Effect Of Electroacupuncture Combined With General Anesthesia On Postoperative Pain And Stress Response Of Patients With Open Posterior Lumbar Spine Surgery

Objective:To observe the effects of electroacupuncture combined with general anesthesia on the dosage of anesthetic analgesics,hemodynamics,acute stress response,postoperative nausea and vomiting in patients undergoing open posterior lumbar spine surgery,and the difference between preoperative and intraoperative electroacupuncture treatment time,so as to evaluate the clinical efficacy of perioperative analgesia,inhibition of stress reaction,stabilization of circulation and reduction of postoperative adverse reactions,so as to guide the better treatment time of electroacupuncture.To provide reference for clinical decision-making and broad the train of thought for the application of acupuncture in perioperative period.Methods:A total of 96 patients who scheduled for open posterior lumbar spine surgery,with 33males and 63 females,aged 18-65 years,ASA physical statusⅠorⅡ,were randomly divided into three groups（n=32 in each group）:preoperative electroacupuncture combined with general anesthesia group（group A）,intraoperative electroacupuncture combined with general anesthesia group（group B）and the control group（group C）.Before the induction of anesthesia,group A was treated with electroacupuncture at bilateral Hegu（LI4）and Neiguan（PC6）for 30 minutes,group B was treated with electroacupuncture at the end of induction of anesthesia until the end of suture,group C was not treated with electroacupuncture.All three groups were given total intravenous anesthesia and patient-controlled intravenous analgesia were performed after surgery.The intraoperative dosage of remifentanil and propofol during operation,the cumulative dose of PCIA in 24 hours and 48 hours after operation,and the VAS score at 6 hours,8 hours,24 hours and 48 hours after operation were recorded.HR and MAP were recorded at the basic values（T₀）,before anesthesia intubation（T₁）,immediately after tracheal intubation（T₂）,10 min after incision（T₃）,immediately after suture（T₄）,immediately awakening（T₅）and immediately after tracheal extubation（T₆）.The concentrations of epinephrine（E）,norepinephrine（NE）,dopamine（DA）,cortisol（Cor）and blood glucose were measured at T₀,T₃ and T₄.The time of postoperative awakening and extubation,and the incidence of postoperative nausea and vomiting and skin pruritus were recorded.SPSS 26.0 software was used to analyze the data.Results:（1）There was no significant difference in gender,age,BMI,ASA and operation time among the three groups（P>0.05）.（2）The intraoperative dosage of propofol and remifentanil in group A was significantly less than that in group C,and the dosage of propofol in group B was less than that in group C（P<0.05）,There was no difference between group A and group B.（3）Compared with T₀,HR of group A and group B increased significantly at T₆and group C at T₂ and T₆,and HR of three groups decreased significantly at T₃ and T₄.MAP decreased in group A and group B at T₁,T₃,T₄ and T₅ and in group C at T₁,T₂,T₃ and T₄.MAP in group B was lower than that in group C at T₂（P<0.05）.（3）At T₃ and T₄,the concentrations of E and DA in group A and E in group B were lower than those in group C.The concentration of NE in group A was lower than that in group B at T₄.Cor in group A was lower than that in group C at T₃ and lower than that in group B at T₄.Compared with T₀,the concentrations of E,DA,Cor and blood glucose in group B and C increased at T₃,and E,NE,DA and Cor increased at T₄（P<0.05）.（4）The cumulative dosage of PCIA in group A was lower than that in group C within 24 hours and48 hours after operation,and the incidence of PONV in group A was lower than that in group C within 48 hours after operation.The VAS score at 24 hours and 48 hours after operation and the utilization rate of postoperative analgesic drugs in group A and group B were significantly lower than those in group C（P<0.05）.Conclusion:Electroacupuncture combined with general anesthesia can reduce the dosage of anesthetic analgesics,maintain hemodynamic stability,reduce acute stress reaction and reduce the incidence of postoperative adverse reactions in patients with open lumbar posterior surgery.Compared with continuous electroacupuncture stimulation during operation,the effect of preoperative electroacupuncture is better.