title: [Effect of Subcutaneous Injection of Lidocaine in Zusanli (ST 36) and Jiaji (EX-B 2) Regions on Immune Function in Patients Undergoing Laparoscopic Cholecystectomy].
abstract: OBJECTIVE
  To observe the effect of acupoint injection of Lidocaine on serum IL-1β, TNF-α and T-lymphocyte subset activities in patients undergoing laparoscopic cholecystectomy (LC), so as to reveal its mechanisms underlying relieving postoperative pain and potentiating rehabilitation.
  
  
  METHODS
  Eighty patients scheduled for elective LC surgery (grade I or II, according to American Standards of Association, ASA) were randomly divided into four groups, namely intravenous analgesia (IVA) , right forearm-injection (forearm-), Jiaji (EX-B 2, Thorax 8)-injection (EX-B 2-1), and Zusanli-injection (ST 36-1), with 20 patients in each group. The conventional anesthetic induction and maintenance with Penehyclidine Hydrochloride, Midazolam, Sulfentanil, Propofol, Atracurium Besilate, and Remifentanil were same in all the 4 groups. For patients of the forearm-I, EX-B 2-I and ST 36-1 groups, 5% Lidocaine was injected into the subcutaneous layer of the anterior side of right forearm near the elbow, EX-B 2 and ST 36 regions, respectively. Analgesia pump (filled with Sulfentanil, Ramosetron + normal saline) was connected af- ter the tracheal extubation. The visual analog scale (VAS) was used to assess the patient's pain reaction after tracheal extubation (T 1), and 6 h (T 2), 24 h (T 3) and 48.h (T 4) after surgery. The times of RCA pressing and the total dose of Sufentanil in the process of postoperative analgesia were recorded as well. The contents of serum IL-1β and TNF-α were analyzed by ELISA, and the counts of CD4+ and CD+ T cells were detected by flow cytometry.
  
  
  RESULTS
  Compared with T 1 in the same one group, the VAS scores at time-points of T 2, T 3 and T 4 after surgery of all the IVA, forearm-1, ST 36- and EX-B 2- groups were reduced significaantly (P < 0.05). The times of PCA-pump pressing and the doses of the administrated Sufentanil were considerably lower in the ST 36-1 and EX-B 2-I groups than in the IVA and forearm-I groups (P < 0.05). In comparison with pre-anesthesia in the same one group, serum TNF-α and IL-1β contents at T 1 were remarkably increased, while the ratios of CD⁴⁺/CD⁸⁺ at T 4 in the 4 groups were evidently down-regulated (P < 0.05). The contents of serum TNF-α and IL-1β at T 3 and T 4 were obviously lower in both ST 36-1 and EX-B 2-1 groups than in the IVA and forearm-I groups (P < 0.05). No significant differences were found among the 4 groups in the VAS scores at the 4 time-points, in the serum TNF-α and IL-1β contents at T 0 and T 1, in the counts of CD⁴⁺ and CD⁸⁺ T cells and ratios of CD⁴⁺/CD⁸⁺ at T 0, T 3 and T 4, and between the ST 36-1 and EX-B 2-groups in all the 8 indexes (P > 0.05).
  
  
  CONCLUSIONS
  Acupoint injection of Lidocaine is effective in relieving pain in LC patients, which is demonstrated by reducing VAS score, PCA pump pressing times, and administrated Sufentanil dose, and may be associated with its effects in down-regulating serum TNF-α and IL-1β contents.
authors.forename: Xin-liang
authors.initials: XL
authors.lastname: Meng
authors.forename: Qiang
authors.initials: Q
authors.lastname: Qu
mesh_terms: D015669:Acupuncture Points; D000293:Adolescent; D000328:Adult; D000777:Anesthetics / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053583:Interleukin-1beta / Q000097:blood / Q000276:immunology; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology; D055815:Young Adult
chemical_list: D000777:Anesthetics; D053583:Interleukin-1beta; D008012:Lidocaine