Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial

Abstract

Purpose To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on urinary retention after laparoscopic cholecystectomy in elderly patients, and to explore the relationship between TEAS and urinary ATP. Patients and Methods The TEAS group was administered active TEAS at specific acupuncture points prior to induction of anesthesia and continued for 45 mins after surgery. In the control group, participants received sham stimulus at the same acupoints and no output current was delivered by disconnecting the device’s output line. Urine samples were collected and evaluated in the first spontaneous voiding after surgery. In this study, postoperative urinary retention (POUR) was the primary outcome, which was diagnosed based on clinical symptoms, ultrasound assessments, and the need for bladder catheterization. Secondary outcomes include urinary ATP, postoperative spontaneous urination, urination symptoms, catheter-related bladder discomfort (CRBD), delirium, duration and hospitalization costs. Results The study involved 598 patients recruited and randomized between August 2018 and June 2020. Among these patients, 547 (91.5%) completed the study and were analyzed. There were 64 cases of POUR, including 23 (8.4%, 95% confidence interval [CI]: 6.4–9.9%) in the TEAS group and 41 (15.0%, 95% CI: 9.3–13.4%) in the control group (p = 0.017). A significant difference was observed between the TEAS and control groups for urinary ATP concentration in the first spontaneous urine postoperatively (344 nmol/L versus 233 nmol/L, p=0.001). There was a shorter spontaneous voiding recovery time, smaller voiding threshold, less postoperative catheterization, less CRBD, and lower hospitalization costs in TEAS group compared with control group. Conclusion TEAS reduces the incidence of POUR in elderly patients undergoing laparoscopic cholecystectomy, which may be related to an increase in bladder ATP release.

Transcutaneous Electrical Acupoint Stimulation for Preventing Postoperative Delirium: A Meta-Analysis

“…A total of 1432 participants were analyzed in these RCTs, with 715 in the TEAS group and 717 in the control group. The surgery types of three studies were abdominal surgery, 17 , 25 , 28 five studies were spinal surgery, 18 , 20 , 23 , 26 , 27 three studies were orthopedic surgery, 21 , 22 , 24 and one study was cardiac surgery. 19 In the included studies, POD was assessed by the Richmond Agitation-Sedation Scale (RASS), CAM, and their variants differed at postoperative first day to seventh day, respectively.…”

“…Most biases were concentrated on selection bias, performance bias, and detection bias. Except for three studies that were evaluated as having low bias, 23 , 25 , 27 the other studies were identified as uncertain based on the risk of bias. 17–22 , 24 , 26 , 28 Besides, three studies 19 , 23 , 27 had a high risk of reporting bias due to the presence of some outcome indicators without analysis.…”

“…Then, a total of 39 duplicate studies were removed, and 54 irrelevant studies were also excluded in the preliminary screening of the title and abstract. Finally, after 13 studies were excluded by a further reading of the full text because without an English abstract, there were no journal articles, and intervention, and main outcome indicators were inconsistent and had fundamental errors, 12 studies [17][18][19][20][21][22][23][24][25][26][27][28] were included in this metaanalysis.…”

“…Of the 12 RCTs (Table 1), 11 studies [17][18][19][20][21][22][23][24][25]27,28 were conducted in the last 2 years, and only 1 study 26 was conducted in 2018. A total of 1432 participants were analyzed in these RCTs, with 715 in the TEAS group and 717 in the control group.…”

“…As is shown in Figure 4, low heterogeneity was detected between studies in each analysis (I 2 = 0, 47%, and 0); thus, all the comparisons used a FEM. The results showed that the difference in the incidence of POD was statistically significant in the TEAS group compared to the control group within postoperative 3 days 17,19,20,[24][25][26] (RR: 0.44, 95% CI: 0.29-0.66, P < 0.0001; Figure 4a), 5 days 23,27 (RR: 0.52, 95% CI: 0.33-0.83, P = 0.006; Figure 4b), and 7 days 18,22,28 (RR: 0.39, 95% CI: 0.18-0.83, P = 0.01; Figure 4c).…”