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Journal of Integrative Medicine ›› 2014, Vol. 12 ›› Issue (6): 512-519.doi: 10.1016/S2095-4964(14)60049-2

• Study Protocol • Previous Articles     Next Articles

Electroacupuncture for the prevention of postoperative gastrointestinal dysfunction in patients undergoing vascular surgery under general anesthesia: Study protocol for a prospective practical randomized controlled trial

Meng-yue Liua, Cheng-wei Wanga, Zhou-peng Wub, Ning Lia   

  1. Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
    Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2014-06-19 Accepted:2014-08-26 Online:2014-11-10 Published:2014-11-15

Background

Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications following major surgeries under general anesthesia (GA). Despite ongoing research and new drug treatments, abdominal distension within 24 h postoperatively occurs in 8%-28% of all surgeries. We aim to analyze the effectiveness of preventing PGD by preoperatively stimulating Neiguan (PC6), Zusanli (ST36) and Shangjuxu (ST37) bilaterally twice a day compared with sham-acupuncture treatment and standard treatment.

Methods and design

This is a single-center, prospective practical randomized controlled trial. All groups will be given standard treatments. Patients undergoing vascular surgery under GA will be included from the Vascular Surgery Unit in West China Hospital of Sichuan University, China, and divided into three groups. The experimental group will receive routine treatments and acupuncture at PC6, ST36 and ST37 bilaterally with electrical stimulation twice a day for 20 min preoperatively. The sham-acupuncture group will receive pseudo-electroacupuncture at sham acupoints of PC6, ST36 and ST37, which are 1 cun away from the real acupoints. The routine-treatment group will not receive electroacupuncture. The outcomes include the incidence of abdominal distention, abdominal circumference, the degree of abdominal distension, the first time of flatus and defecation, and hospitalization duration. 

Discussion

The results from this study will demonstrate whether preoperative electroacupuncture is an effective method for the prevention of PGD in patients undergoing vascular surgery under GA. This study may also provide a standardized acupuncture treatment for reduction of PGD. 

Trial Registration

This study is registered with the Chinese Clinical Trial Registry: ChiCTR-TRC-13003649.

Key words: Electroacupuncture, Gastrointestinal dysfunction, Vascular surgery, Study protocol

Figure 1

Location of Neiguan (PC6) and the sham acupoint of PC6"

Figure 2

Location of Zusanli (ST36) and Shangjuxu (ST37) and their sham acupoints."

Figure 3

The flow chart of study"

Figure 4

The measurement of abdominal circumference"

