OBJECTIVETo observe the effects of different anesthesia ways on endorphin and hemodynamics of laparoscopic cholecystectomy patients in the perioperative phase.

METHODSA total of 90 laparoscopic cholecystectomy patients, 29 to 80 years old, were randomly assigned to Group A (treated with electroacupuncture at acupoints combined general anesthesia), Group B (treated with electroacupuncture at non-acupoints combined general anesthesia), and Group C (treated with general anesthesia) according to American Society of Anesthesiologists (ASA) I-II, 30 cases in each group. All patients were induced by 3 microg/kg Fentanyl (Fen), 2 mg/kg Propofol (Pro), and 0.1 mg/kg Vecuronium (Vcr). Bispectral index (BIS), being 40 -65, indicated the state of general anesthesia. The anesthesia was maintained by intravenous injecting Pro, interruptedly intravenous injecting Fen and Vcr. Each patient received patient controlled intravenous analgesia (PCIA) after operation. On these bases, patients in Group A received electrical acupuncture at bilateral Hegu (LI4), Neiguan (PC6), Quchi (Ll11), Zusanli (ST36), and Yanglingquan (GB34). Patients in Group B received electrical acupuncture at the points beside acupoints. The electroacupuncture was lasted from 15 -30 min before anesthesia induction to the end of the operation in Group A and B. The heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), cardiac output (CO), systemic vascular resistance index (SVRI), and acceleration index (ACI) were recorded before anesthesia induction, immediate before pneumoperitoneum, 5 min after pneumoperitoneum, excision of gallbladder, and at the end of operation. The time consumption from discontinuation to spontaneously breathing recovery, analeptic, and extubation were recorded. The blood samples (3 mL each time) were collected from the peripheral vein before anesthesia induction, 2 h after operation, the 1st day after operation, and the 3rd day after operation to detect the beta-endorphin (beta-EP) level. The visual analogue scale (VAS) were observed and recorded in the 3 groups at post-operative 4, 6, 8, 24, and 44 h, respectively.

RESULTS(1) Compared with before anesthesia induction in the same group, the CI, CO, ACI of all patients decreased significantly at 5 min after pneumoperitoneum and at excision of gallbladder (P < 0.01, P < 0.05). The HR, MAP, SVRI obviously increased in Group B and Group C at each time point (P < 0.05, P < 0.01). Less change happened in Group A. Compared with Group C, the increment of MAP was less in Group A at 5 min after pneumoperitoneum, showing statistical difference (P < 0.05). (2) The time consumption from discontinuation to analeptic and extubation was obviously shorter in Group A than in Group B and Group C (P < 0.05, P < 0.01). (3) The level of beta-EP on the 1st day of operation was significantly lower in Group A than in Group B (P < 0.05) and Group C (P < 0.01). (4) The VAS score at post-operative 44 h was significantly lower in Group A than in Group B and Group C (P < 0.05).

CONCLUSIONSElectroacupuncture at acupoints combined general anesthesia could maintain the stabilization of haemodynamics, and relieve the stress reaction after pneumoperitoneum and operation, and prolong it to early post-operative period, and strengthen the effects of post-operative analgesia. The post-operative recovery was fast, safe, and reliable.