Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.116996
Revised: December 29, 2025
Accepted: February 4, 2026
Published online: May 27, 2026
Processing time: 180 Days and 4.2 Hours
Postoperative gastrointestinal dysfunction is common in patients with colorectal cancer (CRC). Transcutaneous electrical acupoint stimulation (TEAS) is a noninva
To evaluate the effects of TEAS applied at Zusanli and Neiguan as an adjunct to anesthesia on postoperative qi-blood harmonization and spleen–stomach function recovery in patients with CRC.
The medical records of patients who underwent laparoscopic radical resection for CRC in the traditional Chinese medicine department of Zhoukou Hospital of TCM between January 2024 and June 2025 were retrospectively collected. On the basis of actual perioperative intervention plans documented in the medical re
The TG group had a longer duration of the first flatus, first defecation, and abdominal rumbling recovery compared with that in the control group G (P < 0.05). Additionally, visual analog scale scores were significantly lower (P < 0.01), whereas Karnofsky scores were significantly higher (P < 0.01) in the TG group. Postoperative nausea and vomiting, as well as general complications, occurred less frequently in the TG group (P < 0.05).
Based on this prospective study, we have found that the TEAS-assisted anaesthesia regime means may help improve gastrointestinal function reversion, alleviate pain, and reduce complications in colorectal surgery for abdomen after operation. These results need to be confirmed in a subsequent prospective study.
Core Tip: This retrospective study demonstrates that the perioperative application of transcutaneous electrical acupoint stimulation at Zusanli and Neiguan acupoints can significantly promote gastrointestinal function recovery, reduce postoperative pain, and lower the incidence of complications in patients undergoing laparoscopic colorectal cancer surgery. By analyzing clinical medical record data, this study provides evidence for the integration of traditional Chinese medicine’s qi-blood harmonization theory with modern enhanced recovery after surgery practices, supporting the safety and efficacy of this non-pharmacological adjunctive therapy.
- Citation: Yuan Y, Xiao S. Effect of transcutaneous electrical acupoint stimulation at Zusanli and Neiguan on postoperative recovery in patients with colorectal cancer. World J Gastrointest Surg 2026; 18(5): 116996
- URL: https://www.wjgnet.com/1948-9366/full/v18/i5/116996.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v18.i5.116996
Colon cancer, among the worst forms of illness and still surgery in its primary management for early-stage patients[1]. The enhanced recovery after surgery (ERAS) programme has been used to accelerate the recovery process and shorten the hospital stay for colon cancer patients[2]. After surgery in elderly patients with poor constitution or accompanying various illnesses, postoperative gastrointestinal dysfunction occurs more frequently. It can extend the length of hospita
Transcutaneous electric acupuncture stimulation (TEAS) is also known as surface acupuncture stimulation and uses no acupoints; instead, it applies surface electrodes. The method that patients prefer, which can be administered easily with minimal technical skills required, and is commonly used in clinical applications[9]. Electrical stimulation at certain points of TEAS can stimulate the body’s own regulation, strengthen immunity and regulate intestinal motility[10]. Acupuncture or TEAS can reduce the amount of opioid used; accelerate bowel sound recovery and normalize intra-abdominal pressure levels soon after surgery; improve patients’ tolerance of parenteral nutrition support by increasing it; reduce vomiting during anaesthesia [postoperative nausea and vomiting (PONV)] compared with controls[11,12]. Based on this, it is hoped that a better course of action will be taken for these patients after surgery according to the results presented here.
This study is a single-center retrospective cohort study. All the medical records of patients who underwent laparoscopic radical resection for colorectal cancer (CRC) in the department of colorectal surgery of Zhoukou Hospital of TCM between January 2024 and June 2025 were consecutively retrieved from the hospital’s electronic medical record system. This study was reviewed and approved by the institutional ethics committee of Zhoukou Hospital of TCM, and informed consent was obtained from each patient.
Inclusion criteria: (1) Age between 18 years and 70 years; (2) Histopathologically confirmed CRC; (3) Tracheal intubation and laparoscopic abdominal tumor resection under general anesthesia (stomach, colon, or rectum); and (4) Complete clinical data.
