Effect Of Percutaneous Acupoint Electrical Stimulation On Patient-controlled Intravenous Analgesia In Elderly Patients After Total Knee Arthroplasty

Objective:To observe the analgesic effect of transcutaneous electrical acupoint stimulation(TEAS)on patient-controlled intravenous analgesia after total knee arthroplasty.Methods:From August 2017 to January 2018,eighty elderly patients of the elective TKA,aged 65-75 years,ASA physical status ? or ?,randomly divided into 2 groups using random number table: TEAS group(group T)and control group(group C),40 in each group.Patients in group T received TEAS(disperse-dense waves,frequency 2/100 Hz)at the points of PC6(Neiguan)and LI4(Hegu)from 30 min before anesthesia induction till the end of surgery,the optimal intensity was that patients can tolerate with strong tremor but no tingling(6-10 mA).Patients in group C received electrode plate at the same acupoints without any electrical stimulation.Patient-controlled intravenous analgesia(PCIA)was performed immediately after completion of suture skin in 2 groups of patients.The initial loading dose was 2 ml,the background infusion dose was 2 ml/h,the PCA dose was 1 ml,and the locking time was 15 min.The analgesia pump was configured to dilute sufentanil 150 ?g with 0.9% sodium chloride solution to 150 ml.Primary outcomes included resting and activity pain intensity evaluated by visual analog scale(VAS)at 1,6,24,and 48 hours after surgery.Secondary outcomes included the satisfaction score of analgesic scheme at 48 hours after surgery,the cumulative dosage of sufentanil in analgesic pump and the occurrence of adverse reactions such as nausea,vomiting,pruritus,respiratory depression,etc.Morphine 5 mg was intravenously injected as rescue analgesic when visual analog scale score ?4 points.Results:Compared with group C,the amount of propofol and remifentanil used in the T group decreased(P<0.05).Compared with group C,the resting VAS score at 6 hours after operation and the activity VAS score at 1 hour and 6 hour after operation in group T were significantly lower(P<0.05),the cumulative consumption of sufentanil at 6 hours,24 hours and 48 hours after operation decreased significantly(P<0.05)and the occurrence of adverse such as nausea and vomiting were lower in group T(P<0.05).There was no significant difference in the satisfaction score between the two groups.Conclusion:TEAS can reduce the pain degree of the elderly patients after total knee arthroplasty,reduce the amount of intraoperative sedative analgesic drugs,reduce the amount of postoperative patient-controlled intravenous analgesic opioids,and reduce the incidence of postoperative remedial analgesia and nausea and vomiting.