Remifentanil Sparing Effect Of TEAS With Single Or Dual Acupoints In Patients Undergoing Radical Mastectomy: A Single Center, Randomized, Double-blinded, Controlled Clinical Trial

Background:As one of the important part of Chinese Tranditional Medicine, Acupuncture Anesthetic Balanced Anesthesia(AABA) has been proved effective in several studies recently, such as reducing the consumption of anesthetics, alleviating the postoperative nausea and vomiting(PONV) and acute pain. However, the non-uniform operation procedure including the method of acupoints combination is one of the problems during the clinical application of acupuncture. According to the retrieving of the relative literatures, more researchers prefer to combined acupoints rather than single acupoint although the latter is also effective. It is still unclearly whether the effect of dual acupoints stimulation is better than single one. Objective:The purpose of this study was to evaluate the remifentanil sparing effects of single acupoint(Neiguan, PC6) or two acupoints combination(Neiguan, PC6 and Tanzhong, RN17) stimulated with transcutaneous electrical acupoint stimulation(TEAS) on patients undergoing radical mastectomy. Methods:The patients undergoing radical mastectomy under general anesthesia were randomly assigned to receiving single acupoint(PC6) TEAS, dual acupoints(PC6 and CV17) TEAS or sham acupuncture for 30 minutes before anesthesia induction. The primary endpoint was the consumption of remifentanil during the operation. Secondary endpoints included the time to recall and extubation, and the incidence of PONV and postoperative respiratory depression. Results:One hundred and fifty three patients were enrolled from Jul 2015 to Dec 2015. One hundred and thirty six patients completed the trial(46 in dual acupoints group, 45 in single acupoint group, and 45 in sham group). The adjusted consumption of remifentanil in dual acupoints group, single acupoint group and sham group was 0.12±0.04ug/kg/min, 0.15±0.05ug/kg/min and 19±0.06ug/kg/min, respectively. Doses of remifentanil were lower in dual acupoints group and single acupoint group than in sham group(P<0.001), furthermore was lower in dual than single acupoint group(P =0.028). There were no significant difference among the three groups in respect to the time to recall and extubation, and the incidence of PONV and postoperative respiratory depression. Conclusion:The remifentanil sparing effect is stronger with dual acupoints TEAS than single acupoint TEAS in patients undergoing radical mastectomy under general anesthesia.