Exclusion criteria: (1) Surgical incisions or scars near the Zusanli (ST36) and Neiguan (PC6) acupoints; (2) Local skin infection at the acupoint sites; (3) Inoperable colorectal lesions; (4) Severe perioperative complications requiring transfer to the intensive care unit; (5) Conversion from laparoscopic to open surgery; (6) Severe cardiovascular, hepatic, renal, hematologic, immune, and psychiatric disorders or spinal cord injury; (7) Presence of other malignancies; (8) Skin into
Using the inclusion and exclusion criteria, two independent researchers screened the medical records. A total of 124 patients were ultimately included in the analysis. Grouping was based on whether standardized TEAS treatment during the perioperative period was clearly documented in the medical records. Accordingly, the patients were divided into two groups: The general anesthesia group (G group, 58 cases) and the general anesthesia combined with TEAS treatment group (TG group, 66 cases). This study is observational, and group allocation was based on actual clinical decisions and patient preference rather than randomized allocation.
All patients received standard general anesthesia and perioperative management. Preoperative fasting included two hours for clear liquids and six hours for solids. Upon entering the operating room, the patient was subjected to routine monitoring through electrocardiography, pulse oximetry, and noninvasive blood pressure measurement, and end-tidal CO2 assessment. Peripheral venous access was established, and left radial artery catheterization was performed under local anesthesia for invasive blood pressure monitoring. Thirty minutes before anesthesia induction, the patients received intravenous lactated Ringer’s solution at 8-10 mL/kg for volume expansion and then a continuous infusion of lactated Ringer’s and 6% hydroxyethyl starch 130/0.4 in a 3:1 ratio, administered at 8 mL/kg/hour.
Anesthesia induction included intravenous midazolam (0.15 mg/kg), sufentanil (2-5 μg/kg), propofol (1.5-2.0 mg/kg), and rocuronium bromide (0.6-1.0 mg/kg). After tracheal intubation, mechanical ventilation was initiated with a respiratory rate of 10-16 breaths per minute, tidal volume of 8-10 mL/kg, inspiratory-to-expiratory ratio of 1:2, and inspired oxygen concentration of 50%-60%. End-tidal CO2 was maintained at 30-35 mmHg. Anesthesia depth was monitored using bispectral index, which was maintained between 40 and 60. Maintenance anesthesia consisted of sevoflurane (end-tidal concentration 1.0%-2.0%), propofol infusion (4-8 mg/kg/hour), remifentanil (0.1-0.2 μg/kg/minute), and atracurium besylate (0.3-0.6 mg/kg/hour) and was administered through continuous infusion. Dosages were adjusted according to the patients’ vital signs.
Postoperatively, patients were connected to a patient-controlled intravenous analgesia pump containing a 100 mL solution composed of 6 mg of butorphanol, 100 μg of dexmedetomidine, and normal saline. The background infusion rate was set at 2 mL/hour, and the bolus dose was 0.5 mL per demand. Patients were transferred to the recovery room and extubated upon full awakening. Prior to extubation, intravenous sugammadex (2-4 mg/kg) was administered to reverse neuromuscular blockade. When vomiting occurred during recovery or ward stay, intravenous administration of tropise
The specific TEAS intervention received by the patients in the TG group was based on the anesthesia records and postoperative nursing documentation. An SDZ-V electronic acupuncture treatment device was used to stimulate bilateral ST36 and PC6 acupoints 30 minutes before anesthesia induction. The parameters were set at a 2/100 Hertz sparse-dense wave with an intensity of 4-11 mA (adjusted to a level eliciting tolerable sensations of soreness, numbness, and distension in the patient). The stimulation continued until the end of the surgery. On postoperative days 1 to 3, treatment with the same parameters was recorded daily at 9:00 AM, lasting for 30 minutes each session.
A trained data extractor used a standardized form to retrieve the following data from the hospitalization, anesthesia, nursing, and postoperative follow-up records of the included patients.
General information: We monitored and recorded the preoperative general condition and surgical variables of all patients, including age, gender, height, weight, tumor diameter, tumor-node-metastasis staging, intraoperative infusion volume, and duration of surgery.
