Transcutaneous Electrical Acupoint Stimulation Combined With Auricular Acupressure Reduces Postoperative Delirium Among Elderly Patients Following Major Abdominal Surgery: A Randomized Clinical Trial

Abstract

BackgroundPostoperative delirium is common in elderly patients following major surgery. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation combined with auricular acupressure on the incidence of postoperative delirium among older patients undergoing major abdominal surgery.MethodsIn this single-center, randomized controlled clinical trial, 210 patients aged 65 years or older undergoing major abdominal surgery were randomized to receive either intervention treatment (transcutaneous electrical acupoint stimulation started at 30 min before anesthesia until the end of the surgery, followed by intermittent auricular acupressure in the first three postoperative days; n = 105) or standard care (n = 105). The primary outcome was the incidence of delirium at the first seven postoperative days or until hospitalization depended on which came first. Secondary outcomes included delirium severity, opioid consumption, postoperative pain score, sleep quality, length of postoperative hospital stay, and postoperative 30-day complications. Enrollment was from April 2019 to March 2020, with follow-up ending in April 2020.ResultsAll of the 210 randomized patients [median age, 69.5 years, 142 (67.6%) male] completed the trial. The incidence of postoperative delirium was significantly reduced in patients received intervention treatment (19/105 (18.1%) vs. 8/105 (7.6%), difference, –10.5% [95% CI, –1.5% to –19.4%]; hazard ratio, 0.41 [95% CI, 0.18 to 0.95]; P= 0.023). Patients in the control group had a higher postoperative Memorial Delirium Assessment Scale (4 vs. 3; difference, –1; 95% CI, –1 to 0; P = 0.014) and a greater increase in Pittsburgh Sleep Quality Index score from baseline to postoperative day three (2.5 vs. 2.0; difference, –1; 95% CI, –2 to –1; P < 0.001) than patients in the intervention group. No significant difference was observed as of other secondary outcomes.ConclusionIn elderly patients undergoing major abdominal surgery, transcutaneous electrical acupoint stimulation combined with auricular acupressure reduced the incidence of postoperative in-hospital delirium compared with standard care. A multicenter, randomized clinical trial with a larger sample size is necessary to verify these findings.Clinical Trial Registration[https://clinicaltrials.gov], identifier [NCT03726073].

Intraoperative dexmedetomidine on postoperative sleep disturbance in older patients undergoing major abdominal surgery: A randomized controlled trial protocol

“…PSD may worsen neurocognitive dysfunction, impair the psychological state, and delay the recovery after surgery among elderly patients, leading to heavy emotional and financial burdens [ 44 ]. Substantial evidence shows that improving sleep quality could minimize the risk of postoperative delirium and enhance the quality of recovery in elderly patients [ 45 , 46 ]. However, non-pharmacological interventions such as earplugs and eye masks were ineffective to improve sleep quality after major abdominal surgery [ 47 ].…”

Transcutaneous electrical acupoint stimulation for the prevention of postoperative delirium in elderly surgical patients: A systematic review and meta-analysis

“…Its mechanism is related to improving cerebral blood flow and brain metabolism, lowering the permeability of the blood–brain barrier, and reducing neuroinflammation and nerve cell damage. Because pain and sleep disorders are possible confounders of delirium severity, stimulation of PC6 ( Neiguan ) and LI4 ( Hegu ) might reduce the incidence of POD by attenuating the extent of postoperative pain and improving sleep quality ( Fan et al, 2022 ). Regrettably, the question of which specific acupoints, TEAS frequency, intensity, and intervention time are most beneficial could not been solved because of the different combinations of acupoints, the different stimulation parameters, and the limited number of included studies.…”

“…Existing studies have shown that stimulation of PC6 (Neiguan) and LI4 (Hegu) can be used to assist anesthesia, reduce anesthetic use, repress surgical stress, and improve cognitive function (Wang et al, 2014;Matsumoto-Miyazaki et al, 2017). Its mechanism is related to improving cerebral blood flow and brain metabolism, lowering the permeability of the blood-brain barrier, and (Fan et al, 2022). Regrettably, the question of which specific acupoints, TEAS frequency, intensity, and intervention time are most beneficial could not been solved because of the different combinations of acupoints, the different stimulation parameters, and the limited number of included studies.…”

“…TEAS has been used widely for the prevention of common postoperative complications, such as postoperative cognitive dysfunction ( Zhang et al, 2021 ), postoperative nausea and vomiting ( Chen et al, 2020 ), and so on. In recent years, an increasing number of trials have been published to support the effectiveness of TEAS for the prevention of POD in elderly patients in terms of reducing the incidence of POD and shortening the duration of POD ( Yang et al, 2017 ; Fan et al, 2022 ).…”

Advances in the prevention and treatment of postoperative delirium by acupuncture: A review

“…A trend of reduced incidence of POD (6.3% vs 25%) was reported when geriatric patients with silent lacunar infarction received TEAS as an intervention before and during spinal surgery. [27] Likewise, an accordant effect of acupuncture was observed by Fan et al [28] at preventing delirium, which showed that the combination of TEAS and auricular acupressure reduced the incidence and severity of POD in elderly patients undergoing major abdominal surgery, as compared with standard care. Li et al [29] found that scalp acupuncture performed during operation could reduce the incidence of POD and shorten the post-operative hospital stay in elderly patients undergoing hip replacement.…”