Transcutaneous Electrical Acupoints Stimulation Improves Spontaneous Voiding Recovery After Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Abstract

Background Facilitating the recurrence of spontaneous voiding is considered to be a way to prevent urinary retention after surgery, which is of great importance in cholecystectomy. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation (TEAS) on spontaneous voiding recovery after laparoscopic cholecystectom. Methods Participants who underwent elective laparoscopic cholecystectomy were randomly assigned to either the TEAS group or the sham group. Active TEAS or sham TEAS at specific acupuncture points was conducted intraoperatively and postoperatively. The primary outcome was the recovery speed of spontaneous voiding ability after surgery and secondary outcomes included postoperative urinary retention (POUR), voiding dysfunction, pain, anxiety and depression, and early recovery after surgery. Results A total of 1,948 participants were recruited and randomized to TEAS (n = 975) or sham (n = 973) between August 2018 and June 2020. TEAS shortens the time delay of the first spontaneous voiding after laparoscopic cholecystectomy (5.6 h [IQR, 3.7-8.1 h] in the TEAS group vs 7.0 h [IQR, 4.7-9.7 h] in the sham group) (p \ 0.001). The TEAS group experienced less POUR (p = 0.020), less voiding difficulty (p \ 0.001), less anxiety and depression (p \ 0.001), reduced pain (p = 0.007), and earlier ambulation (p = 0.01) than the sham group. Conclusions Our results showed that TEAS is an effective approach to accelerate the recovery of spontaneous voiding and reduce POUR which facilitates recovery for patients after laparoscopic cholecystectomy.Yan-Fang Zhang and Xiang-Yun Li have contributed equally to this work.

Transcutaneous electrical acupoint stimulation for prevention of postoperative urinary retention: A systematic review

“…Appendix B lists the 7 reports excluded by checking complete textual documents. Finally, this review included fourteen studies [ [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. Fig.…”

“…Fourteen studies with 2865 participants were identified. The types of surgery included biliary surgery [ 20 ], anorectal surgery [ 21 , 24 , 25 , 27 , 29 , 31 ], gynecologic surgery [ 22 , 23 , 26 ], orthopedic surgery [ 28 , 30 , 32 ], and urinary surgery [ 33 ]. All studies provided data on the incidence of POUR [ [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ], and two reported information on post-void residual urine volume [ 23 , 26 ].…”

“…One study adopted intraoperative TEAS [ 24 ], four adopted preoperative and intraoperative TEAS [ 23 , 26 , 28 , 33 ], two adopted preoperative, intraoperative and postoperative TEAS [ 20 , 27 ], and the remaining seven used postoperative TEAS [ 21 , 22 , 25 , [29] , [30] , [31] , [32] ]. Regarding TEAS waveforms, dilatational wave [ 21 , 24 , 26 , 27 , [30] , [31] , [32] , [33] ] and continuous wave [ 20 , 23 , 28 , 29 ] were commonly used. Two studies did not report the detailed information about TEAS waveforms [ 22 , 25 ].…”

“…Ten studies used blank control [ [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , 31 , 32 ], and four adopted Sham TEAS as a control [ 20 , 21 , 30 , 33 ]. In three studies, the electrodes were attached to the acupoints but the output wires were cut off [ 20 , 30 , 33 ]. The remaining one applied disposable electrodes to non-acupoint skin area with electrical current output [ 21 ].…”

“…2 and Appendix C showed the risk of bias assessment. Twelve studies described sufficient details of randomization [ [20] , [21] , [22] , [23] , [24] , [25] , [27] , [28] , [29] , [30] , 32 , 33 ], and the remaining two only mentioned randomization [ 26 , 31 ]. Only one study emphasized allocation concealment [ 20 ].…”