.1 | 0.034 | | Time to walk, days | 3.2±1.4 | 4.6±2.8 | 0.085 | | Hospital stay, days | 22.4±4.5 | 31.2±14.4 | 0.035 | | VAS pain score on day 1 | 4.1±2.6 | 4.1±2.5 | 0.935 | | VAS pain score on day 2 | 1.4±1.5 | 3.3±2.3 | 0.006 | | VAS pain score on day 3 | 1.1±1.3 | 2.9±1.9 | 0.004 |
NOTE. All data are expressed as mean ± standard deviation and compared using the Student t test. VAS, visual analogue scale Table 2. Autonomic Mechanisms of TEA | | TEA(n=16) | Sham-TEA(n=16) | P value | | HF on day 1 | 0.36±0.07 | 0.39±0.18 | 0.484 | | HF on day 4 | 0.53±0.10 | 0.43±0.19 | 0.094 | | ΔHF between 4th and 1st | 0.17±0.11 | 0.04±0.11 | 0.003 | | LF on day 1 | 0.64±0.07 | 0.61±0.18 | 0.459 | | LF on day 4 | 0.47±0.10 | 0.57±0.19 | 0.078 | | ΔLF between 1st and 4th | 0.17±0.11 | 0.04±0.11 | 0.003 | | LF/HF on day 1 | 1.92±0.67 | 2.16±1.75 | 0.619 | | LF/HF on day 4 | 0.97±0.43 | 1.92±1.67 | 0.048 | | ΔLF/HF between 1st and 4th | 0.96±0.59 | 0.25±1.00 | 0.018 |
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