TAES PCA AOS CCK CCK-8 CSF EM EOS EOP β-ep β- OFQ PCA PCA demand PCA PCA effect PCA P6 PONV PRCF PREP SCS SG TAES TENS VAS VRS 1
[1,2] [3-5] demand analgesia PCA patient-controlled analgesia [6] PCA TAES transcutaneous acupoint electrical stimulation TAES analgesia, hypoalgesia, pain relief, modulate pain 2
TEAS PCA TAES TAES - β-ep CCK-8 3
TAES PCA TAES - β-ep CCK-8 TEAS 20 ASA I TAES n=10 sham n=10 2-100Hz 30min TAES t 1 TAES30min t 2 TAES30min t 3 TAES β-ep CCK-8 67 ASAI~ 2 PCA M n=32 TEAS+PCA T+M n=35 PCA 0.05% 100ml 1ml/hr 2ml/PCA 6min T+M TAES 2-100Hz - - 6 24 VAS VRS PCA PCA demand PCA PCA effect D e /D d PCA e / PCA d 24 TAES β-ep CCK-8 T+M 23/32 36% M 13/35 72% p<0.01 TAES 2-100Hz 30min 4
TAES β-ep CCK-8 TEAS 2-100Hz PCA - 5
Effects of transcutaneous acupoint electrical stimulation (TAES) on the postoperative patient-controlled analgesia Objective: To evaluate the effects of TAES on the electrical pain threshold in the different site, the concentrations of beta-endorphin( -EP) and cholecystokinin octapeptide(cck-8) in cerebrospinal fluid(csf). To evaluate the efficacy of TAES on the postoperative patient-controlled analgesia(pca). Methods: ( ) 20 patients(asa I) undergoing spinal anesthesia were randomly assigned to two groups: TAES and shamtaes(n=10). For each patient, the electrical sense threshold and pain threshold measurements were recorded pre-,immediately and 30min post-stimulation of the TAES(2-100Hz, at the Hegu, Neiguan bilateral) at the finger, abdominal and neck. The concentrations of -EP and CCK-8 in CSF were detected corresponding the three time points in the TAES group. ( ) 67 patients(asa I~II) undergoing up-abdominal procedures were randomly assigned to two groups: M group-intravenous PCA (n=32); T+M group-taes+pca(n=35). The analgesic in the PCA device was morphine 0.05%(100ml), and was programmed 1ml/hr, 2ml on demand with a lockout time of 6min. The TAES in T+M were started at the end of the operations with 2-100Hz at the Hegu, Neiguan and on either side of the incision. Recorded the VAS(visual analog scales), the number of PCA 6
demand(pca d ) and PCA effect (PCA e ), PCA e /PCA d ratio, the dose of morphine during the first 24hr and the side-effects. Results:( ) No significant differences were found between the two groups on the electrical sense threshold and pain threshold at the three sites and at the three time points. There were not significant changes in the concentrations of -EP and CCK-8 in CSF in the TAES group. ( ) There were not differences between the two groups in the analgesia profile and the dosage of morphine in the first 24hr except the incidences of nausea in the T+M group (23/32 36%) significantly decreased compared with that in M group (13/35 72%), p<0.01. Conclusions: TAES does not alter the electrical sense threshold, pain threshold, and the concentrations of -EP, CCK-8 in CSF after stimulating Hegu, Neiguan bilateral 30min with 2-100Hz. The application of a TAES (2-100Hz, stimulating Hegu, Neiguan and the either side of the incision) has not produced an effective analgesia, and does not decrease the dosage of PCA morphine after up-abdominal operation. However, it significantly decreases the incidences of nausea induced by the morphine analgesia. Key words: transcutaneous acupoint electrical stimulation(taes) patient-controlled analgesia(pca) pain threshold beta-endorphin( -EP) cholecystokinin octapeptide(cck-8) 7
TAES TAES 1 2 3 4 CNS 5 TAES 6 TAES 1 TAES 2 TAES 3 TAES 4 TAES TAES 1 PCA 2 PCA 3 TAES TAES <1000Hz [7] 1965 Melzack Wall [8] 1967 Shealy SCS spinal cord stimulation 8
[9] [10] 3000 365 [11] EA electroacupuncture manual acupuncture [12] [13] transcutaneous electrical nerve stimulation, TENS TAES transcutaneous acupoint electrical stimulation TAES EA [11] TAES EA TENS TAES TENS [14] TENS TAES TENS 1972 Shealy TENS [15] 1974 Hymes TENS [16] 9
TENS TENS [17] TAES TENS TENS [11] TENS [18] 1 gate-control theory 1965 Melzack Wall [8] SG A fiber A and C fiber T Cell SG SG A SG A C A C SG T Cell Aβ fiber SG T Cell Aβ [19] 10
SCS PNS, peripheral nerve stimulation [20] TENS TENS TENS 2 frequency-dependent frequency dependent blockade [21] TENS TENS 50-100Hz 15-100Hz 1-5Hz [22] 30 2Hz 369% 100Hz 49% [23,24] EA [25] TENS 3 - - - 2Hz EA - - 100Hz EA - [26] TENS TENS 2 100Hz TENS TENS [27] 3 EOS endogeneous opioid 11
substances EA P 5- [28] 6mg/kg [29] 40-60Hz 200us 40-80mA β- EP 20-45min [30] EOS EA EOS 4 EOP endogeneous opioid peptide 3 EOP [31] 2Hz 1 EOP 100Hz [32] 3 α β γ 31 β-ep 3-4 ε µ [7] 5-7 - 8-5 - µ δ A B κ δ β-ep [33] EM endomorphine 1997 EOP EM 1 12
EM 2 µ µ-r 2Hz EM 1 EM 2 100Hz [31] 1995 OFQ orphanin FQ/nociceptin EOP OFQ [34] 4 CNS AOS anti-opioid substance, EA [35] AOS 8 CCK-8 cholecystokinin-8 [36] CCK 1975 [37] CCK [38] CCK-8 CCK CCK-4 TFL 1-4ng CCK-8 2-10ug CCK-8 6000~8000 [39,40] CCK 2 CCK A CCK B CCK [41] B CCK-8 µ κ δ [42] CCK-8 13
CCK-8 CCK-8 [43] EA CCK-8 EA30min CCK-8 100Hz 15Hz EA CCK-8 2Hz [44] TENS [45] CCK-8 OFQ EA low-responder to high-responder [46-48] TENS EA responder non- responder TENS EA TENS EA low-responder high-responder EA CCK [49] 10 inbred stains C57BL/10 EA SM 2Hz and 100Hz EA [50] 100HzEA 0.5-3mg/kg 100HzEA [47,48] placebo effect hidden injection open injection [51] [52,53] 14
[ ] [54] β-ep [55] TENS CSF β-ep [33] CSF β-ep CSF β-ep VAS<4 VAS 0-10 β-ep - Met-EK [56] TENS 5 TENS TENS TENS 1994 IASP [57] [29] 1973 [k + ] 15
65%~90% 20-40 16.2 1.9min 45 + [58] 100Hz 200us 2-3 30min TENS 0min 20min 0.81 1.54 [59] A C TENS 100Hz 200us 26mA 25min homotopically 0.4-0.9 heterotopically TENS [60] 10minTENS 5min [61] TENS TENS [30,59,61] PREP EEG PREP TENS [62] PRCF MEG [63] TENS 50Hz 30 TENS PREP PRCF TENS PREP PRCF TENS PREP [64] TENS 150Hz 125 us 15min TENS mechanical pain threshold [65] 16