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Transcutaneous Electrical Acupoint Stimulation for the Prevention of Postoperative Cognitive Dysfunction: A Systematic Review and Meta-Analysis.

ABSTRACT: Background: No specific treatment is available for postoperative cognitive dysfunction (POCD). Recently, interest in the prevention of POCD during the perioperative period has increased. Although some studies suggest that transcutaneous electrical acupoint stimulation (TEAS) may be beneficial, the relevant evidence remains uncertain. Objective: To evaluate the preventive effects of TEAS on POCD. Methods: Seven databases including PubMed, EMBASE, CENTRAL, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang Database, and Chinese Biomedical Literature Database (CBM) were electronically searched up to April 2021. Two reviewers independently selected the studies, collected data, and assessed the risks of bias and grading of recommendations, assessment, development, and evaluations certainty of the evidence. A meta-analysis of the incidence of POCD, cognitive function score, pain, adverse reactions, and length of hospital stay after surgery was also performed. Results: Twenty-nine randomized controlled trials with 1,994 participants were included. The results of the meta-analysis showed that the TEAS group has a significantly lower incidence of POCD compared with the control group on postoperative days 1 [OR = 0.33 (95%CI: 0.23, 0.47); p < 0.001, I ² = 0%, moderate certainty], 3 [OR = 0.38 (95%CI: 0.29, 0.50); p < 0.001, I ² = 0%, low certainty], and 7 [OR = 0.51 (95%CI: 0.32, 0.81); p = 0.005, I ² = 0%, low certainty] but not on day 5 (p > 0.05, low certainty). Moreover, TEAS improved the Mini-Mental State Examination scores on postoperative days 1, 3, and 7 [MD = 2.44 (95%CI: 1.61, 3.27); p < 0.001, I ² = 93%, low certainty]; [MD = 2.07 (95%CI: 1.53, 2.62); p < 0.001, I ² = 87%, low certainty]; and [MD = 0.49 (95%CI: 0.18, 0.79); p = 0.002, I ² = 21%, low certainty], respectively, but not on day 5 (p > 0.05, very low certainty). TEAS promoted a postoperative analgesic effect within 24 h after surgery. Furthermore, patients receiving TEAS showed a lower incidence of postoperative nausea and vomiting and a shorter hospital stay. Conclusions: Limited evidence suggests that the application of TEAS in the perioperative period is associated with a reduced POCD rate and a protected early postoperative cognitive function.

SUBMITTER: Zhang T

PROVIDER: S-EPMC8685241 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveThis systematic review and meta-analysis aimed to evaluate the preventive effect of transcutaneous electrical acupoint stimulation on postoperative delirium in elderly surgical patients.MethodsPubMed, CENTRAL, China National Knowledge Infrastructure, and WanFang databases were searched for randomized controlled trials regarding the effect of transcutaneous electrical acupoint stimulation on preventing postoperative delirium in elderly patients undergoing any type of surgery. The primary outcome was the incidence of postoperative delirium. The secondary outcome was the duration of postoperative delirium. All analyses were conducted using RevMan 5.3 and Stata 13.0 software.ResultsTwelve trials with 991 participants were included, and most of them were at high/unclear risk of bias. Meta-analysis showed transcutaneous electrical acupoint stimulation could reduce the incidence of postoperative delirium (RR = 0.40, 95%CI = 0.29 to 0.55, p < 0.00001) and shorten the duration of postoperative delirium (MD = -0.97 days, 95%CI = -1.72 to -0.22, p = 0.01). Subgroup analyses demonstrated that transcutaneous electrical acupoint stimulation reduced the incidence of postoperative delirium in elderly patients undergoing orthopedic surgery and thoracic surgery, but not digestive surgery; transcutaneous electrical acupoint stimulation with dilatational wave and with continuous wave were both beneficial; and transcutaneous electrical acupoint stimulation was favored when compared to blank and sham control.ConclusionTranscutaneous electrical acupoint stimulation could reduce the incidence of postoperative delirium and shorten the duration of postoperative delirium in elderly surgical patients. The findings should be interpreted with caution due to weak evidence. High-quality, large sample, and multi-center trials are needed to further confirm the preliminary findings.Systematic review registration: https://inplasy.com/inplasy-2022-7-0096/, identifier: INPLASY202270096.

