Effect Of Electroacupuncture On Postoperative Sleep Disorders In Gynecological Laparoscopic Patients

ObjectiveWe aimed to investigate the sleep pattern after gynecological laparoscopic surgery, and explore the effect of electroacupuncture on prevention and treatment of postoperative sleep disorders (PSD) in gynecological laparoscopic patients.Methods80 gynecological patients undergoing laparoscopic operation were sele-cted cases, whose age is between 22 to 59, averaged 37 years old, ASA grade Ⅰ-Ⅰ. They were randomly divided into four groups:group Ⅰ(control group), group Ⅱ (preoperative electroacupuncture (EA)), group Ⅲ (postoperative EA) and group Ⅳ (preoperative and postoperative EA),20 patients in each group. Atropine 0.5mg was given 30 min before general anesthesia. Each EA treatment was last 30min, Baihui (GV 20) and Yintang(GV 29) were selected. Group Ⅰ receiv-ed only basic treatment. In group Ⅱ, the EA treatment was administered before general anesthesia. In group Ⅲ, the EA treatment was administered at about 18:30. In group Ⅳ, the EA treatment was administered both before general anesthesia and at about 18:30. Anesthesia was induced by sufentanil 0.3-0.5mg/ kg, propofol 1.5-2.5mg/kg, cisatracurium 0.12-0.15mg/kg in all patients. Suf-entanil and cisatracurium was given when needed. Anesthesia maintenance was provided by sevoflurane(1-3%) and Narcotrend index (NI) was maintained between 40-60. Ketorolac 30mg was given both 30min before beginning the operation and 30min before ending the operation. The Self-Rating Anxiety Scale(SAS) was observed in the morning the day before the operation. Sleep disorders ques-tionnaires were investigated in the morning the day before the operation (PREOP2), the operation morning (PREOP1) and in the first morning postoperative (PO). From patients went to bed to wake up, the Narcotrend was being monitored the day before and after the surgery. All patients were measured heart rate(HR) and mean arterial pressure(MBP) in the operation evening at 20:00(T1),22:00 (T2),00:00(T3),02:00(T4) 04:00(T5),06:00(T6).12 hour urine samples were collected for tested the day before and after surgery between 19:00 to 07:00.Results1. The patient’s characteristicsAmong four groups, there were no significant difference of patient’s age, height, weight, body mass index(BMI), ASA classification(P>0.05).2. sleep situation(1) The rate of PSD. The total rate in the study was 46.10%, among which group Ⅰ 52.60%, group Ⅱ 57.90%, group Ⅲ 36.80% and group Ⅳ 36.80%. Group Ⅲ and group Ⅳ is lower than group Ⅰ and group Ⅱ, however no significant difference was found in the rate of PSD between groups(P>0.05).(2) The self-reported sleep qualityWhether the patients perceived sleep problems. According to sleep disor-ders questionnaires, four groups have differ significantly on patients’ans-wer in P0(P<0.05), group ⅢI and group Ⅳ answered "yes" were less than group Ⅰ and group Ⅱ. From PREOP2, PREOP1 to P0, trends were found for group Ⅰ, group Ⅱ and group Ⅲ to have more patients answered "yes".Awakening times scores. Based on the observed the patients in group Ⅳ were found to have lower awakening times scores than the other groups (P<0.05). From PREOP2, PREOP1 to P0, awakening times scores in group Ⅰ, group Ⅱ and group Ⅲ were increasing.PSD questionnaires scale. In contrast, no group difference in PSD questio-nnaires scale was found in PREOP2, PREOP1 and P0(P>0.05). From PREOP2, PREOP1 to P0, trends were found for four groups to have higher PSD questionnaires scores.(3) The sleep structure of patientsBased on the observed, no group difference were found on sleep onset latency, patient records total sleep time and Narcotrend monitoring total sleep time(P> 0.05). Comparison of each group in PREOP1,the four groups in PO show longer sleep onset latency, less patient records total sleep time and less Narcotrend monitoring total sleep time (P<0.05).According to the analysis of Narcotrend monitoring, no significant differ- ence was found in the percentage of each level of the Narcotrend index (NI) in sleep duration(P>0.05). Comparison of each group in PREOP1, the A level of the percentage of each level of NI in sleep duration was increasing in PO between four groups (P<0.05), the D level of the percentage of each level of NI in sleep duration was decreasing in PO between four groups(P<0.05). Comparison of each group in PREOP1, the EF level of the percentage of each level of NI in sleep duration was increasing in PO between group Ⅱ (P<0.05), the C level of the percentage of each level of NI in sleep duration was decreasing in PO between group Ⅲ(P<0.05).In four groups, the percentage of DeltaRel in the sleep duration in PREOP1 and PO was not significant(P>0.05). Comparison of each group in PREOP1, the percentage of DeltaRel in the sleep duration was increasing in P0(P<0.05). 3. Surgery and anesthesiaIn contrast, no group difference in self-rating anxiety scale (SAS) scores was found (P>0.05).During the anesthesia surgery process, there were no significant difference of patient’s sufentanil dose, propofol dose, cisatracurium dose, fluid volume, bleeding volume, urinary output, operation time and anesthesia time between groups (P>0.05).The hemodynamics of patients in P0. Four groups in HR showed a trend of gradual decline from T1 to T6. Comparing to group Ⅰ, group Ⅱ, group Ⅲ, group Ⅳ in the fluctuation of MBP was less, and group Ⅳ showed a trend of gradual decline from T1 to T6.The pain VAS, the postoperative nausea score and the postoperative vomiting times score data showed no statistical differences between groups (P>0.05).4. Biochemical testsNo significant difference was found in night secretion of urinary sulphat-oxymelatonin level between groups in PREOP1 and in PO(P>0.05), however, night secretion of urinary sulphatoxymelatonin level showed a trend towards a decreased from PREOP1 to P0(P<0.05).No group difference in night secretion of urinary free cortisol level was found in PREOP1 and in P0(P>0.05), however, night secretion of urinary free cortisol level showed a trend towards an increased from PREOP1 to P0(P<0.05).ConclusionsPostoperative sleep disorders are common following gynecological laparo-scopic surgery at the first postoperative night, showed by 46% of the study. Our objective data showed that perioperative short-term electroacupuncture would improve feeling of sleep quality at the first postoperative night, alth-ough there was no improved sleep architecture, as was also no effect of night secretion of urinary sulphatoxymelatonin level and urinary free cortisol level.