BACKGROUND: Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief. OBJECTIVE: This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room. OUTCOMES AND MEASURES: Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy. RESULTS: The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy. CONCLUSION Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.
Male ; Humans ; Ankle ; Wrist ; Duration of Therapy ; Thyroidectomy ; Postoperative Nausea and Vomiting/drug therapy* ; Acupuncture Therapy ; Analgesics/therapeutic use* ; Pain/drug therapy*

BACKGROUND: Epidural buprenorphine provides good pain relief after Cesarean section, but is often associated with nausea and vomiting. Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, is known to prevent and treat emesis after chemotherapy in cancer patients and after general anesthesia. The purpose of this study was to compare the prophylactic antiemetic effect of ondansetron and metoclopramide on nausea and vomiting after epidural buprenorphine. METHODS: Sixty women undergoing Cesarean section were studied. The patients were given subarachnoid injections of 0.5% tetracaine 9 mg and were inserted with epidural catheters for postoperative pain control. Prior to closure of the peritoneum, we injected a mixture of buprenorphine and bupivacaine through the epidural catheters and gave intravenous boluses of saline 6 ml, metoclopramide 10 mg and ondansetron 4 mg randomly. The incidence of nausea and vomiting and the degree of satisfaction were evaluated until 24 hr after the injection of epidural buprenorphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between the ondansetron group and the metoclopramide group. Also, subjective ratings of satisfaction and incidence of other side effects did not differ significantly between the groups. CONCLUSIONS: Ondansetron, administered intravenously, prevented postoperative nausea and vomiting associated with epidural buprenorphine equally as well as metoclopramide.
Anesthesia, General ; Antiemetics* ; Bupivacaine ; Buprenorphine* ; Catheters ; Cesarean Section ; Drug Therapy ; Female ; Humans ; Incidence ; Metoclopramide* ; Nausea* ; Ondansetron* ; Pain, Postoperative ; Peritoneum ; Postoperative Nausea and Vomiting ; Pregnancy ; Serotonin ; Tetracaine ; Vomiting*

Traction of the extraocular muscles during strabismus surgery could cause nausea and vomiting in postoperative period. Although the extent of these symptoms would vary in wide range, sometimes they are so severe that patients may feel very uncomfortable and have difficulties with adjusting back to their routine life in immediate postoperative period. Authors have investigated whether the 5-hydroxytryptamin-3 [5HT3] receptor antagonist, which is now used as an effective antiememtic agent after general anesthesia and anticancer chemotherapy, can control the nausea and vomiting after strabismus surgery or not. As the occurrence of the oculocardiac reflex during strabismus surgery is closely related with postoperative emesis, we also examined if 5HT3 receptor antagonist can suppress the oculocardiac reflex as well. We performed strabismus surgery in 80 patients under topical anesthesia. In experimental group[N=40], 3 milligramof Granistron in 50 milliliter of normal saline was administered intravenously and in control group[N=40], the same amount of normal saline was administered one hour before the surgery. To evaluate the degree of nausea and vomiting, authors used the Rhodes 'Nausea and Vomiting Estimation Index[NVEI]and monitored heart rate for oculo-car-diac reflex. The NVEI in experimental group was 12.10 +/-5.60 compared with 16.85 +/-8.88 in control[P=0.005]. But there was no difference in frequency of oculocardiac reflex and the degree of heart rate decrement between the two groups [P=0.152, P=0.345]. In conclusion, Granisetron, 5HT3 receptor antagonist, is still effective in controlling the nausea and vomiting after strabismus surgery, but it has no suppressive effect on the oculocardiac reflex.
Anesthesia* ; Anesthesia, General ; Drug Therapy ; Granisetron ; Heart Rate ; Humans ; Muscles ; Nausea* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Receptors, Serotonin, 5-HT3* ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction ; Vomiting*