Project description:BackgroundThis study aimed to evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cognitive dysfunction (POCD) in older patients who were diagnosed with gastrointestinal tumor and received radical resection of gastrointestinal tumors under general anesthesia.MethodsA total of 68 patients who received radical resection of gastrointestinal tumors under general anesthesia were randomly divided into two groups. TEAS group patients received TEAS treatment. The treatment time was 30 min before the induction of anesthesia until the end of the surgery, 1 day before operation and from the first day to the third day after the operation. Except on the day of surgery, we treated the patients for 30 min once a day. In the sham TEAS group, the electronic stimulation was not applied and the treatment was the same as the TEAS group. The primary outcome was perioperative cognition evaluated by the Mini-Mental State Examination (MMSE) and secondary outcomes were the perioperative level of interleukin-6 (IL-6), S100 calcium-binding protein β (S100β), and C-reactive protein (CRP).ResultsThe postoperative score of MMSE, orientation, memory, and short-term recall in the sham TEAS group was significantly lower than the preoperative and TEAS group (P < 0.05). The incidence of POCD in the TEAS group (21.88%) was lower than those in the sham TEAS group (40.63%). S100β, IL-6, and CRP in the TEAS group were significantly lower than those in the sham TEAS group on the third day after the operation (P< 0.05). Postoperative S100β, IL-6, and CRP in two groups were significantly higher than those before operation except for S100β on the third day after the operation in the TEAS group (P < 0.05).ConclusionsPerioperative TEAS treatment reduced the postoperative inflammatory response and increased the postoperative cognitive function score and decrease the incidence of POCD in geriatric patients with gastrointestinal tumor.Trial registrationClinicalTrials.gov NCT04606888 . Registered on 27 October 2020. https://register.clinicaltrials.gov .

Project description:BackgroundInfertility is a common health problem affecting couples of childbearing age. The proposal of in vitro fertilization-embryo transfer (IVF-ET) solves the problem of infertility to a certain extent. However, the average success rate of IVF-ET is still low. Some studies conclude that transcutaneous electrical acupoint stimulation (TEAS) could improve pregnancy outcomes in women undergoing IVF-ET, however, there is a lack of comprehensive synthesis and evaluation of existing evidence.ObjectiveTo conduct a systematic review and meta-analysis to assess whether TEAS is effective and safe to improve the pregnancy outcomes for women undergoing IVF-ET.MethodsEight online databases were searched from inception to 19 November 2021. In addition, four clinical trial registries were also searched, relevant references were screened, and experts were consulted for possible eligible studies. Randomized controlled trials (RCTs) that included patients with infertility who underwent IVF and used TEAS as the main adjuvant treatment vs. non-TEAS or mock intervention controls were included. The clinical pregnancy rate (CPR) was considered the primary outcome. High-quality embryo rate (HQER), live birth rate (LBR), biochemical pregnancy rate (BPR), ongoing pregnancy rate (OPR), early miscarriage rate (EMR), birth defects rate (BDR), and adverse events related to interventions were regarded as secondary outcomes. The selection, data extraction, risk of bias assessment, and data synthesis were conducted by two independent researchers using Endnote software V.9.1 and Stata 16.0 software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the evidence quality of each outcome.ResultsThere were 19 RCTs involving 5,330 participants included. The results of meta-analyses showed that TEAS can improve CPR [RR = 1.42, 95% CI (1.31, 1.54)], HQER [RR = 1.09, 95% CI (1.05, 1.14)], and BPR [RR = 1.45, 95% CI (1.22, 1.71)] of women underwent IVF-ET with low quality of evidence, and improve LBR [RR = 1.42, 95% CI (1.19, 1.69)] with moderate quality of evidence. There was no significant difference in EMR [RR = 1.08, 95% CI (0.80, 1.45)] and BDR [RR = 0.93, 95% CI (0.13, 6.54)] with very low and moderate quality of evidence, respectively. A cumulative meta-analysis showed that the effective value of TEAS vs. controls was relatively stable in 2018 [RR = 1.52, 95% CI (1.35, 1.71)]. In addition, no serious adverse events associated with TEAS were reported.ConclusionOur findings suggest that TEAS may be an effective and safe adjuvant treatment for women undergoing IVF-ET to improve pregnancy outcomes. However, the current evidence quality is considered to be limited, and more high-quality RCTs are needed for further verification in the future.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021238871, identifier: CRD42021238871.

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Transcutaneous Electrical Acupoint Stimulation for the Prevention of Postoperative Cognitive Dysfunction: A Systematic Review and Meta-Analysis.

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