Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Abdominal Pain after Endoscopic Submucosal Dissection: A Single-Center, Prospective, and Randomized Controlled Trial.

objectiveTo evaluate the efficacy of perioperative transcutaneous electrical acupoint stimulation (TEAS) for reducing postoperative abdominal pain in patients after endoscopic submucosal dissection (ESD) for early gastric and esophageal neoplasms.

methodsA total of 129 patients undergoing ESD were assigned randomly to the TEAS group (64 cases) or the sham group (65 cases) using computer-generated random numbers and stratified by the surgical type (i.e., gastric or esophageal ESD). Patients in the TEAS group were treated bilaterally at the acupoints Hegu (LI 4), Neiguan (PC 6), Zusanli (ST 36), and Shangjuxu (ST 37), with the stimulation current frequency 2/100 Hz and intensity to the patient's maximum tolerance level. Patients in the sham group were treated at sham acupoints, and no electrical stimulation was given from the HANS stimulator. The TEAS and sham stimulations are both given from 30 min before ESD to the end of surgery. The primary outcome was the incidence of moderate-to-severe pain within 24 h. Secondary outcomes included the area under the curve (AUC) of Numeric Rating Scale (NRS) pain score from 1 to 48 h, morphine consumption after ESD, intraoperative hemodynamic parameters and postoperative nausea and vomiting (PONV).

resultsThe incidence of moderate-to-severe pain within 24 h postoperative period was significantly decreased by TEAS [22 (37.9%) vs. 40 (64.5%), P=0.004]. Patients needing morphine were also reduced by TEAS treatment [19 (32.7%) vs. 40 (64.5%), P<0.01]. TEAS significantly decreased the proportion and incidence of PONV compared with the sham group (P=0.06). Intraoperative hemodynamic parameters, recovery of gastrointestinal function, postoperative adverse events were similar between the two groups. According to the results of multivariate logistic regression, TEAS treatment was a protective factor associated with reduced incidence of NRS scores ⩾4 (OR=0.227; 95% CI: 0.100 to 0.512; P<0.01), whereas patients undergoing gastric ESD had a much lower incidence of NRS scores ⩾ 4 than esophageal ESD (OR=0.287; 95% CI: 0.133 to 0.621; P=0.002).

conclusionsTEAS can effectively reduce the incidence of moderate-to-severe pain in patients after ESD. TEAS demonstrates an morphine-sparing effect and reduces the occurrence of PONV. (Registration No. ChiCTR2100052837).