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[1] Steinbrook RA . Epidural anesthesia and gastrointestinal motility[J]. Anesth Analg, 1998,86(4):837-844
doi: 10.1213/00000539-199804000-00029
[2] Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R . The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey(PROBE 1)[J]. Pain Med, 2009,10(1):35-42
doi: 10.1111/j.1526-4637.2008.00495.x
[3] Gu KM, Zeng M, Liu M, Mou CX . Comparison of several methods in treating postoperative abdominal distension[J]. Harbin Yi Yao, 2007,27(2):22-24
[4] Nowygrod R, Egorova N, Greco G, Anderson P, Gelijns A, Moskowitz A , McKinsey J, Morrissey N, Kent KC.Trends, complications, and mortality in peripheral vascular surgery[J]. J Vasc Surg, 2006,43(2):205-216
doi: 10.1016/j.jvs.2005.11.002
[5] Ma X, Yuan QH, Yu ZX, Ma YT . Efficacy comparison between endovascular aneurysm repair versus open surgery for patients with abdominal aortic aneurysms: a meta-analysis[J]. Zhonghua Xin Xue Guan Bing Za Zhi, 2012,40(10):878-883
[6] Yamamoto H, Yamamoto F, Ishibashi K, Liu KX, Yamaura G, Chida Y, Motokawa M, Tanaka F . Long-term outcomes of open surgical repair for ruptured iliac artery aneurysms[J]. Ann Vasc Surg, 2011,25(6):740-747
doi: 10.1016/j.avsg.2010.11.011
[7] Girotti ME, Ko CY, Dimick JB . Hospital morbidity rankings and complication severity in vascular surgery[J]. J Vasc Surg, 2013,57(1):158-164
doi: 10.1016/j.jvs.2012.06.099
[8] Eappen S, Lane BH, Rosenberg B, Lipsitz SA, Sadoff D, Matheson D, Berry WR, Lester M, Gawande AA . Relationship between occurrence of?surgical?complications and hospital finances[J]. JAMA, 2013,309(15):1599-1606
doi: 10.1001/jama.2013.2773
[9] Van Noord BA, Roffey P, Thangathurai D . Abdominal compartment syndrome following opioid-induced postoperative ileus[J]. J Clin Anesth, 2013,25(2):146-149
doi: 10.1016/j.jclinane.2012.07.004
[10] Wan Q . Auricular-plaster therapy plus acupuncture at Zusanli for postoperative recovery of intestinal function[J]. J Tradit Chin Med, 2000,20(2):134-135
[11] Wu H, Chen X . Effect of electro-acupuncture of Zusanli on unit discharges in the lateral hypothalamic area induced by stomach distension[J]. Zhen Ci Yan Jiu, 1990,15(3):194-196
[12] Forster J, Damjanov I, Lin Z, Sarosiek I, Wetzel P , McCallum RW.Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings[J]. J Gastrointest Surg, 2005,9(1):102-108
doi: 10.1016/j.gassur.2004.10.001
[13] Kalff JC, Carlos TM, Schraut WH, Billiar TR, Simmons RL, Bauer AJ . Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus[J]. Gastroenterology, 1999,117(2):378-387
doi: 10.1053/gast.1999.0029900378
[14] Kalff JC, Schraut WH, Billiar TR, Simmons RL, Bauer AJ . Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents[J]. Gastroenterology, 2000,118(2):316-327
doi: 10.1016/S0016-5085(00)70214-9
[15] Allen TK, Habib AS . P6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: a systematic review of randomized controlled trials[J]. Anesth Analg, 2008,107(4):1308-1321
doi: 10.1213/ane.0b013e31816d1864
[16] Senna-Fernandes V , ?Fran?a DL, ?de Souza D, ?Santos KC, ?Sousa RS, Manoel CV, ?Santos-Filho SD, Cortez CM, ?Bernardo-Filho M, Guimar?es MA.Acupuncture?at “Zusanli”(St.36) and “Sanyinjiao”(SP.6)?points?on the?gastrointestinal?tract: a?study?of the bioavailability?of 99mTc-sodium?pertechnetate?in?rats[J]. Evid Based Complement Alternat Med, 2011,2011:823941
[17] Sallam H , McNearney TA, Chen JD.Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis(scleroderma)[J]. Aliment Pharmacol Ther, 2006,23(6):691-712
doi: 10.1111/apt.2006.23.issue-6
[18] Ouyang MW, Qin ZS, Lin CS, Gu MN . Prophylactic effect of acupuncture on nausea and vomiting after laparoscopic operation[J]. Zhongguo Zhen Jiu, 2009,29(11):915-918
[19] General Administration of Quality Supervision, Inspection and Quarantine of the People’s Republic of China, Standardization Administration of the People’s Republic of China. Nomenclature and location of acupuncture points. GB/T 12346-2006.
[20] Jamieson S . Likert scales: how to(ab)use them[J]. Med Educ, 2004,38(12):1212-1218
doi: 10.1111/med.2004.38.issue-12
[21] Magalhes FJ , Mendon?a LB, Rebou?as CB, Lima FE, Custódio IL, de Oliveira SC.Risk factors for cardiovascular diseases among nursing professionals: strategies for health promotion[J]. Rev Bras Enferm, 2014,67(3):394-400
[22] īsis K , KrieviD, Na?kovia K, GediM, avlovskis J, Ezīte N, Lietuvietis E, Zari?? K.Quality of life after endovascular abdominal aortic aneurysm repair: nellix sac-anchoring endoprosjournal versus open surgery[J]. Medicina (Kaunas), 2012,48(6):286-291
[23] Ren BB, Yu Z, Xu B . Overview of the two-way regulatory effect of acupuncture on gastrointestinal motility[J]. Zhongguo Zhen Jiu, 2012,32(8):765-768
[24] Lin YP, Yi SX, Yan J, Chang XR . Effect of acupuncture at Foot-Yangming Meridian on gastric mucosal blood flow, gastric motility and brain-gut peptide[J]. World J Gastroenterol, 2007,13(15):2229-2233
doi: 10.3748/wjg.v13.i15.2229
[25] Shen GM, Zhou MQ, Xu GS, Xu Y, Yin G . Role of vasoactive intestinal peptide and nitric oxide in the modulation of electroacupucture on gastric motility in stressed rats[J]. World J Gastroenterol, 2006,12(38):6156-6160
doi: 10.3748/wjg.v12.i38.6156
[26] Tan JH . Effect of electroacupuncture at ST36 on postoperative exhaust[J]. Hu Shi Jin Xiu Za Zhi, 2002,17(8):630
[27] Si CQ, Su GF, Xu ZG . Effect of acupuncture at ST36 on postoperative gastrointestinal function[J]. Zhongguo Zhong Xi Yi Jie He Wai Ke Za Zhi, 2007,13(6):547-549
[28] Yin J, Chen JD . Gastrointestinal motility disorders and acupuncture[J]. Auton Neurosci, 2010,157(1-2):31-37
doi: 10.1016/j.autneu.2010.03.007
[29] Lee A, Chan S . Acupuncture and anesthesia[J]. Best Pract Res Clin Anaesthesiol, 2006,20(2):303-314
doi: 10.1016/j.bpa.2005.10.009
[30] Li KX . One hundred and forty-six cases of posoperative abdominal distension treated by electroacupuncture[J]. World J Acupunct Mox, 2009,19(2):60-61
[31] He J, Chen JM, He HB, Li J, Wang ZQ . Clinical observation on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture[J]. World J Acupunct Moxib, 2010,20(4):17-20
[32] Wang WL, Shen WD . A summary of studies in countries other than China on acupunture in anesthesia and for postoperative complications[J]. J Chin Integr Med, 2009,7(8):797-799
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