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Published in: Trials 1/2015

Open Access 01-12-2015 | Study protocol

Electroacupuncture for postoperative pain and gastrointestinal motility after laparoscopic appendectomy (AcuLap): study protocol for a randomized controlled trial

Author: Gangmi Kim

Published in: Trials | Issue 1/2015

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Abstract

Background

Acupuncture is a widely serviced complementary medicine. Although acupuncture is suggested for managing postoperative ileus and pain, supporting evidence is weak. The AcuLap trial is designed to provide high-level evidence regarding whether or not electroacupuncture is effective in promoting gastrointestinal motility and controlling pain after laparoscopic surgery.

Methods/design

This study is a prospective randomized controlled trial with a three-arm, parallel-group structure evaluating the efficacy of electroacupuncture for gastrointestinal motility and postoperative pain after laparoscopic appendectomy. Patients with appendicitis undergoing laparoscopic surgery are included and randomized into three groups: 1) electroacupuncture group, 2) sham acupuncture group, and 3) control group. Patients receive 1) acupuncture with electrostimulation or 2) fake electroacupuncture with sham device twice a day or 3) no acupuncture after laparoscopic appendectomy. The primary outcome is time to first passing flatus after operation. Secondary outcomes include postoperative pain, analgesics, nausea/vomiting, bowel motility, time to tolerable diet, complications, hospital stay, readmission rates, time to recovery, quality of life, medical costs, and protocol failure rate. Patients and hospital staff (physicians and nurses) are blinded to which group the patient is assigned, electroacupuncture or sham acupuncture. Data analysis personnel are blinded to group assignment among all three groups. Estimated sample size to detect a minimum difference of time to first flatus with 80 % power, 5 % significance, and 10 % drop rate is 29 × 3 groups = 87 patients. Analysis will be performed according to the intention-to-treat principle.

Discussion

The AcuLap trial will provide evidence on the merits and/or demerits of electroacupuncture for bowel motility recovery and pain relief after laparoscopic appendectomy.