Primary indicators: Data were recorded from the nursing documentation (bowel sound auscultation records) and patient reports (time to first flatus and defecation) in the medical records.
Secondary indicators: The time to resume a liquid diet, the time to first ambulation, postoperative hospital stay duration, visual analog scale (VAS) scores on preoperative day 1, postoperative day 1, and postoperative day 3 (extracted from the pain assessment forms), and Karnofsky Performance Status scores before surgery and prior to discharge were recorded for the patients.
Safety indicators: The occurrence of PONV and other complications was extracted from the progress notes, nursing records, and physicians’ order sheets.
Statistical analyses were performed using SPSS version 26.0. Normally distributed continuous data were expressed as mean ± SD, and independent samples t-tests were conducted for comparisons between two groups, and paired samples t-tests were conducted for comparisons within groups. Non-normally distributed data were presented as median (interquartile range), and Mann-Whitney U tests were conducted for intergroup comparisons. Categorical data were expressed as n (%), and χ2 tests were employed for comparisons between groups. A P value of less than 0.05 was considered statistically significant.
After retrospective data extraction, 124 patients were ultimately included in the analysis: 58 in the G group and 66 in the TG group. Comparisons of baseline characteristics, including gender, age, body mass index, tumor diameter, tumor-node-metastasis stage, type of surgery, duration of surgery, extubation time, and intraoperative infusion volume, between the two groups showed no statistically significant differences (P > 0.05), indicating that the groups were comparable in terms of major demographic and clinical features. Details are presented in Table 1.
| Group G (n = 58) | Group TG (n = 66) | t/χ2 | P value | |
| Age (years) | 60.36 ± 10.58 | 58.69 ± 9.21 | 1.012 | 0.314 |
| Gender (male/female) | 32/26 | 38/28 | 0.073 | 0.788 |
| BMI (kg/m2) | 24.17 ± 2.45 | 24.31 ± 2.62 | 0.792 | 0.430 |
| Tumor diameter (cm) | 3.36 ± 2.37 | 3.39 ± 2.52 | 1.146 | 0.254 |
| TNM stage (I/II/III/IV) | 6/33/8/11 | 12/40/9/6 | 3.571 | 0.312 |
| Surgical type (1/2/3/4)1 | 14/6/21/17 | 14/10/22/20 | 0.754 | 0.861 |
| Operative time (minutes) | 166.54 ± 35.02 | 162.87 ± 33.75 | 0.340 | 0.734 |
| Extubation time (minutes) | 20.47 ± 5.20 | 21.06 ± 5.46 | 0.299 | 0.766 |
| Blood loss (mL) | 75.62 ± 40.31 | 71.44 ± 37.89 | 1.544 | 0.125 |
| Infusion volume (mL) | 1432.15 ± 1088.11 | 1450.28 ± 116.32 | 1.823 | 0.071 |
| Urine output (mL) | 365.14 ± 55.81 | 359.31 ± 45.32 | 1.324 | 0.188 |
Comparison of postoperative recovery between groups: The results indicate that the time to first flatus, first bowel movement, and return of bowel sounds in the TG group were significantly shorter than those in the G group (P < 0.05). However, no statistically significant differences in time to resume a liquid diet, time to first ambulation, and length of postoperative hospital stay were found between the two groups (all P > 0.05, Table 2).
| Group G (n = 58) | Group TG (n = 66) | t/χ2 | P value | |
| Time to first flatus (hours) | 28.17 ± 6.02 | 23.66 ± 5.29 | 3.421 | 0.001 |
| Time to first bowel movement (hours) | 66.20 ± 14.13 | 57.59 ± 12.42 | 3.567 | 0.001 |
| Time to return of bowel sounds (hours) | 20.65 ± 8.47 | 16.59 ± 7.35 | 4.291 | < 0.001 |
| Time to resume liquid diet (hours) | 80.45 ± 20.58 | 82.31 ± 26.10 | 1.036 | 0.302 |
| Time to first ambulation (days) | 46.17 ± 15.29 | 44.89 ± 12.26 | 0.044 | 0.965 |
| Length of postoperative stay (days) | 9.04 ± 4.28 | 7.86 ± 2.52 | 1.627 | 0.106 |
Comparison of VAS scores between groups: Within-group comparisons revealed no statistically significant difference in VAS scores between the G groups and TG groups one day prior to surgery (P > 0.05). However, on postoperative days 1 and 3, the VAS scores in the G group were significantly higher than those in the TG group (P < 0.01). Between-group comparisons showed that the VAS score in the G group on postoperative day 1 was significantly elevated compared with the score on the day prior to surgery (P < 0.01), and the score on postoperative day 3 significantly decreased compared with that on postoperative day 1 (P < 0.01, Figure 1 and Table 3).
