Effect of electroacupuncture on sedation requirements during colonoscopy: a prospective placebo-controlled randomised trial

Abstract

Introduction: Propofol provides excellent sedation during colonoscopy. However, its application, namely when used together with an opioid, is associated with cardiopulmonary depression. Acupuncture is used nowadays for the treatment of pain and anxiety, and also to induce sedation. We hypothesised that electroacupuncture (EA) during colonoscopy would have sedative effects, thereby reducing propofol requirements to achieve an adequate level of sedation. Method: The study was designed and conducted as a single centre, patient and observer blinded, sham- and placebo-controlled randomised trial. Patients scheduled for elective colonoscopy under deep propofol/alfentanil sedation were randomly assigned to receive unilateral EA, sham-acupuncture (SA) or placebo-acupuncture (PA) at ST36, PC6 and LI4. The primary outcome parameter was the total dosage of propofol. Secondary outcomes included the patients’ and endoscopists’ satisfaction levels evaluated by questionnaires. Results: The dosage of propofol required (median [IQR]) was not significantly different between the three groups (EA group 147 μg/kg/min [109–193] vs SA group 141 μg/kg/min [123– 180] vs PA group 141 μg/kg/min [112–182]; P=0.776). There was also no significant difference in alfentanil consumption (P=0.634). Global satisfaction (median [IQR]) among patients (EA group 6.6 [6.0–7.0] vs SA group 6.8 [6.0–7.0] vs PA group 6.5 [6.0–7.0]; P=0.481) and endoscopists (6.0 [5.0–6.0] for all groups; P=0.773) did not significantly differ between the three groups. There was no significant difference in the number of cardiorespiratory events. Conclusion: For colonoscopy, the applied mode of EA did not show any propofol-sparing sedative effect compared with sham or placebo acupuncture. Trial registration: The trial is registered in the Netherland’s Trial Registry (NTR4325).

Effects of Acupuncture on Adverse Events in Colonoscopy: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Full-text screening of the remaining 36 articles was performed, resulting in eight articles being selected for inclusion in the metaanalysis (Fig. 1) [13][14][15][16][22][23][24][25]. The j value was 0.87, indicating a high degree of agreement between the two reviewers.…”

“…Interventions in the treatment groups included acupuncture [22][23][24][25], EA [13,16], and TEAS [14,15]. Interventions in the control groups included SA [13,22,25], PA [13], sham TEAS [14,15], no acupuncture [22][23][24][25], and no EA [16]. Six of the studies had Jadad scores C 3 [13][14][15][22][23][24].…”

“…Interventions in the control groups included SA [13,22,25], PA [13], sham TEAS [14,15], no acupuncture [22][23][24][25], and no EA [16]. Six of the studies had Jadad scores C 3 [13][14][15][22][23][24]. The result of bias assessment is shown in Fig.…”

“…Importantly, acupuncture has few side effects and high compliance, effectively demonstrating that it should be considered a valid alternative and/or complementary strategy [12]. A number of clinical trials have investigated the effects of acupuncture on colonoscopy, but the results of these studies were inconsistent [13][14][15][16]. Thus, whether acupuncture can optimize the colonoscopy procedure and improve patient comfort is currently unclear.…”

Alternation of EEG Characteristics During Transcutaneous Acupoint Electrical Stimulation–Induced Sedation

“…6,16,17 However, stimulating at a single frequency may cause subject to habituated to the stimulation and hence reduce the effect of EA. 18 It was reported that the therapeutic effect of EA may be maximized when stimulations were given in dense-disperse mode, in which the stimulation was alternating between 2 frequencies. Hence, in this work, we chose 2-/10-Hz dense-disperse wave to stimulate the selected acupoints.…”