Trial registration

The trial was registered in Clinical Research Information Service (CRiS), Republic of Korea (KCT0001486) on 14 May 2015.
Literature
1.
go back to reference Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101:172–88.CrossRefPubMed Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101:172–88.CrossRefPubMed
2.
go back to reference Rockall TA, Demartines N. Laparoscopy in the era of enhanced recovery. Best Pract Res Clin Gastroenterol. 2014;28:133–42.CrossRefPubMed Rockall TA, Demartines N. Laparoscopy in the era of enhanced recovery. Best Pract Res Clin Gastroenterol. 2014;28:133–42.CrossRefPubMed
3.
go back to reference Varut L. Impact of enhanced recovery program on colorectal cancer surgery. Asian Pac J Cancer Prev. 2014;15:3825–8.CrossRef Varut L. Impact of enhanced recovery program on colorectal cancer surgery. Asian Pac J Cancer Prev. 2014;15:3825–8.CrossRef
4.
go back to reference Zhuang C-L, Ye X-Z, Zhang X-D, Chen B-C, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–78.CrossRefPubMed Zhuang C-L, Ye X-Z, Zhang X-D, Chen B-C, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–78.CrossRefPubMed
5.
go back to reference Lee T-G, Kang S-B, Kim D-W, Hong S, Heo SC, Park KJ. Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum. 2011;54:21–8.CrossRefPubMed Lee T-G, Kang S-B, Kim D-W, Hong S, Heo SC, Park KJ. Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum. 2011;54:21–8.CrossRefPubMed
6.
go back to reference Donohoe CL, Nguyen M, Cook J, Murray SG, Chen N, Zaki F, et al. Fast-track protocols in colorectal surgery. Surgeon. 2011;9:95–103.CrossRefPubMed Donohoe CL, Nguyen M, Cook J, Murray SG, Chen N, Zaki F, et al. Fast-track protocols in colorectal surgery. Surgeon. 2011;9:95–103.CrossRefPubMed
8.
go back to reference Kehlet H, Dahl JB. Anesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921–8.CrossRefPubMed Kehlet H, Dahl JB. Anesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921–8.CrossRefPubMed
9.
go back to reference Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–41.CrossRefPubMed Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–41.CrossRefPubMed
10.
go back to reference Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol. 2013;31:952–60.CrossRefPubMedPubMedCentral Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol. 2013;31:952–60.CrossRefPubMedPubMedCentral
11.
go back to reference Ng SSM, Leung WW, Mak TWC, Hon SSF, Li JCM, Wong CYN, et al. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterol. 2013;144:307–13.CrossRef Ng SSM, Leung WW, Mak TWC, Hon SSF, Li JCM, Wong CYN, et al. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterol. 2013;144:307–13.CrossRef
12.
go back to reference Deng G, Wong WD, Guillem J, Chan Y, Affuso T, Yeung KS, et al. Randomized controlled trial of acupuncture for reduction of postcolectomy ileus. Ann Surg Oncol. 2015;20:1164–9.CrossRef Deng G, Wong WD, Guillem J, Chan Y, Affuso T, Yeung KS, et al. Randomized controlled trial of acupuncture for reduction of postcolectomy ileus. Ann Surg Oncol. 2015;20:1164–9.CrossRef
13.
go back to reference Strasberg SM, Linehan DC, Hawkins WG. The Accordion Severity Grading System of surgical complications. Ann Surg. 2009;250:177–86.CrossRefPubMed Strasberg SM, Linehan DC, Hawkins WG. The Accordion Severity Grading System of surgical complications. Ann Surg. 2009;250:177–86.CrossRefPubMed
14.
go back to reference Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMed Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMed
15.
go back to reference Yu GJ, Fu GQ, Li FR, Li LH, Guo F, Xue H, et al. Efficacy on analgesia with electric stimulation of long-term retaining needle after laparoscopic cholecystectomy. Zhongguo Zhen Jiu. 2014;34:169–72.PubMed Yu GJ, Fu GQ, Li FR, Li LH, Guo F, Xue H, et al. Efficacy on analgesia with electric stimulation of long-term retaining needle after laparoscopic cholecystectomy. Zhongguo Zhen Jiu. 2014;34:169–72.PubMed
16.
go back to reference Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled trial. JAMA. 2000;284:2755–61.CrossRefPubMed Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled trial. JAMA. 2000;284:2755–61.CrossRefPubMed
17.
go back to reference Li QS, Cao SH, Xie GM, Gan YH, Ma HJ, Lu JZ, et al. Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J. 1994;107:289–94.PubMed Li QS, Cao SH, Xie GM, Gan YH, Ma HJ, Lu JZ, et al. Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J. 1994;107:289–94.PubMed
18.
go back to reference Poulain P, Leandri EP, Laplanche A, Montange F, Bouzy J, Truffa-Bachi J. Electroacupuncture analgesia in major abdominal and pelvic surgery: a randomised study. Acupunct Med. 1997;15:10–3.CrossRef Poulain P, Leandri EP, Laplanche A, Montange F, Bouzy J, Truffa-Bachi J. Electroacupuncture analgesia in major abdominal and pelvic surgery: a randomised study. Acupunct Med. 1997;15:10–3.CrossRef
