Post-operative electrical muscle stimulation attenuates loss of muscle mass and function following major abdominal surgery in older adults: a split body randomised control trial

Abstract

Introduction Significant losses of muscle mass and function occur after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in post-operative patients is limited. This study assesses the efficacy of NMES for attenuating muscle atrophy and functional declines following major abdominal surgery in older adults. Methods Fifteen patients undergoing open colorectal resection completed a split body randomised control trial. Patients’ lower limbs were randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on post-operative days (PODs) 1–4. Ultrasound measurements of Vastus Lateralis cross-sectional area (CSA) and muscle thickness (MT) were made preoperatively and on POD 5, as was dynamometry to determine knee extensor strength (KES). Change in CSA was the primary outcome. All outcomes were statistically analysed using linear mixed models. Results NMES significantly reduced the loss of CSA (−2.52 versus −9.16%, P < 0.001), MT (−2.76 versus −8.145, P = 0.001) and KES (−10.35 versus −19.69%, P = 0.03) compared to CON. No adverse events occurred, and patients reported that NMES caused minimal or no discomfort and felt that ~90-minutes of NMES daily would be tolerable. Discussion NMES reduces losses of muscle mass and function following major abdominal surgery, and as such, may be the promising tool for post-operative recovery. This is important in preventing long-term post-operative dependency, especially in the increasingly frail older patients undergoing major abdominal surgery. Further studies should establish the efficacy of bilateral NMES for improving patient-centred outcomes.

Loss of muscle mass in the immediate post-operative period is associated with inadequate dietary protein and energy intake

“…In this group of patients who lost 9.16 ± 2.0% quadriceps muscle mass (measured as Vastus Lateralis cross sectional area via ultrasound [9]) in the 5 days after surgery [9], mean daily energy intake was 536.6 ± 527.8 kcal across the 4 post-operative days, and 490.0 ± 470.7, 505.0 ± 251.8, 541.0 ± 488.1, 610.5 ± 900.5 kcal on POD 1 to 4 respectively (Fig. 1A).…”

Efficacy of neuromuscular electrical stimulation for thoracic and abdominal surgery: A systematic review and meta-analysis

“…Overall, there were 10 studies [ 30 – 39 ] in cardiovascular surgery, two [ 40 , 41 ] in pulmonary surgery, five [ 42 – 46 ] in digestive system surgery, and one [ 47 ] in other surgeries. Cardiovascular surgery studies included aortic valve replacement, coronary artery bypass grafting, heart transplantation, mitral valve replacement, mitral valve reconstruction, or tricuspid valve reconstruction.…”

“…The length of the intervention spanned 5 days to 4 weeks, and the frequency of the intervention ranged from three times per week to every day. Seven studies involved stimulation of one muscle [ 30 , 31 , 35 , 39 , 43 , 45 , 46 ], nine involved stimulations of multiple muscles [ 32 – 34 , 36 – 38 , 41 , 42 , 44 ], one involved stimulation of the common peroneal nerve [ 47 ], and one involved stimulation of the lower limb [ 41 ]. The most common stimulation site was the quadriceps.…”

“…The evidence is very uncertain about the effect of NMES on lower limb muscle strength in digestive system surgery (three studies [ 42 , 43 , 46 ], 86 participants): SMD, 0.36; 95% CI −0.03 to 0.76; very low certainty evidence ( Fig 3A and Table 3 ). HR-QOL and adverse events were not reported for digestive system surgery.…”

Reversal of Soleus Muscle Atrophy in Older Adults: A Non-Volitional Exercise Intervention for a Changing Climate

“…In a recent short-term study on hospitalized, post-surgery patients, vastus lateralis muscle size and strength were shown to be significantly increased following 90 minutes per day of NMES applied for four days. 16 However, three quarters of the subjects in the study found the stimulation to be uncomfortable. In an eight-week trial in the home setting, NMES was utilized to activate the quadriceps and calf muscles in middle-aged individuals with early heart failure.…”