Effect of transcutaneous electrical acupoint stimulation on gastrointestinal function recovery after laparoscopic radical gastrectomy - A randomized controlled trial

Introduction: Acupuncture is widely used as perioperative analgesia and promotes postoperative physical recovery. Transcutaneous electrical acupoint stimulation (TEAS) is a acupuncture method that has many advantages. However, there has been little study on the application of TEAS in laparoscopic radical gastrectomy. This is a study exploring the effects of TEAS on gastrointestinal function recovery after laparoscopic radical gastrectomy in order to provide a stimulation model for clinical use. Methods: A total of 120 gastric cancer patients undergoing laparoscopic radical gastrectomy were randomly assigned into the long duration TEAS (L-TEAS) group, or the placebo-control (C-TEAS) group. All patients were routinely anesthetized. For the L-TEAS group TEAS was maintained from 30 min before anesthetic induction to 30 min after the operation, and TEAS was also performed for 30 min at 8 a.m., 1 p.m. and 6 p.m. within 2 d of the operation. But in the C-TEAS group, the output wires of the stimulator were broken. The stimulation sites included bilateral Zusanli (ST 36) and Neiguan (PC 6) acupoints. Postoperatively, the patients received patient-controlled intravenous analgesia (PCIA). The consumption of analgesics as well as the scores of the visual analogue scale (VAS) and Ramsay Sedation Scale (RSS) at 4 h (T1), 8 h (T2), 16 h (T3), 24 h (T4) and 36 h (T5) were observed and recorded after the operation in the 2 groups. The duration of first bowel sounds, flatus and defecation were recorded after the operation. The incidence of postoperative nausea and vomiting (PONV) as well as patient satisfaction was recorded. Results: Compared to the C-TEAS group, the VAS scores at 4 h (2.79 +/- 0.48 vs. 3.41 +/- 0.62), 8 h (2.65 +/- 0.42 vs. 3.17 +/- 0.49), and 24 h (1.98 +/- 0.39 vs. 2.72 +/- 0.73) were significantly decreased in the L-TEAS group (P < 0.05) after the operation. Compared to the C-TEAS group, analgesic consumption at 4 h (10.02 +/- 2.26 vs. 13.38 +/- 2.98), 8 h (20.55 +/- 4.59 vs. 24.63 +/- 3.94) and 36 h (72.64 +/- 9.74 vs. 76.01 +/- 10.43) was significantly decreased in the L-TEAS group (P < 0.05) after the operation. There was a significant difference in the incidence of PONV between the L-TEAS (12%) and C-TEAS (32.2%) groups (P < 0.05). No significant difference was observed with respect to RSS among the 2 groups (P > 0.05). The time intervals from surgery to the first bowel sounds as well as the passage of flatus and defecation were shorter in the L-TEAS group than in the C-TEAS group (19.69 +/- 7.61 h vs. 26.58 +/- 7.43 h, 36.58 +/- 10.75 h vs. 43.56 +/- 9.57 h and 71.48 +/- 20.62 h vs. 77.27 +/- 22.67 h, respectively) (P < 0.05). The rate of moderately satisfaction and above in the L-TEAS (67.3%) group was higher than for that in the C-TEAS group (42.4%), and for very satisfied, the LTEAS (55.2%) group was higher than that in the C-TEAS group (15.3%) (P < 0.05). Conclusions: Preoperative TEAS and sustained TEAS within 2 d of the operation can effectively reduce the early postoperative pain, reduce the early postoperative consumption of analgesics, the total consumption of anesthetics, and the incidence of PONV as well as shorten the duration of first bowel sounds, first flatus and first defecation after the operation, promoting the recovery of gastrointestinal function and improving the patient satisfaction rate.