Effectiveness of Thread Embedding Acupuncture Analgesia at the EX-B2 Point Combined With Standard Therapy After Laparoscopic Living Donor Nephrectomy
Condition: Post Operative Pain, Acute; Renal Transplant Donor of Left Kidney; Quality of Life; Acupuncture Analgesia
MeSH terms: Pain, Postoperative; Acute Pain
Study type: Interventional

Summary: 
      Kidney transplantation is the main option besides hemodialysis and continuous ambulatory
      peritoneal dialysis (CAPD) to prolong and improve the quality of life for patients with
      end-stage renal disease. The main option for obtaining organs from living donors is surgical
      action to remove the kidney (nephrectomy) using the laparoscopic method (laparoscopic live
      donor nephrectomy or LLDN). Postoperative management of LDNH in the form of intravenous
      paracetamol 1000 mg cannot overcome innovative pain and has drug-related risk effects.

      Non-pharmacological pain management is the first line of pain management. One
      non-pharmacological therapy that can be an option is acupuncture. Thread embedding
      acupuncture (TEA) is an acupuncture method that uses certain medical threads such as catgut
      or polydioxanone (PDO) which are inserted into subcutaneous tissue or muscle at certain
      acupuncture points.

      The working mechanism of TEA in treating pain is through local mechanisms in the form of
      releasing adenosine which binds to adenosine A1 receptors, releasing substance P, inhibiting
      the expression and activation of Nuclear Factor Kappa B; through a segmental mechanism in the
      form of a control gate mechanism; through extrasegmental mechanisms in the form of downward
      pain inhibition pathways; through a central mechanism in the form of release of endogenous
      opioids in the hypothalamus. ATB can provide a continuous stimulating effect of infiltration
      and acceleration of tissue regeneration, increasing anti-pain.
    

Detailed description: 
      The main outcome is to determine the effect of thread embedding acupuncture at the EX-B2
      point on first lumbar on pain intensity in patients after laparoscopic living donor
      nephrectomy (LLDN) and to determine the effect of thread embedding acupuncture at the EX-B2
      point on first lumbar on the quality of life in patients after laparoscopic living donor
      nephrectomy (LLDN).

      The thread embedding will use Polydioxanone thread size 30G x 25,4 mm. This thread will last
      maximum 7 months before fully absorbed.

      Pain intensity will be assessed using the VAS score 7 days before LLDN surgery (before the
      thread implant acupuncture procedure); and on the first, second, third, and fourteenth days
      after the LLDN procedure.

      Quality of life scores will be measured with the Indonesian version of SF-36 questionnaire
      carried out seven days before LLDN surgery, on the first postoperative day, and on the
      fourteenth day after LLDN surgery.

      The research design in this study was a case series with 6 subject only.
    

Intervention name(s): Thread embedding acupuncture and standard therapy
Intervention type(s): Other
Intervention description(s): In the treatment, thread embedding acupuncture was performed using a needle containing polydioxanone (PDO) thread at the EX-B2 acupuncture point (12.5 mm lateral to the spinous process) at the level of the 1st lumbar vertebra with an insertion angle perpendicular to the skin surface. All patients are also given standard therapy after surgery in the form of intravenous Paracetamol 1000 mg, 3 times a day.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Laparoscopic Living Donor Nephrectomy; Post Operative Acute Pain; Quality of Life; Thread Embedding Acupuncture