Study on acupuncture with thoracic paravertebral block for patients with intercostal nerve transfer and general anesthesia

doi:10.16139/j.1007-9610.2021.06.016

Abstract

Abstract: Objective To analyze the clinical effect of acupuncture combined with thoracic paravertebral block (TPVB) in the treatment of pain and complications of the patients with intercostal nerve transfer and general anesthesia. Methods Eighty-eight patients with intercostal nerve transfer were randomized into three groups: 34 cases with patient controlled intravenous analgesia (PCIA) just after operation in group A, 28 cases with TPVB given when entering the operation and(PCIA) at the end of operation in group B, and 26 cases with TPVB and(PCIA) combined with acupuncture in group C. Acupuncture analgesia was used in group C with electroacupuncture stimulated for 20 minutes on points of Zhigou, Houxi, Hegu and bilateral Neiguan just the day before operation. Incidence of postoperative nausea and vomiting and the postoperative dosage of analgesic fentanyl were recorded. The indices related with analgesia including β-endorphin (β-EP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), 5-hydroxytryptamine (5-HT) and cortisol were detected using ELISA method before and after operation and compared among 3 groups. Results The dosage of fentanyl was lower in group C than those in group A and B significantly (P<0.05) and the incidence of nausea and vomiting lower than those in group A and B (P<0.05). Only serum IL-6 concentration 2 hours after operation in group B decreased significantly compared with that in group A (P<0.05). When compared those in group A, β-EP increased and IL-6, TNF-α and cortisol decreased in group C significantly (P<0.05). The concentration of β-EP increased and cortisol decreased significantly in C group(P<0.05) compared with those in B group. Comparing with that of 1 day before operation, The concentrations of serum β-EP, 5-HT and cortisol decreased and IL-6 increased in C group significantly (P<0.05) after acupuncture intervention. The concentration of β-EP, 5-HT and TNF-α in serum decreased significantly 2 hours after operation than before, while the concentrations of IL-6 in serum increased significantly (P<0.05). The concentration of TNF-α in patients 2 hours after operation decreased significantly (P<0.05). Conclusions Acupuncture combined with TPVB and general anesthesia could have good analgesic effect, which increases the concentration of β-EP and inhibits the release of pro-inflammatory factors such as IL-6, TNF-α and cortisol.

Key words: Acupuncture, Thoracic paravertebral block, Postoperative analgesia

CLC Number:

R614.2

YU Shijian, WANG Xuehu, ZHANG Lin, LIN Weiwei, CUI Wei. Study on acupuncture with thoracic paravertebral block for patients with intercostal nerve transfer and general anesthesia[J]. Journal of Surgery Concepts & Practice, 2021, 26(06): 537-542.

