Electroacupuncture in Reducing the Dose of Analgesic in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Study Overview
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Brief Summary
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A prospective, multiple-center, double-blinded, randomized, controlled clinical study to evaluate the antalgic effects between distal-proximal acupoints combination and regional acupoints combination stimulated with electroacupuncture on patients undergoing Off-Pump Coronary-Artery Bypass Grafting(OP-CABG).This clinical trial is to investigate whether electroacupuncture(EA) anesthesia can reduce analgesic in OP-CABG surgery in distal-proximal group.The origins of therapeutic acupuncture can be traced back at least 2,500 years in China. There has been an explosion of interest in Western medicine within the United States and Europe in application of acupuncture technique. Acupuncture enjoys worldwide acceptance for treating diseases such as migraine, chronic low back pain, and knee osteoarthritis. In 2002, WHO recommended 107 symptoms, syndromes, and diseases definitively shown to be effectively treated by acupuncture. Coronary heart disease (angina pectoris) is among these pathologies. A recent clinical trial demonstrated an acupuncture-assisted anesthesia strategy reduces postoperative morbidity and medical costs in open-heart surgery under cardiopulmonary bypass. Previous researches in animal models have demonstrated that electroacupuncture pretreatment protects the heart from ischemic injury. The investigators observed that electroacupuncture pretreatment (EAP, 30-minute electric stimulation through 4 electrodes attached to the bilateral forearm acupoints) before surgery significantly attenuated serum troponin levels during and shortly post-surgery in adult heart valve replacement patients and children undergoing cardiac surgery correcting congenital heart malformation.However, whether electroacupuncture anesthesia may reduce analgesic in OP-CABG surgery,especially in different combination of acupoints,has never been previously investigated.

Detailed Description
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The anesthesia will be performed in a standard way. The propofol and sufentanil will be infused in target-controlled infusion mode. The dosage of analgesic will be assessed by the consumption of sufentanil. And the electroacupuncture anesthesia will be implemented by a device named Hua Tuo electronic acupuncture treatment instrument.

Official Title
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Effects of Regional and Distant Combination of Acupoints Stimulated With Electroacupuncture on Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Conditions
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Coronary Disease

Intervention / Treatment
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* Device: TEAS (transcutaneous electric acupoint stimulation)
* Device: TEAS
* Device: TEAS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists I-III Scheduled for Off-Pump Coronary-Artery Bypass Grafting surgery First thoracotomy Signed written informed consent obtained Exclusion Criteria: American Society of Anesthesiologists IV Undergoing surgery within 12 h of admission to hospital Life expectancy < 1 year at the time of enrollment Hemodynamic instability as defined by a systolic blood pressure <90 mmHg Preoperative Intra-aortic Balloon Pumping or Ventricular Assisted Device Severe hepatic or renal dysfunction Not the first thoracotomy Mediastinal fiber thickening or severe pleural adhesions Severe adverse reactions Severe systemic infection With contraindications to the use of electroacupuncture, such as skin damage or infection at the acupoints Suffering from nervous system disease or abnormal mental state Participate in the other clinical trial 3 month before the enrollment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: distal-proximal group<br>TEAS (transcutaneous electric acupoint stimulation) on Danzhong and Hegu | Device: TEAS (transcutaneous electric acupoint stimulation)<br>* transcutaneous electric acupoint will commence at 30 min on Danzhong and Hegu before anesthesia in distal-proximal group<br>|
| Active Comparator: regional group<br>TEAS (transcutaneous electric acupoint stimulation) on Danzhong and Juque | Device: TEAS<br>* transcutaneous electric acupoint will commence at 30 min on Danzhong and Juque before anesthesia in regional group<br>|
| Sham Comparator: control group<br>no TEAS (transcutaneous electric acupoint stimulation) on Danzhong and Hegu . | Device: TEAS<br>* The device will be connected to Danzhong and Hegu but no stimulation to the acupoints 30 min before anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dosage of sufentanil used during anesthesia | Dosage of sufentanil used during anesthesia | during the anesthesia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of inotropic scores | inotropic drugs used postoperatively | 24h postoperatively | 
| Dosage of propofol used during anesthesia | Dosage of propofol used during anesthesia | During the anesthesia | 
| Time of mechanical ventilation | length of mechanical ventilation postoperatively | at 30 days | 
| In-hospital stay | It is the length of hospital stay postoperatively | at 30 days | 
| Incidence of overall complication | Incidence of overall complication postoperatively | at 30 days | 
| Incidence of overall mortality | Incidence of overall mortality postoperatively | at 30 days | 
| The length of CCU stay | Length of CCU stay postoperatively | at 30 days | 
| Heart rate during the anesthesia | Heart rate during the anesthesia | during the anesthesia | 
| Mean arterial pressure during the anesthesia | Mean arterial pressure during the anesthesia | during the anesthesia | 
| Bispectral index during the anesthesia | Bispectral index during the anesthesia | during the anesthesia | 
| Incidence of overall complication | Incidence of overall complications postoperatively | at 1 year | 
| Incidence of overall mortality | Incidence of overall mortality postoperatively | at 1 year |