Effect of electroacupuncture stimulation of Ximen

Authors: Yanhu Xie Xiaoqing Chai Yuelan Wang Yanchun Gao Jun Ma

Publish Date: 2014/08/19

Volume: 34, Issue: 4, Pages: 569-574

PDF Link

Abstract

The clinical analgesic effect of electroacupuncture EA stimulation EAS on breakthrough pain induced by remifentanil in patients undergoing radical thoracic esophagectomy and the mechanisms were assessed Sixty patients ASAIII scheduled for elective radical esophagectomy were randomized into three groups group A control receiving a general anesthesia only group B sham given EA needles at PC4 Ximen and PC6 Neiguan but no stimulation and group C EAS electrically given EAS of the ipsilateral PC4 and PC6 throughout the surgery The EAS consisting of a dispersedense wave with a low frequency of 2 Hz and a high frequency of 20 Hz was performed 30 min prior to induction of general anesthesia and continued through the surgery At the emergence sufentanil infusion was given for postoperative analgesia with loading dose of 75 μg followed by a continuous infusion of 225 μg/h The patient selfadministration of sufentanil was 075 μg with a lockout of 15 min as needed Additional breakthrough pain was treated with dezocine 5 mg intravenously at the patient’s request Blood samples were collected before T1 2 h T2 24 h T3 and 48 h T4 after operation to measure the plasma βEP PGE2 and 5HT The operative time the total dose of sufentanil and the dose of selfadministration and the rescue doses of dezocine were recorded Visual Analogue Scale VAS scores at 2 12 24 and 48 h postoperatively and the incidence of apnea and severe hypotension were recorded The results showed that the gender age weight operative time and remifentanil consumption were comparable among 3 groups Patients in EAS group had the lowest VAS scores postoperatively among the three groups P005 The total dose of sufentanil was 115±60 μg in EAS group significantly lower than that in control 1343±59 μg and sham 1335±70 μg groups Similarly the rescue dose of dezocine was the least in EAS group P005 among the three groups Plasma βEP levels in EAS group at T3 17690±4573 and T4 16296±3500 pg/mL were significantly higher than those in control 13233±3675 and 12879±4124 pg/mL and sham 13656±4580 and 12985±3614 pg/mL groups P005 for all EAS could decrease the release of PGE2 Plasma PGE2 levels in EAS group at T2 and T3 41±5 and 40±5 pg/mL respectively were significantly lower than those in control 64±5 and 62±7 pg/mL and sham 66±6 and 62±6 pg/mL groups Plasma 5HT levels in EAS group at T2 13366±4085 and T3 15466±5249 ng/mL were significantly lower than those in control 16833±5694 and 22528±8203 and sham 16454±4753 and 21774±7645 ng/mL groups For intragroup comparison plasma 5HT and PGE2 levels in control and sham groups at T2 and T3 and βEP in EAS group at T3 and T4 were significantly higher than those at T1 P005 PGE2 and 5HT levels in EAS group showed no significant difference among the different time points P005 No apnea or severe hypotension was observed in any group It was concluded that intraoperative ipsilateral EAS at PC4 and PC6 provides effective postoperative analgesia for patients undergoing radical esophagectomy with remifentanil anesthesia and significantly decrease requirement for parental narcotics The underlying mechanism may be related to stimulation of the release of endogenous βEP and inhibition of inflammatory mediators 5HT and PGE2

Keywords: