Effect of intradermal needle therapy at combined acupoints on patients’ gastrointestinal function following surgery for gastrointestinal tumors

Table 1 Procedures in the intervention group and control group

Components	Intervention group	Control group
Preoperative stage
Counseling and patient education	Patients were educated regarding knowledge of the disease and perioperative cautions, and key points to achieve better cooperation.	Same as the intervention group
Preoperative optimization	The use of tobacco and alcohol was restricted; patients were instructed to perform efficient cough and back percussion and were required to perform activities (e.g., blow balloons or climb stairs) to improve lung function.
Preoperative nutritional care	Using the Nutritional Risk Screening score (NRS 2002) to assess nutritional risk. Patients at risk received oral nutritional supplements for 5–7 d prior to surgery.
Preoperative fasting and carbohydrate loading	Fasting from solid foods for 6 h before surgery; 2–3 h before surgery, patients without diabetes received 200–350 mL of electrolyte drinks under the guidance of dietitians (ingredients: glucose 100 mmol/L, sodium 50 mmol, potassium 20 mmol/L, chloride 50 mmol/L, magnesium 1 mmol/L, phosphorus 2 mmol/L); water was prohibited during the 2 h before surgery.
Intraoperative stage
Optimization of anesthesia	Medium- and short-acting anesthetics were recommended.	Same as the intervention group
Tube placement	Nasogastric tube, abdominal drainage tube or urinary catheter were selectively placed when indicated.
Prevention of intraoperative hypothermia	Intraoperative normothermia was maintained at 36 °C or over, using the following methods. The operating room temperature was set at 26 ℃–27 ℃ before surgery and 30 min before the end of the operation; during the operation, the temperature was set at 22 ℃–23 ℃, and the exposed area of the patient’s body was wrapped with a quilt. The skin antiseptic agent was heated to 40 ℃, and the rinse solution and intravenous infusion fluid were heated to 37 ℃.
Postoperative stage
Postoperative analgesia	Multimodal analgesia: Intravenous patient-controlled analgesia and NSAIDs.	Same as the intervention group
Prevention of nausea and vomiting	Antiemetics were appropriately administered to patients based on their number of risk factors.
Tube management	Avoidance or early removal of nasogastric tube, abdominal drainage tube or urinary catheter.
Postoperative early oral intake	Patients were encouraged to drink when they were awake after the operation. If there was no discomfort, a liquid diet was allowed after the first postoperative flatus passage, and the semi flow and general diet were gradually recovered.
Postoperative nutritional care	According to the NRS-2002, oral nutritional supplementation (or additional parenteral nutrition when indicated) was provided for malnourished patients.
Early mobilization	Six hours after recovering from anesthesia, the patients were restricted to the lateral or semi-recumbent position; the patients were allowed to turn over in the bed on the first day, move out of bed on the second day, and stand and walk around on the third day after the operation.
INT	Disinfecting the bilateral acupoints LI-4, PC-6, LR-3, SP-4, ST-36, ST-37, and ST-39 with 75% medical alcohol. Removing the sealing paper from the press needle, then attaching the adhesive tape with press needle to the acupoints. Pressure was applied to the acupoints until the patients experienced local soreness, numbness, and/or pain. The patient or caregiver was instructed to press each acupoint for 2 min at 4–6 h intervals. The press needles were changed every 24 h. INT was performed immediately upon the patient's return to the ward after surgery and continued for seven consecutive days.	The patients in the control group did not receive INT. However, adhesive tapes were attached at their corresponding acupoints with the same appearance as the adhesive tapes with needles applied to the acupoints of the patients in the intervention group.

NSAID: Non-steroidal anti-inflammatory drugs; INT: Intradermal needle therapy; GI: Gastrointestinal.

Table 2 Demographic and clinical characteristics at baseline (n = 64)

Variable	mean ± SD or n (%)		t /x2	P value
	Intervention group (n = 32)	Control group (n = 32)
Age (years)	65 ± 9.3	61 ± 10.6	1.696	0.10
Gender
Male	18 (56.3)	19 (59.4)	0.064	0.80
Female	14 (43.8)	13 (40.6)
Education level			0.309	0.86
Middle school or below	12 (37.5)	11 (34.4)
High school or junior college	12 (37.5)	11 (34)
Baccalaureate or above	8 (25.0)	10 (31.3)
Occupations1			3.442	0.50
Farmer	12 (37.5)	12 (37.5)
Worker	4 (12.5)	2 (6.3)
Government official	1 (3.1)	5 (15.6)
Retiree	12 (37.5)	10 (31.3)
Other	3 (9.4)	3 (9.4)
Residence			0.000	1.00
Rural areas	12 (37.5)	12 (37.5)
Urban areas	20 (62.5)	20 (62.5)
Marital status1			0.408	1.00
Married	28 (87.5)	27 (84.4)
Widowed	2 (6.3)	2 (6.3)
Divorced	2 (6.3)	3 (9.4)
Smoking			0.080	0.78
Yes	8 (25.0)	9 (28.1)
No	24 (75.0)	23 (71.9)
Drinking1			0.554	0.83
Often	8 (25.0)	8 (25.0)
Occasionally	18 (56.2)	20 (62.5)
Never	6 (18.8)	4 (12.5)
Cancer types1			1.059	0.64
Gastric cancer	12 (37.5)	16 (50.0)
Colon cancer	14 (43.7)	11 (34.4)
Rectal cancer	6 (18.8)	5 (15.6)
Pathological type1			0.75	0.71
Adenocarcinoma	27 (84.4)	29 (90.6)
Squamous cell carcinoma	5 (15.6)	3 (9.4)
Stages of disease1			0.877	0.67
Ⅰ	2 (6.3)	1 (3.1)
Ⅱ	21 (65.6)	24 (75.0)
Ⅲ	9 (28.1)	7 (21.9)
Surgical approach			0.577	0.45
Traditional radical resection	20 (62.5)	17 (53.1)
Laparoscopy	12 (37.5)	15 (46.9)

¹Fisher’s exact test.

Table 3 Intradermal needle therapy effect on postoperative functions

Outcomes	Group	Merged			Subgroup
					Gastric cancer			Colon cancer
		n	mean ± SD	P value	n	mean ± SD	P value	n	mean ± SD	P value
Time to first flatus passage (h)	Intervention group	32	66 ± 27	< 0.001	12	83 ± 32	0.06	20	56 ± 17	0.002
	Control group	32	103 ± 41		16	110 ± 37		16	97 ± 44
Time to first defecation (h)	Intervention group	32	106 ± 44	< 0.001	12	125 ± 36	0.09	20	94 ± 44	0.001
	Control group	32	153 ± 50		16	155 ± 48		16	150 ± 53
Time to first oral feeding (h)	Intervention group	32	73 ± 30	< 0.001	12	94 ± 30	0.02	20	61 ± 22	< 0.001
	Control group	32	115 ± 38		16	126 ± 35		16	105 ± 40

Table 4 Comparison within and between groups for gastrointestinal symptoms

Measure	Intervention group (n = 32)		Control group (n = 32)		Between-group difference
	Mean difference (95%CI)	P value	Mean difference (95%CI)	P value	Mean difference (95%CI)	P value
Abdominal distension
T1	Reference	N/A	Reference	N/A	-0.2 (-0.5, 0.1)	0.26
T2	-0.2 (-0.5, -0.2)	0.72	0.5 (0.2, 0.7)	<0.001	-0.8 (-1.1, -0.5)	< 0.001
T3	-0.7 (-1.0, -0.4)	< 0.001	0.2 (-0.3, 0.6)	0.97	-1.0 (-1.3, -0.7)	< 0.001
Nausea
T1	Reference	N/A	Reference	N/A	0.1 (-0.2, 0.5)	0.46
T2	-0.6 (-0.9, -0.6)	< 0.001	-0.1 (-0.4, 0.2)	1.00	-0.5 (-0.8, -0.3)	< 0.001
T3	-1.0 (-1.3, -0.8)	< 0.001	-0.6 (-1.0, -0.2)	0.002	-0.3 (-0.5, -0.2)	< 0.001
Vomiting
T1	Reference	N/A	Reference	N/A	0 (-0.3, 0.3)	0.83
T2	-0.2 (-0.4, 0)	0.02	-0.1 (-0.2, 0.1)	1.00	-0.2 (-0.4, 0.1)	0.19
T3	-0.3 (-0.5, 0)	0.02	-0.3 (-0.5, 0)	0.06	-0.1 (-0.2, 0)	0.14
Fatigue
T1	Reference	N/A	Reference	N/A	-0.3 (-0.7, 0)	0.04
T2	-0.8 (-1.0, -0.5)	< 0.001	-0.2 (-0.4, 0)	0.13	-0.9 (-1.2, -0.6)	< 0.001
T3	-1.1 (-1.4, -0.9)	< 0.001	-0.7 (-0.9, -0.5)	< 0.001	-0.8 (-1.1, -0.5)	< 0.001

N/A: Not applicable.

