Clinical Study Of Transcutaneous Electrical Acupoint Stimulation On Reducing Postoperative Nausea And Vomiting In Female Patients Undergoing Bariatric Surgery

PART 1 INVESTIGATION OF RISK FACTORS FOR POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING BARIATRIC SURGERY—A RETROSPECTIVE STUDYObjectives: Postoperative nausea and vomiting(PONV)is the most common complication after bariatric surgery.It is particularly important to identify risk factors for prevent PONV in bariatric patients.This study reviewed the relevant information of patients underwent bariatric surgery to explored the risk factors of PONV in those patients.Methods: Data of patients who underwent bariatric surgery in the Local Hospital from January 2014 to May 2018 were collected,including items such as patient’s general condition,past medical history,obesity-related comorbidities,smoking history,PONV history,motion sickness history,perioperative medication,ASA grading,anesthesia time,extubation time,intraoperative blood pressure,intraoperative and postoperative opioid dosage,infusion volume,surgical method and PONV according to medical records.The occurrence of nausea and vomiting during hospitalization were also checked by telephone follow-up.The patients were divided into PONV group and non-PONV group according to whether PONV occurred during hospitalization.Logistic regression analysis was used to determine the risk factors of PONV.Results: A total of 125 patients underwent bariatric surgery,9 patients were excluded(7 patients with directly returned to the ICU after surgery,and 2 patients underwent unplanned secondary surgery).116 patients were finally included in this study.71 patients were experienced PONV,the incidence rate of PONV was 61.2%,PON occurred in 11 patients,accounting for 15.5%,and POV occurred in 60 patients,accounting for84.5%.Patients with and without PONV had significant differences in gender(P=0.000),smoking history(P=0.001),and postoperative tramadol consumption(P=0.000).Further multivariate logistic regression analysis showed that gender(OR: 8.959,95% confidence interval: 2.487,32.272),postoperative tramadol consumption(OR: 0.992,95% confidence interval:0.988,0.996)were the important risk factors of PONV for patients who underwent bariatric surgery.Conclusions: Gender is one of the important influencing factors of PONV in patients underwent bariatric surgery,and female is a high risk factor for developing PONV,suggesting that we should take comprehensive prevention in female patients to effectively reduce the incidence of PONV in bariatric surgery.PART 2 TRANSCUTANEOUS ELECTRICAL ACUPOINT STIMULATION PREVENTS POSTOPERATIVE NAUSEA AND VOMITING IN FEMALE PATIENTS UNDERGOING BARIATRIC SURGERY: A PROSPECTIVE,RANDOMIZED CONTROLLED TRIALObjectives: Postoperative nausea and vomiting(PONV)is an important factor affecting the quality of rehabilitation after bariatric surgery.Despite the administration of prophylactic antiemetics,female patients who undergo bariatric surgery remain at high risk for PONV.Although many trials have been conducted,the effectiveness of transcutaneous electrical acupoint stimulation(TEAS)on the prevention of PONV remains unknownMethods: Sixty-two female patients undergoing elective bariatric surgery in the First Affiliated Hospital of Chongqing Medical University from May 2018 to February 2020 were included and randomly assigned to a TEAS group(n = 31)and a control group(n = 31).In the TEAS group,electrical acupoint stimulation in PC6 and ST36 acupoint positions was administrated about 30 min before induction and maintained during the operation.In the control group,the patients had gel electrodes applied and connected to an acupuncture instrument without stimulation.Prophylactic dexamethasone(10 mg intravenously)was administered during anesthesia induction and tropisetron(4 mg intravenously)at the start of skin closure in both groups.Patients with emetic episodes or who requested antiemetic therapy were administered 10 mg of metoclopramide intravenously in the PACU or ward.If symptoms persisted,4 mg of ondansetron or 4 mg of tropisetron was added.The incidence and severity of PONV,as well as the need for rescue antiemetics,were collected within 48 h after surgery.Clinically important PONV was calculated based on PONV impact scale.The Postoperative outcomes were also collected.The chi-square test was used to compare the incidence of PONV in both groups.Results: The patients in both groups had similar clinical characteristics,and all patients underwent the LSG.In the TEAS group,13patients(41.9%)had PONV within 48 h after LSG compared to 24 patients(77.4%)in the control group(P = 0.004,relative risk: 0.39 [0.19,0.80],relative risk reduction: 45.9%).The severity of PONV differed significantly between groups,with five patients(16.1%)in the TEAS group and 15patients(48%)in the control group experiencing clinically important PONV(P = 0.007,relative risk: 0.62 [0.42,0.90],relative risk reduction:32.3%).Moreover,fewer patients required antiemetic rescue medication in the TEAS group compared with the control group(29.0% vs.58.1%,P =0.021).Besides,the time to first flatus passage in the TEAS group was significantly shorter than that in the control group(23.6±7.7 vs.32.3±13.2h,respectively,P = 0.003),but no differences were observed in the times to oral diet and mobility after surgery.Conclusion: Multimodal antiemetic prophylaxis consisting of TEAS and antiemetics was effective in reducing PONV incidence,reducing the relative risk of PONV by 45.9%,while reducing the severity of PONV.PART 3 TREATMENT OF TRANSCUTANEOUS ELECTRICALACUPOINT STIMULATION ON ESTABLISHED POSTOPERATIVE NAUSEA AND VOMITING IN FEMALE PATIENTS UNDERGOING BARIATRIC SURGERY:A PROSPECTIVE,RANDOMIZED CONTROLLED TRIALObjectives: PONV is the most common complication after female patients underwent bariatric surgery.Although preventive antiemetics are widely used,the rescue options are limited for established PONV in those patients.This study was designed to determine if the TEAS could be used to treat established PONV in female patients underwent bariatric surgery.Methods: A total of 94 female patients who suffered PONV without drug treatment after bariatric surgery from February 2020 to February 2022 were enrolled and randomly divided into TEAS(stimulation group)and control(control group)group.If patients in both groups still experienced PONV lasted 2 hours,and who required further treatment,then drug(metoclopramide 10 mg iv and ondansetron 4 mg iv)were given.The primary endpoint was complete response,defined as the absence of nausea and vomiting within 30 minutes to 24 hours after treatment,and the absence of rescue antiemetics.The chi-square test was used to compare the complete response rate of PONV in the two groups.Results: In the stimulation group,CR occurred in 36 of 47 patients(76.6%),of which 20(42.6%)and 16(34.0%)patients after TEAS and after drug use,respectively.While 21 patients(44.7%)in the control group developed CR(P=0.002),and 9(19.1%)(P=0.014)and 12(25.5%)patients developed CR after sham stimulation and drug use,respectively(P =0.367).The number of drug use differed significantly between groups,with 21patients(44.7%)in the stimulation group and 33 patients(70.2%)in the control group using drug therapy(P=0.012).In addition,there were 11(23.4%)and 9(19.1%)patients with motion sickness in the stimulation group and control group,and 2(4.3%)and 1(2.1%)patients developed CR,respectively.Conclusion: TEAS is effective in the treatment of established PONV in female patients underwent bariatric surgery and reduces the use of antiemetics.Multimodal treatment consisting of TEAS and antiemetics was more effective in the treatment of established PONV in female patients underwent bariatric surgery than that of antiemetics alone,but poor effect in female patients with motion sickness.