[Clinical Trials for Thyroidectomy Under Acupuncture-aided Anesthesia by Using Electroacupuncture or Transcutaneous Acupoint Electrical Stimulation of Different Acupoints]

Abstract

Objective: To observe the effectiveness of transcutaneous acupoint electrical stimulation (TAES) or electroacupuncture (EA) stimulation of different acupoints in combination with anesthetics in the management of thyroidectomy patients, so as to choose a better stimulating method and most effective acupoints for thyroidectomy.

Methods: A total of 216 thyroidectomy patients (ASA Ⅰ-Ⅱ grades) with thyroid gland adenoma, thyroid cyst or thyroid nodules from 3 hospitals (3 research centers) were randomized into 6 groups, i.e., local anesthesia (LA, n=34), Futu (LI 18)-EA (n=36), Hegu (LI 4)-Neiguan (PC 6)-TAES (n=34), LI 4-PC 6-EA (n=36), Yanglingquan (GB 34)-EA (n=36) and non-acupoint (NA, about 1.5 cm latero-posterior to KI 9)-EA (n=34) groups according to the hospitalizition sequence. For patients of the LI 18-EA, LI 4-PC 6-TAES/EA, GB 34 and non-acupoint-EA groups, EA or TAES (2 Hz/100 Hz) was applied to the abovementioned bilateral acupoints or non-acupoint till the termination of the surgical operation. The surgery was conducted under anesthesia by local injection of 0.5% lidocaine and midazolam, and intravenous injection of fentanyl (for severe pain cases) 20 min after beginning of TAES or EA. The patients' scores of visual analogue scale (VAS),mean arterial pressure (MAP) and heart rate (HR) at the time-points of pre-anesthesia (T 0), skin-incision (T 1), skin flap-freeing (T 2), anterior cervical muscle traction (T 3), thyroid upper/lower-pole-sectioning (T 4/T 5), and thyroidectomy (T 6), and the dosages of the administered fentanyl and lidocaine were recorded.

Results: Compared with the corresponding time-points of the non-acupoint group, the VAS scores at T 1 and T 4 time-points in the LI 18-EA group and LI 4-PC 6-EA group, at T 1, T 5 and T 6 time-points in the LI 4-PC 6-TAES group were significantly lower (P<0.05). Compared with the corresponding time-points of the LA group, the VAS scores at T 2, T 3, T 5 and T 6 time-points in the LI 18-EA group and LI 4-PC 6-EA group, at T 3, T 5 and T 6 in the LI 4-PC 6-TAES group, and the MAP levels at T 2, T 3, T 4 and T 6 time-points in the LI 18-EA group, at T 3, T 4 in the LI 4-PC 6-EA group, at T 3, T 4, T 6 in the LI 4-PC 6 TAES group, as well as the HR levels at T 4, T 5 and T 6 in the LI 18-EA group, and at T 5, T 6 in the LI 4-PC 6-TAES group were significantly lower (P<0.05). The dosages of fentanyl in the LI 18-EA and LI 4-PC 6-TAES groups, and those of lidocaine in the LI 18-EA, LI 4-PC 6-EA and TAES groups were significantly lower relevant to the LA group and non-acupoint group (P<0.05). No significant differences were found between the LA and GB 34-EA groups, and between the LA and non-acupoint groups, as well as between the LI 4-PC 6-EA and LI 4-PC 6-TAES groups in the VAS scores, the MAP and HR levels, the dosages of lidocaine and fentanyl consumption (P>0.05).

Conclusions: EA stimulation of both LI 18 and LI 4-PC 6 and TAES of LI 4-PC 6 combined with anesthetics have a better effect in inducing analgesia and controlling MAP and HR, and need lower dosages of anesthetics for patients undergoing thyroidectomy, for which LI 18 and LI 4-PC 6 are evidently superior to GB 34 and non-acupoint. Hence, combined EA or TAES and anesthetics is highly recommended for thyroidectomy.