The Clinical Research Of Wrist-ankle Acupuncture Combined With PCIA Used For Postoperative Analgesia After Laparoscopic Cholecystectomy

BackgroundPain was identified as the 5th vital signs after breath,pulse,body temperature,blood pressure.Pain can be divided into acute and chronic pain,Postoperative pain belong to acute pain,which is the most common and need to be treated.Postoperative patients with severe pain not only cuse emotional distress,but also can delay the rehabilitation or lead to the occurrence of adverse events.Therefore,it is important to keep effective postoperative analgesia to promote the rehabilitation of patientsWith the progress of technology of laparoscope,laparoscopic cholecystectomy(LC)has become the most common surgical procedure of cholecystectomy.Compared to cholecystectomy,LC can reduce abdominal trauma and the incidence of complications,but CO2 pneumoperitoneum increased the rate of postoperative shoulder pain and nausea,vomiting and other adverse events.There are many ways of analgesia for LC.Such as oral analgesic drugs,intramuscular injection or intravenous injection analgesic drugs,etc,but the patient controlled analgesia(PCA)is still the most effectively way,and intravenous self-control algesia(PCIA)is the most commonly used.The opioid-based analgesic drugs such as fentanyl,sufentanil etc are used commonly,which act on the opioid receptor and have strong analgesic effects.But it also can bring adverse reactions to patients,such as nausea,vomiting,dizziness etc.Wrist-ankle acupuncture is a kind of acupuncture treatment,which work quickly,and is easy to operate,and does not affect the patients activities,etc.Domestic and foreign research have shown that it has a good analgesia effect on acute and chronic pain.Wrist-ankle acupuncture reduces pain mainly through its role in the central and peripheral analgesic medium.The studies suggest acupoint stimulation can reduce LC postoperative cytokines levels like IL-6,reduced the postoperative adverse reactions.But the wrist-ankle acupuncture used for LC postoperative analgesia is still not reported.In this paper,the wrist-ankle acupuncture joint PCIA were used for the postoperative analgesia of LC,to observe the effectiveness of the wrist-ankle acupuncture and the influence on adverse reactions such as postoperative nausea and vomiting,abdominal distension etc,and observe the LC postoperative patients' stress level influenced by the wrist-ankle needle bytesting patients with CRP levels before and after operation.ObjectiveWith the wrist-ankle needle joint PCIA after laparoscopic cholecystectomy,observe the effectiveness of analgesia and observe the influence on adverse reactions such as postoperative nausea and vomiting,abdominal distension etc.Methods150 cases were randomly divided into three groups,each group of 50 cases.The control group of conventional anesthesia,no special treatment;wrist-ankle needle Group before induction use wrist-ankle needle treatment and retain needle 12 hours;Sham needle group before induction light point next to the skin and retain needle 12 hours,three groups of patients adopt static absorption composite general anesthesia,postoperative PCIA analgesia.Observation index of 1,2,4,8,12,24,36 and 48 h at different time points of incision pain,visceral pain VAS score and the number of cases of shoulder pain;patients in each group recorded the number of total postoperative analgesia pump presses and the number of effective presses;Record the additional doses of fentanyl;Record the number of postoperative adverse reactions such as nausea and vomiting,dizziness,abdominal distension etc.Detect patients with Preoperative CRP levels and postoperative 12 h and 24 h CRP levels.ResultsThree groups of patients with general and operation information has no statistical significance(P>0.05).Comparison of postoperative analgesia:in the first 1~2h postoperative,the three groups of patients with incisional pain and visceral pain scores were not significantly different in VAS.Compared with control group and sham acupuncture group,wrist-ankle acupuncture group at different time points,the VAS scores in 4~36h of incision pain and visceral pain was lower(P<0.01 or 0.05);there were no differences between the sham acupuncture group compared with the control group at every time point of incision pain and visceral pain VAS score(P>0.05).There was no significant difference in the VAS score between the three groups of patients in 48h(P>0.05).The number of shoulder pain is limited,there is no significant difference among three groups(P>0.05).The usage of PCIA: compared with control group and sham acupuncture group,the number of total press and effective press times of PCIA postoperative in wrist-ankle acupuncture group were reduced(P < 0.05 or 0.01);the control group and shamacupuncture group compared,there is no significant difference(P > 0.05).Additional dose of fentanyl in wrist-ankle acupuncture group was significantly less than the control group and sham acupuncture group(P<0.01).Comparison of adverse reactions: Wrist-Ankle acupuncture group's number of postoperative nausea and vomiting,dizziness and abdominal distension were less than the control group and the sham acupuncture group,the total number of cases had significant difference(P<0.01);if there were serious adverse reactions,it would be treated immediately.CRP level: three groups of CRP level preoperative is no difference.The CRP level of Wrist-ankle acupuncture group after 24 h,48h is lower than the control group and the sham acupuncture group(P <0.01);There is no significant difference between the control group and the sham acupuncture group(P> 0.05)ConclusionWrist-ankle acupuncture joint PCIA used for postoperative analgesa of LC has a good effect,which can reduce the VAS scores of 4~36h postoperative,reduce the number of the analgesia pump pressing times and the additional dose of fentanyl;which also reduce the number of adverse reactions such as postoperative nausea,vomiting,abdominal distension.Compared with PCIA,wrist-ankle acupuncture joint PCIA used for the postoperative analgesia of LC produce a synergistic effect,It can alleviate pain,promote patients' postoperative rehabilitation.Wrist-ankle acupuncture could reduce the increased levels of CRP at the 24 h and 48 h postoperative,which also reduce the stress levelof LC postoperative and promote rehabilitation.