Comparison of intraoperative opioids-sparing effects of transcutaneous electrical stimulation of different acupoints in patients undergoing video-assisted thoracoscopic lobectomy

Abstract

Objective To compare the intraoperative opioids-sparing effects of transcutaneous electrical acupoint stimulation (TEAS) of Lieque (LU7)-Quchi (LI11)-Neiguan (PC6)-Hegu (LI4) versus Xinshu (BL15)-Feishu (BL13)-PC6-LI4 in patients undergoing video-assisted thoracoscopic lobectomy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 34-83 yr,weighing 50-93 kg,scheduled for elective video-assisted thoracoscopic lobectomy,were randomly divided into 3 groups (n =20 each):control group (group C),LU7-LI11-PC6-LI4 group (group S1),and BL15-BL13-PC6-LI4 group (group S2).TEAS was applied to the corresponding acupoints on the operated side starting from 30 min before induction of anesthesia until the end of operation in S1 and S2 groups.The wave length was 0.6 ms when the frequency was 2 Hz,and the wave length was 0.2 ms when the frequency was 100 Hz.The intensity was the maximum current that could be tolerated,and the intensity was 6-18 mA for LU7,LI11,PC6 and LI4,or 20-35 mA for BL15 and BL13.Anesthesia was induced with iv injection of midazolam,propofol,sufentanil and cisatracurium and maintained with target-controlled infusion of remifentanil and propofol,iv infusion of cisatracurium,and iv boluses of sufentanil when necessary.The plasma concentration of propofol was adjusted to maintain BIS value at 40-60 during operation.The initial effect-site concentration of remifentanil was set at 1 ng/ml and then adjusted to 4 ng/ml at skin incision,and the concentration of remifentanil and consumption of sufentanil was adjusted to maintain Analgesia Nociception Index (ANI) value at 50-70.If the concentration of remifentanil was increased to 4 ng/ml,ANI value was still less than 50,and then sufentanil 0.1 μg/kg was injected intravenously.The time of operation and intraoperative consumption ofremifentanil and propofol were recorded.Results Compared with group C,the intraoperative consumption of remifentanil was significantly decreased in S1 and S2 groups (P ＜ 0.05).There was no significant difference in the intraoperative consumption of remifentanil between group S1 and group S2 (P ＞ 0.05).There was no significant difference in the time of operation and intraoperative consumption of propofol between the three groups (P ＞0.05).Conclusion TEAS of LU7-LI1 1-PC6-LI4 provides similar opioids-sparing effects during operation as TEAS of BL15-BL13-PC6-LI4 in patients undergoing video-assisted thoracoscopic lobectomy. Key words: Acupuncture points;  Transcutaneous electric nerve stimulation;  Analgesics, opioid; Pneumonectomy