Effects of TEAS combined with general anesthesia versus epidural block combined with general anesthesia on recovery of patients undergoing laparoscopic radical resection of colorectal cancer

Abstract

Objective To compare the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia and epidural block combined with general anesthesia on the recovery of patients undergoing laparoscopic radical resection of colorectal cancer. Methods Eighty-four patients of both sexes, aged 35-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer, were divided into 3 groups (n=28 each) using a random number table method: general anesthesia group (group G), TEAS combined with general anesthesia group (group TG), and epidural block combined with general anesthesia group (group EG). In group TG, patients received continuous TEAS of bilateral Neiguan, Hegu, Zusanli, Shangjuxu and Xiajuxu acupoints starting from 30 min before anesthesia induction until the end of surgery at a frequency of 2/100 HZ and intensity of 3-8 mA with disperse-dense waves.In group EG, an epidural catheter was placed at L1, 2 and advanced for 3 cm in the epidural space in cephalad direction, 2% lidocaine 3 ml was given as a test dose, 0.375% ropivacaine 6-10 ml was injected into the epidural space, the level of anesthesia was adjusted to T6, and then 0.375% ropivacaine 5 ml/h was infused to the epidural space until the end of operation.Patients were endotracheally intubated after routine induction of general anesthesia and mechanically ventilated, and combined intravenous-inhalational anesthesia was used to maintain anesthesia.The Quality of Recovery (QoR-15) score was recorded on 1 day before surgery and 1-3 days after surgery.The development of nausea and vomiting, cognitive decline and requirement for rescue analgesics was recorded within 3 days postoperatively.The intraoperative consumption of remifentanil and propofol, vasoactive drugs, extubation time, time of PACU stay, time of passing flatus and length of postoperative hospital stay were recorded. Results Compared with group G, the consumption of remifentanil was significantly decreased, the QoR-15 scores were increased at 1-3 days after surgery, the incidence of nausea and vomiting and cognitive decline was decreased, and the extubation time, time of passing flatus and length of postoperative hospital stay were shortened in group TG and group EG (P<0.05). Compared with group TG, the intraoperative requirement for vasoactive drugs was significantly increased in group EG (P<0.05). Conclusion TEAS combined with general anesthesia and epidural block combined with general anesthesia have the comparable effect on the recovery of patients undergoing laparoscopic radical resection of colorectal cancer, however, the former one provides more stable hemodynamics during surgery. Key words: Electric stimulation therapy; Anesthesia, epidural; Laparoscopy; Colorectal surgery; Prognosis