Effects of Needleless Transcutaneous Electrical Acustimulation on Gastrointestinal Function Recovery After Multi-Level Lumbar Surgery: A Randomized Clinical Trial

Background/Aims: Postoperative gastrointestinal dysfunction is a common complication of spinal surgery.This study aimed to determine the effect of transcutaneous electrical acustimulation (TEA) on the recovery of postoperative gastrointestinal function in patients undergoing lumbar surgery and to explore the underlying mechanism.Methods: Fifty patients undergoing multi-level (n ≥ 2) lumbar surgery were randomly assigned to receive TEA or sham-TEA treatment for 1 hour twice daily from postoperative day (POD)1 to POD3.Zusanli (ST36) and Neiguan (PC6) were selected as the stimulation points for the TEA group.The time to first flatus and defecation after surgery and other outcome measures were recorded.Gastric slow waves (GSW) were detected using an electrogastrogram, and autonomic function was assessed by analyzing heart rate variability derived from electrocardiogram recordings.Serum levels of interleukin (IL)-6, serotonin, and norepinephrine (NE) were also examined.Results: Compared with sham-TEA, TEA significantly shortened the time to first flatus (P < 0.001) and defecation (P < 0.05) and reduced gastrointestinal symptom scores (P < 0.01).TEA increased the percentage of normal GSW (P < 0.05) and vagal activity (P < 0.001) postoperatively.Compared with POD1, TEA decreased the levels of IL-6, serotonin, and NE on POD4.Additionally, vagal activity on POD4 was negatively correlated with the time to first flatus (r = -0.383,P = 0.009).TEA treatment was identified as a factor independently associated with the time to first postoperative flatus and defecation.Conclusions: Needleless TEA is probably associated with accelerated recovery of gastrointestinal function after lumbar surgery, possibly through the modulation of autonomic activity.