Traction of the extraocular muscles during strabismus surgery could cause nausea and vomiting in postoperative period. Although the extent of these symptoms would vary in wide range, sometimes they are so severe that patients may feel very uncomfortable and have difficulties with adjusting back to their routine life in immediate postoperative period. Authors have investigated whether the 5-hydroxytryptamin-3 [5HT3] receptor antagonist, which is now used as an effective antiememtic agent after general anesthesia and anticancer chemotherapy, can control the nausea and vomiting after strabismus surgery or not. As the occurrence of the oculocardiac reflex during strabismus surgery is closely related with postoperative emesis, we also examined if 5HT3 receptor antagonist can suppress the oculocardiac reflex as well. We performed strabismus surgery in 80 patients under topical anesthesia. In experimental group[N=40], 3 milligramof Granistron in 50 milliliter of normal saline was administered intravenously and in control group[N=40], the same amount of normal saline was administered one hour before the surgery. To evaluate the degree of nausea and vomiting, authors used the Rhodes 'Nausea and Vomiting Estimation Index[NVEI]and monitored heart rate for oculo-car-diac reflex. The NVEI in experimental group was 12.10 +/-5.60 compared with 16.85 +/-8.88 in control[P=0.005]. But there was no difference in frequency of oculocardiac reflex and the degree of heart rate decrement between the two groups [P=0.152, P=0.345]. In conclusion, Granisetron, 5HT3 receptor antagonist, is still effective in controlling the nausea and vomiting after strabismus surgery, but it has no suppressive effect on the oculocardiac reflex.
Anesthesia* ; Anesthesia, General ; Drug Therapy ; Granisetron ; Heart Rate ; Humans ; Muscles ; Nausea* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Receptors, Serotonin, 5-HT3* ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction ; Vomiting*

BACKGROUND: Intrathecal morphine provides good pain relief after anorectal surgery, but often associated with unpleasant side effects. Ondansetron, a selective 5-hydroxytryptamine3 (5-HT3) receptor antagonist, have been introduced for the prevention and treatment of emesis after chemotherapy in cancer patients and after general anesthesia. METHODS: Thus we studied the effect of ondansetron on the postoperative analgesic and side effects of spinal morphine in 60 patiens. The patients were given subarachnoid injection of 0.5% tetracaine 5 mg mixed with morphine 0.3 mg and positioned to jack-knife after fixation of anesthetic level. Either simple 5% dextrose solution 1000 ml or dextrose solution 1000 ml mixed with ondansetron 8 mg was injected intravenously in a rate of 100 ml/hr. The visual analog scale (VAS) of pain and incidence and severity of postoperative nausea, vomiting, pruritus and urinary retention were evaluated at 12 hour, 24 hour and 48 hour after injection of spinal morphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between groups. Also, the VAS and the incidence and severity of other side effects such as pruritus and urinary retention did not differ significantly between groups. CONCLUSION: Ondansetron administered intravenously, did not prevent side effects of intrathecal morphine.
Analgesics ; Anesthesia, General ; Drug Therapy ; Glucose ; Humans ; Incidence ; Morphine* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Pruritus ; Serotonin ; Tetracaine ; Urinary Retention ; Visual Analog Scale ; Vomiting

