Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 696754, 7 pages doi:10.1155/2011/696754 Research Article Needle-Free Electroacupuncture for Postoperative Pain Management Daniel Lee,1 Hong Xu,1 Jaung-Geng Lin,2 Kerry Watson,1 Rick Sai Chuen Wu,2 and Kuen-Bao Chen2 1 School of Biomedical and Health Sciences, Victoria University, Melbourne, VIC 8001, Australia 2 Department of Anesthesiology, China Medical University Hospital, Taichung 40447, Taiwan Correspondence should be addressed to Hong Xu, [email protected] Received 17 January 2011; Accepted 24 March 2011 Copyright © 2011 Daniel Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This study examined the effects of needle-free electroacupuncture, at ST36 on postoperative pain following hysterectomy. Based on a double-blind, sham and different intervention controlled clinical experimental design, 47 women were randomly allocated to four different groups. Except for those in the control group (Group 1, n = 13), a course of treatment was given of either sham (Group 2, n = 12), high-frequency stimulation (Group 3, n = 12), or low-frequency stimulation (Group 4, n = 10). All groups were assessed during the postoperative period for 24 hours. The Visual Analogue Scale was used to determine the amount of perceived pain felt by each subject. Differences were found between the means postoperatively at three, four, eight, 16 and 24 hours. Post hoc comparison tests indicated that Group 4 was significantly different from Groups 1, 2, and 3 at 24 hours. A one- way ANOVA analysis for total patient-controlled analgesia demand and doses indicated significant differences between the groups F(3, 42) = 3.59, P<.05. Post hoc analysis confirmed the differences between Groups 1 (M = 84.54) and 4 (M = 41.60). Treatment outcomes of this therapy showed a positive effect for the management of postoperative pain. 1. Introduction analgesia on subjects recovering from hysterectomies would be greater than the control groups. The results may help Acupuncture has been used for pain relief for thousands patients by contributing to the knowledge of pain control of years, and more recently has included electroanalgesic and providing significant improvement in treatment. therapies as an alternative to conventional pharmaceutical pain relievers [1]. The aims of this study were to examine the effects of needle-free electroacupuncture (EA) analgesia on 2. Methodology subjects recovering from hysterectomies. Silver Spike Point (SSP) needle-free EA was used in this study as opposed 2.1. Study Design. Based on a double-blind, sham, and dif- to traditional acupuncture, where needles are inserted into ferent intervention controlled clinical experimental design. acupuncture points. SSP needle-free EA stimulation is Hysterectomized patients at the China Medical University achieved continuously with controlled current and frequency Hospital were invited to be subjects in the study. The study ensuring that each subject received the same stimulation and was approved by the related institutions, and ethics approval dosages. Xu et al.’s study in Australia [2]confirmedthesig- was gained from the Human Research Ethics Committee of nificant pain-relieving effects that SSP needle-free EA could La Trobe University Australia and China Medical University provide. SSP needle-free EA, if effective, would have the Hospital Taiwan, before conducting the clinical trial. All advantage of providing pain control with no opioid-related subjects were asked to complete a medical suitability form side effects, such as nausea, dizziness, or the more serious for SSP needle-free EA treatment, received an explanation respiratory depression, central nervous system depression form, and were asked to sign a consent form. Forty- including somnolence and conscious disturbance. In this nine hysterectomized patients who had all received general study, it is anticipated that the effects of SSP needle-free EA anesthetics of propofol 2 mg/kg and atracurium 0.5 mg/kg 2 Evidence-Based Complementary and Alternative Medicine Table 1: The proposed four experiment groups and their treatment regimes. Subject EA treatment groups Preoperative Postoperative Group 1 PCA NIL (control group) NIL (control group) SSP electrode at sham acupuncture point near to ST36 SSP electrode at sham acupuncture point near to ST36 Group 2 PCA (no stimulation) for 30 minutes. (no stimulation) for 30 minutes. SSP electrode at ST36 with continuous wave of 100 Hz SSP electrode at ST36 with continuous wave of 100 Hz Group 3 PCA electrical stimulation for 30 minutes. electrical stimulation for 30 minutes. SSP electrode at ST36 with dense-sparse wave SSP electrode at ST36 with dense-sparse wave Group 4 PCA 3Hz/4sec,10Hz/4sec,and20Hz/4secelectrical 3Hz/4sec,10Hz/4sec,and20Hz/4secelectrical stimulation for 30 minutes. stimulation for 30 minutes. Table 2: Description of subjects. Table 3: Time