Effect Of Teas Aided Anesthesia On T-lymphocyte Subsets In Elderly Patients With Total Knee Arthroplasty And Its Role In Postoperative Outcome

Objective:To evaluate the effect of TEAS aided anesthesia on T-lymphocyte subsets in elderly patients with total knee arthroplasty and its role in postoperative outcome.Methods:Ninety elderly patients who are scheduled for elective unilateral total knee arthroplasty,from july 2017 to december 2018 were randomly divided into three groups.In TEAS group,TEAS was applied to Neiguan-Hegu acupoints from 30 min before intravertebral anesthesia to the end of surgery.In Sham group,TEAS was applied at 3cm beside Neiguan-Hegu acupoints from 30 min before intravertebral anesthesia to the end of surgery.In Control group,the patients only received electrodes at Neiguan-Hegu acupoints,but received no stimulation.The stimulation parameters that frequency was 2/100 Hz applied to patients whose felt there was obvious tremor but no pain after stimulation intensity current increased gradually from 1mA.CD3+,CD4+,CD8+,Treg level were assessed before stimulation,at the end and 24 h after surgery.VAS scores,bruggrmann comfort scale and whether to pressure analgesia pump after surgery were recorded.We record datas including the rate of postoperative adverse events,the leaving bed time after operation,the days remaining in the drain tube,postoperative suction drainage,postoperative hospitalization day.Results:There were 90 cases in accordance with the criteria of inclusion and exclusion,30 cases in each group.There was no significant difference in sex,age,height,weight,BMI and operation time between the three groups(P > 0.05).1 Effect of TEAS on T-lymphocyte subsets in elderly patients undergoing total knee arthroplasty(1)Comparison among groups: When comparing the levels of T-lymphocyte subsets following surgery,we observed that CD3+ and CD4+ at the end and 24 h after surgery decreased in the three groups comparison before the electrical stimulation,the Treg level was higher than that before the electrical stimulation at the end of and 24 hours after surgery(P < 0.05).(2)Comparison between groups: Compared with group Control,the CD3+,CD4+ of TEAS were significantly higher at the end of surgery,the CD4+ was significantly higher at 24 h after surgery,and Treg was significantly decreased at the end and 24 h after surgery(P < 0.05).2 Effect of TEAS on adverse effect in elderly patients undergoing total knee arthroplasty Compared with Control group,the incidence rate in TEAS group of nausea, vomiting were significantly decreased(P < 0.05).3 Effect of TEAS on postoperative outcomes in elderly patients undergoing total knee arthroplastyCompared with Control group,the data in TEAS group including postoperative24hVAS score and BCS score were significantly elevated,the leaving bed time after operation were significantly decreased(P < 0.05).Conclusion:Transcutaneous electrical acupoint stimulation aided anesthesia in elderly patients undergoing total knee arthroplasty reduce the decreasion that number of T-lymphocyte subsets,improve immune function,alleviate postoperative pain,reduce the incidence of adverse effects,shorten the first time of leaving bed after operation,improve postoperative comfort,and promote postoperative outcome.