Comparison of Karnofsky scores before and after treatment: Before treatment, there were no statistically significant differences in Karnofsky performance status scores between the G groups and TG groups (P > 0.05). After treatment, both groups showed an increase in Karnofsky scores (P < 0.01), and the TG group demonstrated significantly higher scores than the G group (P < 0.01; Table 4).
| Karnofsky score | Group G (n = 58) | Group TG (n = 66) | t | P value |
| Before | 71.26 ± 8.40 | 72.45 ± 7.18 | 0.788 | 0.432 |
| After | 76.44 ± 7.21 | 82.27 ± 8.62 | 3.960 | < 0.001 |
| t | 2.755 | 6.364 | ||
| P value | 0.008 | < 0.001 |
The medical records indicated that 22 patients in the TG group had postoperative complications: 14 patients experienced PONV, 6 had abdominal distension and pain, 2 had anastomotic leaks, 1 had a surgical site infection, and 1 had intestinal obstruction. Meanwhile, 36 patients in the G group had postoperative complications, 26 patients experienced PONV, 8 had abdominal distension and pain, 2 had fever, 3 had anastomotic leaks, 1 had a surgical site infection, 1 had a pulmonary infection, and 3 had intestinal obstruction. The incidence of PONV and total complications was significantly lower in the TG group than in the G group (P < 0.05, Table 5).
| Complications | Group G (n = 58) | Group TG (n = 66) | t | P value |
| PONV | 26 | 14 | 7.879 | 0.005 |
| Abdominal distension and pain | 8 | 6 | 0.682 | 0.409 |
| Fever | 2 | 0 | 2.313 | 0.128 |
| Anastomotic leak | 3 | 2 | 0.366 | 0.545 |
| Surgical site infection | 1 | 1 | 0.008 | 0.927 |
| Pulmonary infection | 1 | 0 | 2.754 | 0.097 |
| Intestinal obstruction | 3 | 1 | 1.323 | 0.250 |
| Total | 36 | 22 | 10.239 | 0.001 |
Surgeries remain a high-quality method of treating CRC. Factors such as surgical trauma, anaesthesia method and intra-operative manipulation may cause reduced gastric blood supply, compression of gastrointestinal microcirculation due to surgery, etc., resulting in oedema and stasis of the digestive tract and inhibiting gastrointestinal peristalsis. In addition, the intake of CO2 in the peritoneum during surgery activates the sympathetic nerve to produce high [H+] and acidic environments that can suppress excitability of enteric neurons and reduce gastrointestinal motility. Gastrointestinal dysfunction after surgery for radical CRC via laparoscopy often presents with a lack of bowel sounds, abdominal distension, and reduced flatus-defecation tolerance. TEAS-assisted anaesthesia was observed to be associated with favourable outcomes for most indicators; The trend showed that postoperative abdominal movement could return earlier compared with conventional group, and also there was significant decrease in pain level after operation and improve
Regarding TCM theory, the stomach receives and breaks down food, the spleen carries out transportation outside? After surgery for CRC, many patients will have a dysfunction of the spleen and stomach due to imbalanced yin and yang or blocked liver Qi; therefore, it cannot bring enough energy for nourishment upwards, leading to deficiency of both spleen and stomach qi accompanied by rebellious qi in the abdomen[13,14]. Acupuncture belongs to a category of treatments for restoring weakened patients’ bodies following illness, improving function once impaired, among which activating relevant acupoints situated at various places on multiple meridians all over the outside of the human body can regulate Qi flows in these locations in order to stop diseases from further spreading and promote recovery. Intestinal Diseases often utilise this therapy in clinical situations. TEAS is an entirely different kind of acupuncturist that uses a low-frequency micro-irritant current penetrates through accurate into acupoints, keeping a feeling like getting pricked but strengthening therapeutic effect. TEAS can stimulate the vagus nerve at specific acupuncture points to promote gastrointestinal peristaltic movement; increase abdominal pressure and relax smooth muscles to assist in defecation by increasing bowel motility, etc. Therefore, TEAS is widely used to promote gastrointestinal recovery after abdominal surgery[15-17].