Figures/Tables 4

References 26

[1]	牛俊飞. 神经病理性疼痛的药物治疗及研究进展[J]. 重庆医学, 2015, 44(36):5170-5173.
[2]	王红莉, 张妍, 居家宝, 等. 肩袖损伤患者术前焦虑状况与肩关节镜术后疼痛的相关性分析[J]. 中华肩肘外科电子杂志, 2021, 9(1):38-41.
[3]	崔娓, 张弛, 葛培青, 等. 超声引导联合神经刺激仪定位胸椎旁阻滞在肋间神经移位术中的应用[J]. 上海交通大学学报(医学版), 2017, 37(1):89-92.
[4]	薛建军, 马亚兰, 侯怀鹏. 全膝关节置换术后疼痛机制与针刺镇痛研究进展[J]. 西部中医药, 2020, 33(4):146-150.
[5]	张云霄, 陈冀衡, 万有, 等. 针药复合麻醉对胸腔镜肺癌根治术患者术后镇痛效果的影响[J]. 中国疼痛医学杂志, 2015, 21(3):206-209.
[6]	陈云. 不同电针输出波形对瑞芬太尼麻醉诱发痛觉过敏的作用及机制[D]. 天津医科大学, 2020.
[7]	崔娓, 张弛, 任翱翔, 等. 针刺减轻肋间神经移位患者术后疼痛和恶心呕吐的临床随机对照研究[J]. 国际麻醉学与复苏杂志, 2018, 39(1):27-30.
[8]	姚伟伟, 周凯翔, 王健, 等. TNF-α抑制剂对神经病理性痛大鼠镇痛作用及其机制探讨[J]. 神经解剖学杂志, 2016, 32(4):423-428.
[9]	陈丽, 王健. 针刺镇痛之体液调节机制研究进展[J]. 上海中医药杂志, 2015, 49(11):91-93.
[10]	穆强. 中枢5-HT系统与疼痛的相关性研究进展[J]. 现代医药卫生, 2020, 36(19):3117-3121.
[11]	周友龙, 刘宜军, 付杰娜, 等. 踝三针对腰椎间盘突出根性痛大鼠中枢镇痛递质的影响[J]. 中国针灸, 2007, 27(12):923-926.
[12]	梁繁荣, 刘雨星, 陈瑾, 等. 电针镇痛后效应与脑干5-HT、下丘脑β-EP 含量的关系[J]. 上海针灸杂志, 2001, 20(3):37-39.
[13]	陈瑾, 刘光谱, 唐勇. 中枢及外周5-HT、5-HIAA 在针刺镇痛后效应中的作用[J]. 中医药学刊, 2003, 21(9):1446-1449.
[14]	韩知忖, 任莉莉, 路飞, 等. 针刺联合中药治疗腹泻型肠易激综合征患者的效果观察[J]. 中华全科医学, 2019, 17(11):120-122.
[15]	韦克. 围术期老年患者应激反应研究新进展[J]. 医学理论与实践, 2019, 32(3):345-347.
[16]	吴世民, 张威伟, 李跃琼. 恩再适预镇痛对术后自控静脉镇痛应激反应的影响[J]. 中国临床实用医学, 2008, 2(3):4-6.
[17]	侯保科, 董丽蕴, 陈永学. 不同药物麻醉对高龄患者麻醉效果,术后应激反应及认知功能的影响[J]. 河北医药, 2020, 42(10):91-94.
[18]	刘宏武, 张楠, 宋相宇, 等. 硬膜外麻醉与全身麻醉及麻醉深度对子宫颈癌患者围术期免疫功能,应激反应的影响[J]. 中国性科学, 2020, 29(7):33-37.
[19]	张亚君, 林楠, 陈茜茜, 等. 针刺对急性缺血性卒中继发脑心综合征患者心脏自主神经功能失衡和儿茶酚胺的影响[J]. 上海针灸杂志, 2020, 39(2):131-136.
[20]	冯秀玲, 魏清琳, 王昱. 针刺复合小剂量硬膜外麻醉对老年骨科手术围术期血糖及皮质醇的影响[C]. 中医杂志社, 2016.
[21]	Syuu Y, Matsubara H, Hosogi S, et al. Pressor effect of electroacupuncture on hemorrhagic hypotension[J]. Am J Physiol Regul Integr Comp Physiol, 2003, 285(6):1446-1452.
[22]	谢波, 林亚平. 针刺治疗阴虚阳亢型原发性高血压病临床疗效观察[J]. 中国针灸, 2014, 34(6):547-550.
[23]	何玲, 陈思平, 王立君. 临床腧穴学[M]. 北京: 人民军医出版社, 2003.
[24]	Gliedt JA, Daniels CJ, Wuollet A. Narrative review of perioperative acupuncture for clinicians[J]. J Acupunct Meridian Stud, 2015, 8(5):264-269.
[25]	王华. 针灸学[M]. 北京: 中国中医药出版社, 2012.
[26]	Lu Z, Dong H, Wang Q, et al. Perioperative acupuncture modulation: more than anaesthesia[J]. Br J Anaesth, 2015, 115(2):183-193.

组别	n	男/女	年龄（岁）	ASA分级（Ⅰ/Ⅱ）	体重（kg）	身高（cm）	截取肋间神经数量（根）	P值
A组	34	28/6	35±12	27/7	64±11	168±9	3.1±1.0	>0.05^a）
B组	28	22/6	34±9	21/7	63±10	170±6	2.9±0.9	>0.05^a）
C组	26	21/5	34±10	20/6	61±13	169±7	3.0±1.2	>0.05^a）

组别	n	芬太尼用量（μg）	术后恶心呕吐发生率（%）
A组	34	270±15^a）	26.5^a）
B组	28	180±14^b）	21.4^b）
C组	26	68±23^a）b）	0^a）b）