Effects of buccal acupuncture on postoperative analgesia in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial

Abstract

Objective: This study aimed to evaluate the efficacy and safety of buccal acupuncture on postoperative analgesia, perioperative stress response and adverse events in elderly patients undergoing laparoscopic radical gastrectomy.

Methods: It was a prospective, outcome assessor-blinded, randomized controlled trial, involving 90 patients aged 65-80 years who were treated with an elective laparoscopic radical gastrectomy. They were randomly assigned to buccal acupuncture group (Group B) and control group (Group C). Buccal acupuncture was applied to patients of Group B before the induction of general anesthesia, while no additional application was given to those in Group C. Patient-controlled intravenous analgesia (PCIA) with sufentanil was postoperatively performed in both groups. Sufentanil consumption and the Visual Analog Scale (VAS) score within 48 h postoperatively were assessed as primary outcomes. Secondary outcomes included peripheral levels of stress markers, intraoperative consumptions of anesthetic drugs and postoperative recovery.

Results: Patients in Group B presented significantly lower VAS scores within 24 h and less consumption of sufentanil within 48 h postoperatively (both p < 0.01). The awaking time, time to extubation and length of stay were significantly shorter in Group B than in Group C (p = 0.005, 0.001 and 0.028, respectively). Compared with Group C, stress response and inflammatory response within 24 h postoperatively were also significantly milder in Group B.

Conclusion: The use of buccal acupuncture before general anesthesia induction favors the postoperative analgesic effect and recovery in elderly patients undergoing laparoscopic radical gastrectomy, the mechanism of which involves relieving postoperative stress response and inflammatory response.

Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 15/06/2023 (ChiCTR2300072500).

Keywords: analgesia; buccal acupuncture; elderly; laparoscopic radical gastrectomy; stress response.

Figure 1

Buccal acupuncture and acupoints. (A,B) A biological holographic model of buccal acupuncture (A) (18), and acupoints on the cheek (B) (19). (C,D) Buccal acupoints of a (Shoulder point), b (Middle Jiao point), c (Lower Jiao point) on the left cheek (C), and b (Middle Jiao point), c (Lower Jiao point) on the right cheek (D). Acupoint a is situated on the midpoint of temporozygomatic suture for relieving the left shoulder pain; b is situated on the midpoint of Upper Jiao (the cross of the posterior coronoid of the mandible and the lower edge of the zygomatic arch) and Lower Jiao (anterior oblique line of the mandible); c is situated on the anterior oblique line of the mandible.

Figure 2

CONSORT flow diagram of participant enrollment. In the study, a total of 90 participants were initially screened and 3 of them were excluded during the trial. Finally, there were 87 participants included in the statistical analysis (43 in Group C and 44 in Group B, respectively). CONSORT: The Consolidated Standards of Reporting Trials.