In recent years epidural anesthesia and analgesia techniques were used in pediatric surgery owing to the development of pediatric epidural catheter needles. And the need of postoperative pain control in pediatric patients is also increasing. We compared combined general-epidural anesthesia and analgesia technique with intravenous fentanyl analgesia after general anesthesia for postoperative analgesic effect and complications in these pediatric patients. We randomly allocated 91 pediatric patients undergoing lower extremities surgery into epidural lidocaine group (n=61) and IV fentanyl group (n=30). During the operation, end-tidal sevoflurane concentration (ETsev) was controlled to maintain the blood pressure and heart rate within 10% of preoperative value. At the postoperative period, Parent Visual Analog Scale (PVAS), Objective Pain Score (OPS) and the incidence of nausea/ vomiting were checked immediately, 6 hours and 24 hours after the patient's arrival at general ward. ETsev was significantly low in epidural lidocaine group (p < 0.05). Compare to IV fentanyl group, epidural lidocaine group had significantly lower OPSs at 6 hours after arrival. Epidural lidocaine group had significantly lower PVASs immediately, 6 hrs and 24 hours after arrival. There was no significant difference in the incidence of postoperative nausea and vomiting. A combined general-epidural anesthesia technique significantly reduces intraoperative end-tidal sevoflurane concentration compared to general anesthesia alone. And continuous patient-controlled epidural analgesia reduces postoperative pain scores significantly more than continuous patient-controlled IV fentanyl analgesia without any serious complications in pediatric lower extremity surgery.
*Analgesia, Epidural ; Anesthesia, General ; Child ; Child, Preschool ; Comparative Study ; Female ; Fentanyl/*administration & dosage ; Humans ; Lidocaine/*administration & dosage ; Lower Extremity/*surgery ; Male ; Pain, Postoperative/*drug therapy ; Postoperative Nausea and Vomiting/epidemiology

OBJECTIVETo evaluate the clinical efficacy of sufentanil and fentanyl at equivalent dose for patient-controlled intravenous analgesia (PCIA) after thoracotomy.

METHODSSixty ASA I-II patients (20-60 years of age) undergoing radical operation for lung or esophageal cancer were randomly divided into sufentanil intravenous analgesia group (group S, with sufentanil 1 microg/ml) and fentanyl intravenous analgesia group (group F, fentanyl 10 microg/ml). PCIA was administered with background infusion of 2.5 ml/h, bolus injection of 2.5 ml and lockout time of 15 min. The pain intensity according to visual analogue scale (VAS), cumulative analgesic consumption (CAC), sedative scores and side effects at 24 and 48 h after administration were recorded. SpO(2), respiratory rate (RR), blood pressure (BP) and ECG were continuously monitored.

RESULTSThere were no significant differences in CAC between the two groups, but he VAS was lower in group S than in group F (P<0.05) and the sedative efficacy was superior in group S (P<0.05). The incidence of nausea and vomiting in group S was lower than that in group F (P<0.05). No significant differences were observed in SpO(2), RR, heart rate and mean arterial pressure between the two groups.

CONCLUSIONPCIA with sufentanil provides better efficacy of analgesia and sedation with lower incidence of nausea and vomiting than with fentanyl in postoperative patients with thoracotomy.

Adult ; Analgesia, Patient-Controlled ; Esophageal Neoplasms ; surgery ; Female ; Fentanyl ; administration & dosage ; adverse effects ; Humans ; Infusions, Intravenous ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Nausea ; chemically induced ; Pain, Postoperative ; drug therapy ; Sufentanil ; administration & dosage ; adverse effects ; Thoracotomy ; Vomiting ; chemically induced

BACKGROUND: Use of opioids to relieve postoperative pain may cause nausea and vomiting. There is growing interest in the use of nonpharmacologic approaches to the prevention of nausea. Particularly transcutaneous electrical nerve stimulation (TENS) of the P6 acupoint has been shown to reduce the incidence of pregnancy-induced nausea and chemotherapy associated emesis. The aim of this study was to investigate the effect of stimulation of the P6 acupoint on nausea induced by opioids for postoperative pain control. METHODS: We studied 103 patients receiving intravenous patient controlled analgesia (PCA) with fentanyl after a hysterectomy under general anesthesia. No antiemetic agent or device was provided in the N group (n = 31), and TENS on the P6 acupoint was applied after closure of the peritoneum in the T group (n = 32). In the P group (n = 39), a transdermal scopolamine patch was attached below the mastoid process about 1 hour before induction of general anesthesia. Incidence of nausea and pain score were assessed. RESULTS: The incidence of nausea was significantly less in the T and P groups than in the N group. There was no difference in the incidence of nausea between the T and P groups. The pain score was decreased in all three groups after beginning the PCA. No difference was seen in pain scores among the groups over the time course. CONCLUSIONS: TENS of the P6 acupoint reduced the incidence of opioid-induced nausea after a hysterectomy. This result suggests that TENS of the P6 acupoint may be useful as a new therapeutic approach to reduce or prevent nausea caused by opioids.
Acupuncture Points* ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthesia, General ; Drug Therapy ; Fentanyl ; Humans ; Hysterectomy ; Incidence ; Mastoid ; Nausea* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Scopolamine Hydrobromide ; Transcutaneous Electric Nerve Stimulation ; Vomiting

