Transcutaneous electrical acupoint stimulation (TEAS) is an effective analgesic measure. We studied the analgesic effect of TEAS by applying it alone after ureteroscopic lithotripsy, rather than applying it as a supplementary analgesic measure. Participants (n = 120) scheduled to undergo ureteroscopic holmium laser lithotripsy, were enrolled and randomly assigned into Group T (TEAS n = 60) and Group C (Control, n = 60). The participants in Group T were treated with TEAS for postoperative analgesia. TEAS were implemented on bilateral Shenyu (BL23) and Yinlingquan (SP9) at the time backward and the time at 4, 8, 12 h postoperatively. TEAS was re-implemented three times on the target acupoints for the next 2 days. When TEAS failed to meet the analgesic effect, the participants were given tramadol hydrochloride tablets of 100 mg. Participants of Group C were given tramadol hydrochloride tablets for postoperative analgesia. The primary outcome of VAS scores at the time backward (T), 4 h (T), 12 h (T), 24 h (T), 48 h (T) postoperatively and the amount of remedy for analgesic consumption within 48 h postoperatively were compared. The secondary outcome of adverse reactions and plasma concentrations of serotonin (5-HT) and substance P (SP) at T, T, T, T, T were detected, respectively. The VAS scores at T, T, T, T postoperatively in two groups were lower than T. Compared to group C, the VAS scores at T (3.68 ± 0.68 vs. 4.79 ± 0.82, P = 0.01), T (2.64 ± 0.72 vs. 3.92 ± 0.88, P = 0.03), T (2.21 ± 0.88 vs. 3.38 ± 0.74, P < 0.01) in Group T were lower, and total remedy of analgesic consumption was significantly lower (127.14 ± 28.46 vs. 415.27 ± 86.37, P < 0.01) within 48 h postoperatively. The plasma concentrations of 5-HT in Group T was lower than Group C at T (348.54 ± 138.49 vs. 418.69 ± 124.68, P = 0.03), T (324.28 ± 112.73 vs. 398.52 ± 114.53, P < 0.01), T (309.64 ± 129.09 vs. 388.46 ± 115.36, P = 0.04) postoperatively and concentrations of SP at T (59.38 ± 24.68 vs. 78.93 ± 26.32, P < 0.01), T (49.36 ± 25.55 vs. 66.49 ± 23.57, P = 0.02), T (42.19 ± 24.36 vs. 64.15 ± 28.16, P = 0.04), T (39.26 ± 19.88 vs. 54.64 ± 20.62, P = 0.02) postoperatively were also lower than Group C. Meanwhile, the occurrences of vertigo (6.7 vs. 18.3%, P < 0.01), nausea and vomiting (11.7 vs. 21.7%, P < 0.01), constipation (10.0 vs. 20.0%, P = 0.03) in Group T were also lower. Application of TEAS alone was associated with effective alleviation of postoperative pain, reduction of postoperative analgesics consumption, decrease of plasma concentration of algogenic substance and the incidence of adverse reactions after ureteroscopic lithotripsy.
Objective The meta-analysis was conducted to assess the effectiveness and safety of intravenous administration of dexmedetomidine for cesarean section under general anesthesia, as well as neonatal outcomes. Materials and methods We searched PubMed, Embase, Cochrane Central Register of Controlled Trials and the China National Knowledge Infrastructure database for relevant randomized controlled trials (RCTs) about the application of intravenous dexmedetomidine under general anesthesia for cesarean section. RevMan 5.3 was used to conduct the meta-analysis of the outcomes of interest. Results Eight RCTs involved 376 participants were included in this study. The meta-analysis showed that the mean blood pressure at the time of intubation (weighted mean difference [WMD]: −15.67, 95% CI: −21.21, −10.13, P<0.00001), skin incision (WMD: −12.83, 95% CI −20.53, −5.14, P=0.001), and delivery (WMD: −11.65, 95% CI −17.18, −6.13, P<0.0001) in dexmedetomidine group were significantly lower than that in the control group. The heart rate (HR) at the time of intubation (WMD: −31.41, 95% CI −35.01, −27.81, P<0.00001), skin incision (WMD: −22.32, 95% CI −34.55, −10.10, P=0.0003), and delivery (WMD: −19.07, 95% CI −22.09, −16.04, P<0.00001) were also lower than that in control group. For neonatal parameters, no differences existed in umbilical blood gases at delivery, and Apgar scores at 1 minute (WMD: −0.12, 95% CI −0.37, 0.12, P=0.33) and 5 minutes (WMD: −0.17, 95% CI −0.13, 0.46, P=0.27) among two groups. Conclusion Intravenous administration of dexmedetomidine could efficiently attenuate the maternal cardiovascular response during cesarean section, without affecting Apgar score of the neonate.
Purpose. Transcutaneous electrical acupoint stimulation (TEAS) is widely used. However, no study evaluated TEAS on systemic inflammatory response syndrome (SIRS) of patients after percutaneous nephrolithotomy (PCNL). The study was to evaluate TEAS on SIRS of patients after PCNL. Methods. 67 patients were enrolled and divided into group TEAS and group sham TEAS. Data were collected from 60 participants finally. In the study, TEAS or sham TEAS on bilateral Shenshu (BL23), Yinlingquan (SP9), Hegu (LI4), and Neiguan (PC6) was performed continuously throughout the procedure. The primary outcome included the incidence of systemic inflammatory response syndrome (SIRS) within 48 h after surgery. The secondary outcomes included the serum levels of inflammatory cytokines, hemodynamics changes, complications, and hospital stay after surgery. The serum levels of tumor necrosis factor- (TNF-) α and interleukin- (IL-) 6, mean arterial pressure (MAP), and heart rate (HR) at 30 min before anesthesia (T0), the time after surgery (T1), 24 h postoperation (T2), and 48 h postoperation (T3) were recorded. The consumption of analgesic during surgery was also recorded, as well as the complications and duration of hospital stay after PCNL. Results. The incidence of SIRS in group TEAS was lower than group sham TEAS (30% vs. 6.67%, p = 0.023 ). Compared with the sham TEAS group, both levels of TNF-α and IL-6 at T1, T2, and T3 were lower in the TEAS group ( p < 0.05 ). The levels of MAP and HR in sham TEAS at T1, T2, and T3 were markedly higher than that in the TEAS group ( p < 0.05 ). The total consumption of propofol and remifentanil during surgery in group TEAS was lower than that in the sham TEAS group. The incidence of hypotension, hypertension, emergence agitation, and postoperative nausea and vomiting (PONV) was also lower in group TEAS after PCNL ( p < 0.05 ). Conclusions. TEAS could effectively reduce the incidence of SIRS and inflammatory cytokines for patients who underwent PCNL. In addition, TEAS helped to maintain the hemodynamic stability and cut down the consumption of analgesics during PCNL, reducing the complications after PCNL.
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