19.
go back to reference Dang W, Yang J. Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med. 1998;18:31–8.PubMed Dang W, Yang J. Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med. 1998;18:31–8.PubMed
20.
go back to reference Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C. Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol. 2003;21:4120–6.CrossRefPubMed Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C. Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol. 2003;21:4120–6.CrossRefPubMed
21.
go back to reference Wong RH, Lee TW, Sihoe AD, Wan IY, Ng CS, Chan SK, et al. Analgesic effect of electroacupuncture in postthoracotomy pain: a prospective randomized trial. Ann Thorac Surg. 2006;81:2031–6.CrossRefPubMed Wong RH, Lee TW, Sihoe AD, Wan IY, Ng CS, Chan SK, et al. Analgesic effect of electroacupuncture in postthoracotomy pain: a prospective randomized trial. Ann Thorac Surg. 2006;81:2031–6.CrossRefPubMed
22.
go back to reference Crew KD, Capodice JL, Greenlee H, Apollo A, Jacobson JS, Raptis G, et al. Pilot study of acupuncture for the treatment of joint symptoms related to adjuvant aromatase inhibitor therapy in postmenopausal breast cancer patients. J Cancer Surviv. 2007;1:283–91.CrossRefPubMed Crew KD, Capodice JL, Greenlee H, Apollo A, Jacobson JS, Raptis G, et al. Pilot study of acupuncture for the treatment of joint symptoms related to adjuvant aromatase inhibitor therapy in postmenopausal breast cancer patients. J Cancer Surviv. 2007;1:283–91.CrossRefPubMed
23.
go back to reference He BM, Li WS, Li WY. Effect of previous analgesia of scalp acupuncture on post-operative epidural morphine analgesia in the patient of intestinal cancer. Zhongguo Zhenjiu. 2007;27:369–71. He BM, Li WS, Li WY. Effect of previous analgesia of scalp acupuncture on post-operative epidural morphine analgesia in the patient of intestinal cancer. Zhongguo Zhenjiu. 2007;27:369–71.
24.
go back to reference Mehling WE, Jacobs B, Acree M, Wilson L, Bostrom A, West J, et al. Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage. 2007;33:258–66.CrossRefPubMed Mehling WE, Jacobs B, Acree M, Wilson L, Bostrom A, West J, et al. Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage. 2007;33:258–66.CrossRefPubMed
25.
go back to reference Deng G, Rusch V, Vickers A, Malhotra V, Ginex P, Downey R, et al. Randomized controlled trial of a special acupuncture technique for pain after thoracotomy. J Thorac Cardiovasc Surg. 2008;136:1464–9.CrossRefPubMedPubMedCentral Deng G, Rusch V, Vickers A, Malhotra V, Ginex P, Downey R, et al. Randomized controlled trial of a special acupuncture technique for pain after thoracotomy. J Thorac Cardiovasc Surg. 2008;136:1464–9.CrossRefPubMedPubMedCentral
26.
go back to reference Crew KD, Capodice JL, Greenlee H, Brafman L, Fuentes D, Awad D, et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol. 2010;28:1154–60.CrossRefPubMed Crew KD, Capodice JL, Greenlee H, Brafman L, Fuentes D, Awad D, et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol. 2010;28:1154–60.CrossRefPubMed
27.
go back to reference Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28:2565–70.CrossRefPubMedPubMedCentral Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28:2565–70.CrossRefPubMedPubMedCentral
28.
go back to reference Xia YQ, Zhang D, Yang CX, Xu HL, Li Y, Ma LT. An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med. 1986;6:23–6.PubMed Xia YQ, Zhang D, Yang CX, Xu HL, Li Y, Ma LT. An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med. 1986;6:23–6.PubMed
29.
go back to reference Dundee JW, Ghaly RG, Fitzpatrick KT, Lynch GA, Abram WP. Acupuncture to prevent cisplatin-associated vomiting. Lancet. 1987;1:1083.CrossRefPubMed Dundee JW, Ghaly RG, Fitzpatrick KT, Lynch GA, Abram WP. Acupuncture to prevent cisplatin-associated vomiting. Lancet. 1987;1:1083.CrossRefPubMed
30.
go back to reference Dundee JW, Ghaly RG, Fitzpatrick KT. Randomised comparison of the antiemetic effects of metoclopramide and electro-acupuncture in cancer chemotherapy. Br J Clin Pharmacol. 1988;25:678–9. Dundee JW, Ghaly RG, Fitzpatrick KT. Randomised comparison of the antiemetic effects of metoclopramide and electro-acupuncture in cancer chemotherapy. Br J Clin Pharmacol. 1988;25:678–9.
31.
go back to reference Streitberger K, Friedrich-Rust M, Bardenheuer H, Unnebrink K, Windeler J, Goldschmidt H, et al. Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Clin Cancer Res. 2003;9:2538–44.PubMed Streitberger K, Friedrich-Rust M, Bardenheuer H, Unnebrink K, Windeler J, Goldschmidt H, et al. Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Clin Cancer Res. 2003;9:2538–44.PubMed
32.
