title: Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Although opioids are widely used as analgesics in general anaesthesia, they have unpleasant side-effects and can delay postoperative recovery. Acupuncture and related techniques are effective for acute and chronic pain, and reduces some side-effects. We assessed the effect of transcutaneous electric acupoint stimulation (TEAS) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects.
  
  
  METHODS
  Sixty patients undergoing sinusotomy were randomly assigned to TEAS or control group. TEAS consisted of 30 min of stimulation (6-9 mA, 2/10 Hz) on the Hegu (LI4), Neiguan (PC6), and Zusanli (ST36) before anaesthesia. The patients in the control group had the electrodes applied, but received no stimulation. Bispectral index was used to monitor the depth of anaesthesia. Perioperative haemodynamics were recorded, and peripheral blood samples were collected to measure the levels of mediators of surgical stress. The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anaesthesia-related side-effects.
  
  
  RESULTS
  Patients in the TEAS group required 39% less remifentanil during surgery than controls [0.0907 (SD 0.026) μg kg(-1) min(-1) vs 0.051 (0.018) μg kg(-1) min(-1)]. There were no differences in intra-operative haemodynamics or surgical stress between groups. However, the time to extubation and recall in the control group was 16.8 (6.8) min and 23.0 (5.0) min, respectively, significantly longer than that in the TEAS group (P<0.01). TEAS also decreased the incidence of dizziness and pruritus within the first 24 h after surgery (P<0.01).
  
  
  CONCLUSIONS
  The use of TEAS significantly reduced intra-operative remifentanil consumption and alleviated postoperative side-effects in patients undergoing sinusotomy.
  
  
  BACKGROUND
  The trial was registered at clinicaltrials.gov (NCT01700855).
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: N
authors.initials: N
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Zhong
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Dong
authors.affiliation: Department of Anesthesiology, School of Medicine, Stony Brook University, New York, NY 11794-8480, USA.
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China.
authors.forename: T
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China wangqiang@fmmu.edu.cn lxiong@fmmu.edu.cn.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China wangqiang@fmmu.edu.cn lxiong@fmmu.edu.cn.
authors.forename: L
authors.initials: L
authors.lastname: Xiong
mesh_terms: D015669:Acupuncture Points; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000762:Anesthesia Recovery Period; D004311:Double-Blind Method; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D010256:Paranasal Sinuses / Q000601:surgery*; D010880:Piperidines / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011446:Prospective Studies; D000077208:Remifentanil; D013312:Stress, Physiological / Q000502:physiology; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil
keywords: electroacupucture; nausea; remifentanil; vomiting