of first bowel movement (in hours). N Minimum Maximum Mean SD Group Number Mean SD Age (years old) 47 14.00 59.00 42.02 8.31 1 13 37.54 2.93 Weight (Kg) 47 40.00 158.00 59.74 17.54 2 12 38.03 2.71 Duration (min) 47 65.00 240.00 127.70 34.56 3 12 35.50 2.64 Anesthesia time 4 10 33.30 2.43 47 94.00 275.00 166.04 35.95 (min) Valid N 47 In Groups 2, 3, and 4, subjects received treatment com- mencing 30 minutes before general anesthesia. Subjects in Group 2 received no stimulation. Subjects in Group 1 received general anesthesia only. Group 3 received SSP for induction (but no narcotics), and sevoflurane with 50% stimulation at 100 Hz, and Group 4 received SSP stimulation nitrous oxide and oxygen for anesthesia were randomly by a mixture of dense-sparse wave at 3 Hz, 10 Hz, and allocated to receive one of the four pre- and postoperative 20 Hz. After surgery, SSP needle-free EA treatment was procedures. All subjects were randomly assigned to the four administered once only and was initiated once the subject groups, and the group assignments were kept fully blinded regained consciousness in the recovery room. The SSP from the subjects and data collectors. needle-free EA procedure was provided for 30 minutes, Neither the subjects nor the research assistant carrying the 1/f Yuragi waves were used. All subjects in each group out the procedures was aware of who was receiving the received PCA postoperatively. As the subjects received their therapy. The subjects were treated in silence in the surgery treatment in different rooms, confidentiality was strictly preparing room before the operation. The chief of the followed, and as a result there was no opportunity for them to anesthetic team in the operation theatre marked the point communicate with each other. Furthermore, as the subjects on the subjects’ legs. Neither the doctor performing the inter- had no prior experience of such treatment they were unable ventions, the subjects, nor the nurse collecting the results was to identify which treatment they are receiving. aware of the differences between the different interventions. All groups were assessed during the postoperative period Therefore, there was no disclosure to the subjects in relation for 24 hours using a Visual Analogue Scale (VAS), and total to what interventions they had received. amount of PCA demand and total amount of PCA doses were In this study there were four groups of subjects (Table 1). recorded. The time of the first PCA demand and the fre- To ensure that the groups consisted of randomly assigned quency of subsequent demands were noted over the first 24- subjects, each subject was assigned to a treatment group hour period postoperatively. The total dosage of morphine in numbered order, as they became available. A random used was calculated for each group. A VAS measurement number table was used for grouping. Every subject in each for pain intensity was administered. The data was collected group received patient-controlled analgesia (PCA) (Pain over a 24-hour period commencing postoperatively (see Management Provider TM, Abbott Laboratories, North Figure 2). Chicago, IL, USA). The groups differed only in the acupunc- Before discharge, the subjects were asked to answer ques- ture procedure they received. In an attempt to control for tions pertaining to the occurrence of any side effects from the placebo effect of SSP therapy, one “sham acupuncture” the SSP needle-free EA treatment, such as bruising, dizziness, treatment group was included. and anxiety. The VAS was again used to determine the According to Traditional Chinese Medicine (TCM) the- intensity of pain. ory, the acupuncture point Zusanli (ST36) was selected for this study, as it lies on the stomach meridian that traverses 2.2. Subjects. Subjects with medical conditions such as through the abdominal area surrounding the female repro- hypertension, diabetes, cachexia, cardiac, respiratory, kidney ductive organs. and nervous system problems, coagulopathy, and other Evidence-Based Complementary and Alternative Medicine 3 Assessed for eligibility (n = 49) Enrolment Randomly assigned to group 1, 2, 3, or 4 Allocation Group 1 Group 2 Group 3 Group 4 received received received received allocated allocated allocated allocated intervention intervention intervention intervention (n = 13) (n = 12) (n = 12) (n = 12) Discontinued Completed Completed Completed intervention allocated allocated Follow up allocated (n = 2) due to intervention intervention intervention the inability (n = 13) (n = 12) (n = 12) to carry out the VAS Analysed Analysed Analysis Analysed Analysed (n = 13) (n = 12) (n = 12) (n = 10) Figure 1: Flow chart of participants through each stage of the trial. Table 4: Time of first ambulation (in hours). acupuncture point (on the same level as ST36 but above the tuberositas tibia) was identified in all subjects one day Group Number Mean SD prior to the operation.