go back to reference Melchart D, Ihbe-Heffinger A, Leps B, von Schilling C, Linde K. Acupuncture and acupressure for the prevention of chemotherapy-induced nausea: a randomized cross-over pilot study. Support Care Cancer. 2006;14:878–82.CrossRefPubMed Melchart D, Ihbe-Heffinger A, Leps B, von Schilling C, Linde K. Acupuncture and acupressure for the prevention of chemotherapy-induced nausea: a randomized cross-over pilot study. Support Care Cancer. 2006;14:878–82.CrossRefPubMed
33.
go back to reference Gottschling S, Reindl TK, Meyer S, Berrang J, Henze G, Graeber S, et al. Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology: a randomized multicenter crossover pilot trial. Klin Padiatr. 2008;220:365–70.CrossRefPubMed Gottschling S, Reindl TK, Meyer S, Berrang J, Henze G, Graeber S, et al. Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology: a randomized multicenter crossover pilot trial. Klin Padiatr. 2008;220:365–70.CrossRefPubMed
34.
go back to reference Yang Y, Zhang Y, Jing NC, Lu Y, Xiao HY, Xu GL, et al. Electroacupuncture at Zusanli (ST 36) for treatment of nausea and vomiting caused by the chemotherapy of the malignant tumor: a multicentral randomized controlled trial. Zhongguo Zhenjiu. 2009;29:955–8. Yang Y, Zhang Y, Jing NC, Lu Y, Xiao HY, Xu GL, et al. Electroacupuncture at Zusanli (ST 36) for treatment of nausea and vomiting caused by the chemotherapy of the malignant tumor: a multicentral randomized controlled trial. Zhongguo Zhenjiu. 2009;29:955–8.
35.
go back to reference Enblom A, Tomasson A, Hammar M, Steineck G, Borjeson S. Pilot testing of methods for evaluation of acupuncture for emesis during radiotherapy: a randomized single subject experimental design. Acupunct Med. 2011;29:94–102.CrossRefPubMed Enblom A, Tomasson A, Hammar M, Steineck G, Borjeson S. Pilot testing of methods for evaluation of acupuncture for emesis during radiotherapy: a randomized single subject experimental design. Acupunct Med. 2011;29:94–102.CrossRefPubMed
36.
go back to reference Enblom A, Johnsson A, Hammar M, Onelov E, Steineck G, Borjeson S. Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea: a randomized controlled study. Ann Oncol. 2012;23:1353–61.CrossRefPubMed Enblom A, Johnsson A, Hammar M, Onelov E, Steineck G, Borjeson S. Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea: a randomized controlled study. Ann Oncol. 2012;23:1353–61.CrossRefPubMed
37.
go back to reference Garcia MK, Skibber JM, Rodriguez-Bigas MA, Chang DZ, Feig BW, Bisanz AK, et al. Acupuncture to prevent prolonged postoperative ileus: a randomized controlled trial. Med Acupunct. 2008;20:83–8.CrossRef Garcia MK, Skibber JM, Rodriguez-Bigas MA, Chang DZ, Feig BW, Bisanz AK, et al. Acupuncture to prevent prolonged postoperative ileus: a randomized controlled trial. Med Acupunct. 2008;20:83–8.CrossRef
38.
go back to reference Yin SH, Du YQ, Liu B. Clinical study on acupuncture combined with medication in restoration of gastrointestinal functions for postoperative patients with gastric cancer. Zhongguo Zhenjiu. 2009;29:459–62. Yin SH, Du YQ, Liu B. Clinical study on acupuncture combined with medication in restoration of gastrointestinal functions for postoperative patients with gastric cancer. Zhongguo Zhenjiu. 2009;29:459–62.
39.
go back to reference Meng ZQ, Garcia MK, Chiang JS, Peng HT, Shi YQ, Fu J, et al. Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World J Gastroenterol. 2010;16:104–11.CrossRefPubMedPubMedCentral Meng ZQ, Garcia MK, Chiang JS, Peng HT, Shi YQ, Fu J, et al. Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World J Gastroenterol. 2010;16:104–11.CrossRefPubMedPubMedCentral
40.
go back to reference Sun BM, Luo M, Wu SB, Shen XX, Wu MC. Acupuncture versus metoclopramide in treatment of postoperative gastroparesis syndrome in abdominal surgical patients: a randomized controlled trial. J Chin Integr Med. 2010;8:641–4.CrossRef Sun BM, Luo M, Wu SB, Shen XX, Wu MC. Acupuncture versus metoclopramide in treatment of postoperative gastroparesis syndrome in abdominal surgical patients: a randomized controlled trial. J Chin Integr Med. 2010;8:641–4.CrossRef
41.
go back to reference Du YQ, Zhang SY. Use of Jiangqi Hewei Tongfu method to improve gastrointestinal function and immune function in patients with intestinal tumors after surgery. World Chin J Digestol. 2011;19:687–92. Du YQ, Zhang SY. Use of Jiangqi Hewei Tongfu method to improve gastrointestinal function and immune function in patients with intestinal tumors after surgery. World Chin J Digestol. 2011;19:687–92.
Metadata
Title
Electroacupuncture for postoperative pain and gastrointestinal motility after laparoscopic appendectomy (AcuLap): study protocol for a randomized controlled trial
Author
Gangmi Kim
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Trials / Issue 1/2015
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-015-0981-x

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