| 소속 |
Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea, Department of Rehabilitation Medicine1, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea, Pancreatobiliary Cancer Clinic, Department of Surgery2, Yonsei University College of Medicine, Seoul, Republic of Korea, Department and Research Institute of Rehabilitation Medicine3 |
| 저자 |
Jinyoung Park1*†, Hyung Sun Kim2, Joon Seong Park2†, Jung Hyun Park1, Sanghoon Shin3, Jae Eun Park3, Sangwon Hwang3, Do Young Kim1 |
Objective
Pylorus preserving pancreaticoduodenectomy (PPPD) is a treatment for the resectable tumor or cancer in pancreaticoduodenal system. Although laparoscopic PPPD has been limitedly performed, open surgery is currently the main trend. In open surgery, incision and suture of the abdominal muscles cause the inflammatory changes, strain, and contraction in the skeletal muscles, and consequently elicit muscular pain which deteriorates the quality of life. We therefore suggest electrical twitch obtaining intramuscular stimulation (ETOIMS) as a new treatment modality for pain control after PPPD.
Methods
Between June 2018 and January 2019, among the patients who underwent PPPD in Department of Surgery, participated 45 patients were randomly assigned to two groups. The Group 2 received ETOIMS right after surgery under the general anesthesia. ETOIMS was conducted on each patient using Clavis (Alpine Biomed ApS, Denmark). Aseptic monopolar needle electrode was inserted into the transverse abdominis muscle under ultrasound guidance. The stimulations were delivered with 2-mA intensity, 0.2-ms pulse duration, and 1-Hz frequency with unipolar negative square waves for 5 seconds at each stimulation point, which induced muscle twitching. The 14 dermatomal points, 2 cm bilaterally apart from the incision line were stimulated (Figure 1). The pain score (visual analogue scale, VAS), peak cough flow (PCF), gait speed were compared with proportion to the preoperative values. Pain score was taken 13 times; a day before surgery, post-operative day (POD) 0~9, discharge day, and 3 weeks after discharge in outpatient clinic. The PCF and gait speed were measured 5 times; a day before surgery, POD 2, 7, discharge day, and 3 weeks after discharge. The independent T test, chi-square test were applied to analyze the basic characteristics. The 3 main outcomes were analyzed by linear mixed model or repeated measures ANOVA using SPSS 23.0.
Results
With 7 dropouts, total 38 patients’ data were analyzed. The basic characteristics including age, sex, height, weight, body mass index, preoperative pain score and PCF were not significantly different, where the gait speed was faster in Group 1 (P = 0.03) (Table 1). The pain score was highest on the day of surgery (Group 1: 6.5 ± 2.2, Group 2: 5.5±1.9, P = 0.17) and decreased gradually. Through the course of pain relieving, the pain scores were significantly lower in Group 2 after PPPD (P = 0.01) (Figure 2A). Although the PCF at each measuring time points didn’t show the group difference (P = 0.20), the improved PCF from the second day of surgery to discharge was greater in Group 2 (P = 0.02) (Figure 2B). Although the gait speeds at each time point were not significantly different, the time course of improving was significantly faster in Group 2 (P < 0.01) (Figure 2C).
Conclusion
The ETOIMS is helpful in fast reducing postoperative somatic pain developed after PPPD, and also helpful in fast improvement of PCF and gait speed.
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