The Clinical Study Of Acupuncture-assisted Anesthesia With Different Frequencies Continuous Waves On Thyroid Surgery

Objectives:To investigate the effects of acupuncture-assisted anesthesia (transcutaneous electrical nerve stimulation TENS with different frequencies) combined with cervical plexus block(CPB)on the stress reaction and analgesic effect in patients undergoing thyroidectomy.Methods:80 patients undergoing elective thyroidectomy,ASAⅠ～Ⅱ,were divided randomly into four groups.In Group A,20 patients received CPB plus a low frequency(2Hz)TENS;In group B,20 patients received CPB plus middle frequency(15Hz)TENS;In group C,20 patients received CPB plus high frequency (100Hz)TENS;In group D,20 patients received CPB plus sham TENS(as a controlled group).CPB was performed after TENS administered 20 minutes.Blood pressure(MAP),heart rate(HR),respiratory rate(RR),pulse oxygen saturation (S_PO₂)and the additional drugs were recorded at 8 time points(baseline,before the anesthesia,15 minutes after CPB,skin incision,30 minutes after CPB, maximum operative trauma,1h after CPB,end of surgery).Analgesic effect was assessed through the standard about degree of pain by world health organization (WHO).At the same time,the venous blood samples were taken for measurements of cortisone(COR),adrenocorticotrophic hormone(ACTH),β-endorphin(β-EP) and norepinephrine(NE)before the anesthesia,before the skin incision, maximum operative trauma and the end of surgery.Complications and toxic side effects were documented during perioperative period.Statistical analysis was performed with SPSS12.0 software.All the quantitative data of the 4 groups were compared with one-way analysis of variance(ANOVA),the categorical data with chi-square test.P＜0.05 means representing significance difference in statistics.Results:In all the patients undergoing thyroidectomy,analgesic effect is better than the second level,and no one was changed in the way of Anesthesia. The group B(15Hz)is the best in the analgesic effect and the group D is the worst,there is a significance difference between the groups(P＜0.05).BP and HR showed significant higher levels in group A,C and D after CPB 15 minutes versus group B(P＜0.O5),and it's a little higher in group D than group A and C,but there were no significant differences between the three groups(P＞0.05); BP was no significant higher in group C than it before CPB at the time of maximum operative trauma(P＞0.05).At the end of surgery,there were no significant differences between the four groups(P＞0.05).RR is slower in Group D than in A,B and C at maximum operative trauma (P＜0.05);S_PO₂ showed no significant differences between the four groups(P＞0.05);the need of additional fentanyl is more in Group D than in A,B and C(P＜0.05).The concentration of COR was significantly lower in group B than in group D at maximum operative trauma time and the end of surgery(P＜0.05);comparing with the baseline,there were significantly higher in four groups at maximum operative trauma time and the end of surgery(P＜0.05).The concentration ofβ-EP in plasma was significantly higher in Group B than in Group D at maximum operative trauma time(P＜0.05);at the end of surgery, there was significantly higher in Group C than in Group A,B and D.Comparing with the baseline,β-EP concentration in Plasma was significantly higher at maximum operative trauma in Group B and at the end of surgery in Group C(P＜0.05).Plasma ACTH was significantly higher in Group D than in Group B at maximum operative trauma time and at the end of surgery(P＜0.05).Plasma NE was significantly higher in Group D than in Group A,B and C at maximum operative trauma time(P＜0.05).At the end of surgery,there was significantly lower in Group D than in other three groups(P＜0.05).Complications and side effects:two patients appeared hoarse voice in each group,and no one appeared dyspnea.All the patients didn't need oxygen given except two patients in Group D at the whole perioperative periods.At the same time,two patients needed to treatment because of hypertension in Group D. Significantly more side effects occurred in Group D(P＜0.05).Conclusion:Acupuncture-assisted anesthesia by 15HZ continuous waves stimulation has better analgesic effects than 2HZ and 100HZ on thyroid surgery,and can obviously relieve the system stress reaction because of anesthesia and surgery.