ST36 and PC6, which are often used alone or combined with other points to improve gastrointestinal motility through acupoint therapy in TCM. ST36 at the extremity of the Yangming stomach meridian has a strong effect for strengthening the spleen and stomach, nourishing qi and blood, relaxing meridians to promote circulation of energy substances, aiding metabolism, etc. Improve intestinal blood flow distribution, inhibit the release of gastrin via somatostatin, and increase intestinal motility through increased nitric oxide-mediated vascular tension[18]. clinically, ST36 points are mainly used for the treatment of various gastro-intestinal problems including stomach ache ,abdominal pain, stomach disorder, diarrhoea, constipation etc. The PC6 acupoint is on the pericardium meridian of hand jueyin, connected to the yinwei vessel; it can regulate the stomach fire, relieve hiccups and vomiting, pacify the heart and spirit, regulate qi and pain relief. Help regulates functions of the endocrine system to lessen gastric secretions and maintain stability in the activities intestines[19]. Stimulation of PC6 and ST36 acupoints can enhance gastrointestinal motility and decrease the acidity in stomachs via an endocrine regulatory pathway[20-23]. Based on the above-mentioned studies and theories, applying electrical stimulation to ST36 and PC6 via TCM’s visceral theory perspective. It is an approved, efficient and non-intrusive preoperative supplement for anaesthesia.
Gastrointestinal dysfunction in postoperative patients of major abdominal surgery is relatively frequent. Bowel sound occurs due to peristalsis of the intestines causing intestinal content movement in the small intestine; its reappearance indicates a restored condition postoperatively with respect to gastric motility[24]. Retrospective analysis of the results showed that both times for bowel sounds to disappear and flatus to pass were markedly earlier in the TG group com
Post-operative pain limits prompt commencement of functional exercise postoperatively. Based on TCM, surgery is an “injury from a metal blade”, damaging the skin, flesh, blood and vessels; qi and blood stasis, meridians blocked, leading to visceral dysfunction such as pain or abnormal function[27]. VAS scores for pain reduction at postoperative days 1 and 3 showed significant differences between the TG group and the G group (P < 0.05); that is to say, it relieved pain quickly after using TEAS-assisted anaesthesia. It aligns with those of Zhang et al[17], respectively. Stimulation at ST36 is in the region of the deep peroneal nerve area; it regulates several system functions to varying degrees and has a certain effect on enhancing gastric movement or promoting immunity, etc. PC6 is located within the territory of the median nerve; it helps relieve postoperative pain frequently linked with anxiety and stress by adjusting the balance of the autonomic nervous system and activity level of the limbic system to reduce the tendency towards “pain-anxiety-pain aggravation”.
The first limitation of this research is that it is a non-randomised group design. The selected treatments might have been affected by multiple reasons including the condition of each patient, what their attending doctor or patient themselves wanted. Although the base-line data indicated comparability among all groups; still there are unobservable confounders remaining. Secondly, there are problems with the accuracy of some outcomes measured by patients themselves or nurses in record keeping; thus, it is easy for these biases to occur. Additionally, as a result of following the standardised and perioperative TEAS treatment plan specified in this text throughout normal surgical activities. Provided rich data for the research results, it can be considered feasible to apply the standardised add-on treatments widely in clinical settings regularly. In the future, rigorous-designed prospective randomised-controlled trials are required to verify the association observed in this prospective study and clarify its mechanism.
TEAS-aided anaesthesia can be considered a relatively safe, effective and straightforward way of adjusting qi-blood disharmony and strengthening the weak spleen-stomach in patients with CRC before surgery. As an invasive-free option with good patient acceptance, the former should be widely used in clinical practice soon.
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