BACKGROUND:

Functional gastrointestinal disturbance occurs after abdominal surgeries and could last for an extended period of time in some cases. This study was designed (1) to evaluate the effects of needleless transcutaneous electrical acustimulation (TEA) on postoperative recovery, and (2) to investigate the mechanisms involving autonomic function in postoperative patients after removal of gastrointestinal cancers.

METHODS:

Forty-two patients (33 male, age: 69.5±1.5 years) scheduled for abdominal surgical removal of gastrointestinal cancers were randomized to TEA (n= 21) and sham-TEA (n= 21). TEA was performed via acupoints ST36 and PC6 1 h twice daily from the postoperative day (POD) 1 to day 3. Sham-TEA was performed at non-acupoints.

RESULTS:

(1) TEA improved major postoperative symptoms by about 30%, including a reduction in time to defecation by 31.7%(P< 0.01 vs. sham-TEA), time to first flatus by 35.9%(P< 0.001), time to ambulation by 42.8%(P< 0.01), time to resuming diet by 26.5%(P< 0.01) and hospital stay by 30%(P< 0.05) as well as pain score by 50%(P< 0.01).(2) TEA significantly increased vagal activity (P< 0.001) and decreased sympathetic activity on POD 4 (P< 0.001) compared with POD 1 as well as the serum level of NE (P< 0.05).(3) The vagal activity, high frequency assessed from the spectral analysis of heart rate variability, was negatively correlated with time to resuming diet, whereas the sympathetic measurement, serum norepinephrine was positively correlated with time to resuming diet and time to flatus.(4) TEA but not sham-TEA decreased TNF-α by 17.4% from POD 1 to POD 4.(5) TEA was an independent predictor of a shorter hospital stay.

CONCLUSIONS:

Needleless TEA improves major postoperative symptoms by enhancing vagal and suppressing sympathetic activities.

INTRODUCTION

The postoperative disturbance is a frequent complication after abdominal surgery which is clinically characterized by delayed passage of gas and stool, resumption of oral feeding, postoperative ambulation and postoperative pain, and results in prolonged postoperative hospital stay and increased healthcare costs [1-3]. According to the Health Care Financing Administration (HCFA) data, Medicare patients who underwent surgical procedures stayed in the hospital for a total of 1.82 million days (a mean of 11.3 days per patient), and cost healthcare industries approximately US $1.75 billion during the year of 2000 [4]. It is estimated that the annual healthcare system costs will be reduced by 155 million dollars if the hospital stay for each patient is reduced by 1 day with the major abdominal colorectal surgeries in the United States [4].