OBJECTIVETo evaluate the efficacy of transcutaneous electroacupoint stimulation with a train-of-four (TOF) mode for the prevention of postoperative nausea and vomiting (PONV) in the patients undergoing laparoscopic cholecystectomy.

METHODSNinety-six ASA Grade I - II patients scheduled for laparoscopic cholecystectomy were randomized into Neiguan (P6) electroacupoint stimulation group (treated group) and a placebo control group (placement of electrodes without electroacupoint stimulation). The anesthetic regimen was standardized by needling at Neiguan on the left side and connecting the TOF peripheral nerve stimulator. The incidence of nausea, vomiting, severity, antiemetic dosage and the degree of pain were assessed at 0, 60, 120 min, and 24 h after surgery.

RESULTSThe incidence of nausea and vomiting, the dose of antiemetics and the occurrence of severe nausea were all significantly lower in the treated group compared with the control group and the score for pain was obviously reduced in patients of the treated group at 24 h post-operation (P<0.05 or P<0.01).

CONCLUSIONTranscutaneous electroacupoint stimulation at P6 with the TOF mode could reduce the incidence and severity of nausea and vomiting with analgesic effects.

Acupuncture Points ; Adult ; Antiemetics ; therapeutic use ; China ; epidemiology ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Incidence ; Intraoperative Period ; Male ; Pain ; pathology ; Postoperative Nausea and Vomiting ; drug therapy ; epidemiology ; prevention & control ; Transcutaneous Electric Nerve Stimulation ; methods

OBJECTIVETo investigate the method for preventing the postoperative nausea and vomiting (PONV) after laparoscopic gynecologic surgery.

METHODSOne hundred and twenty patients being for laparoscopic gynecologic surgery at I- II grade as American Society of anesthesiologists (ASA) were randomly divided into three groups, 40 cases in each group. Twenty minutes before the operation, the mixture of 2. 5 mg Droperidol (1 mL) and 1 mL 0. 9% sodium chloride solution was injected into the bilateral Neiguan (PC 6) in group I , and an intravenous injection with 1 mL Droperidol was used in group II , while there was no treatment carried out in group Ill'. Twenty four hours after the operation, the frequency and degree of nausea and vomiting were observed and scored according to the criteria standard.

RESULTSThe incidence rate of nausea was 10. 0% (4/40) in group I , 57. 5% (23/40) in group II , which was significantly different from 80. 0% (32/40) in group III (P<0. 01, P<0. 05, respectively), while it was lower in group I than in group II (P<0. 01). The incidence rate of vomiting was 7. 5% (3/40) in group I , 52. 5% (21/40) in group II , which was significantly different from 75.0% (30/40) in group III (P<0.01, P<0.05 respectively), while it was lower in group I than in group II (P<0.01). No complication, such as obvious drowsiness, anxiety and extracorticospinal tract reaction, was observed among the three groups.

CONCLUSIONAcupoint injection at Neiguan (PC 6) with a small dose of Droperidol can effectively prevent the PONV after laparoscopic gynecologic surgery without other adverse effects.

Acupuncture Points ; Adult ; Aged ; Droperidol ; administration & dosage ; Female ; Gynecologic Surgical Procedures ; adverse effects ; Humans ; Injections ; Laparoscopy ; adverse effects ; Middle Aged ; Postoperative Nausea and Vomiting ; drug therapy ; prevention & control ; Young Adult