Table 5 Subgroup analysis for gastrointestinal symptoms

Subgroup/measure		Intervention group		Control group		Between-group difference
		Mean difference (95%CI)	P value	Mean difference (95%CI)	P value	Mean difference (95%CI)	P value
Abdominal distension
Gastric cancer (n = 28)	T1	Reference	N/A	Reference	N/A	0 (-0.5, 0.5)	1.00
	T2	-0.1 (-0.7, 0.5)	1.00	0.4 (0.1, 0.8)	0.01	-0.5 (-1.0, 0)	0.04
	T3	-0.7 (-1.3, -0.1)	0.02	0.2 (-0.4, 0.8)	1.00	-0.9 (-1.3, -0.4)	< 0.001
Colon cancer (n = 36)	T1	Reference	N/A	Reference	N/A	-0.3 (-0.7, 0.1)	0.17
	T2	-0.2 (-0.6, 0.2)	0.56	0.5 (0.1, 0.9)	0.003	-1.0 (-1.4, -0.6)	< 0.001
	T3	-0.7 (-1.0, -0.3)	< 0.001	0.2 (-0.5, 0.9)	1.00	-1.1 (-1.5, -0.7)	< 0.001
Nausea
Gastric cancer (n = 28)	T1	Reference	N/A	Reference	N/A	0.6 (0.1, 1.0)	0.01
	T2	-0.9 (-1.1, -0.7)	< 0.001	0.2 (-0.2, 0.6)	0.71	-0.5 (-0.9, -0.1)	0.009
	T3	-1.3 (-1.8, -0.9)	< 0.001	-0.4 (-0.9, 0.2)	0.32	-0.4 (-0.7, -0.1)	0.01
Colon cancer (n = 36)	T1	Reference	N/A	Reference	N/A	-0.2 (-0.7, 0.3)	0.38
	T2	-0.9 (-1.2, -0.5)	< 0.001	-0.4 (-0.7, 0)	0.04	-0.5 (-0.8, -0.2)	0.004
	T3	-0.7 (-0.9, -0.4)	< 0.001	-0.8 (-1.3, -0.2)	0.003	-0.3 (-0.5, -0.1)	0.007
Vomiting
Gastric cancer (n = 28)	T1	Reference	N/A	Reference	N/A	0.2 (-0.3, 0.7)	0.43
	T2	-0.3 (-0.7, 0)	0.04	0.1 (-0.2, 0.3)	1.00	-0.2 (-0.7, 0.2)	0.35
	T3	-0.5 (-1.0, -0.1)	0.02	-0.2 (-0.6, 0.2)	0.71	-0.1 (-0.3, 0)	0.13
Colon cancer (n = 36)	T1	Reference	N/A	Reference	N/A	-0.2 (-0.5, 0.2)	0.37
	T2	-0.1 (-0.3, 0.1)	0.067	-0.2 (-0.4, 0.1)	0.10	-0.1 (-0.3, 0.1)	0.44
	T3	-0.2 (-0.4, 0.1)	0.11	-0.3 (-0.7, 0.1)	0.15	0 (0, 0)	1.00
Fatigue
Gastric cancer (n = 28)	T1	Reference	N/A	Reference	N/A	-0.5 (-1.1, 0)	0.06
	T2	-0.5 (-1.0, 0.1)	0.07	-0.1 (-0.5, 0.2)	1.00	-0.9 (-1.3, -0.5)	< 0.001
	T3	-0.8 (-1.2, -0.5)	< 0.001	-0.8 (-1.1, -0.5)	< 0.001	-0.5 (-0.9, -0.2)	0.003
Colon cancer (n = 36)	T1	Reference	N/A	Reference	N/A	-0.3 (-0.7, 0.2)	0.28
	T2	-0.9 (-1.2, -0.6)	< 0.001	-0.3 (-0.5, 0)	0.06	-0.9 (0.4, 1.4)	< 0.001
	T3	-1.3 (-1.6, -1.0)	< 0.001	-0.6 (-0.9, -0.3)	< 0.001	-1.0 (-1.4, -0.6)	< 0.001

N/A: Not applicable.

Table 6 Parameter estimates of needle therapy effect on gastrointestinal symptoms

Measure	Parameters	B	95%CI lower	95%CI upper	P value
Abdominal distension	(group = 1) × (time = 3)	-0.8	-1.3	-0.4	< 0.001
	(group = 1) × (time = 2)	-0.6	-1.0	-0.3	< 0.001
Nausea	(group = 1) × (time = 3)	-0.5	-0.9	-0.1	0.02
	(group = 1) × (time = 2)	-0.7	-0.9	-0.4	0.001
Vomiting	(group = 1) × (time = 3)	0.1	-0.3	0.3	0.83
	(group = 1) × (time = 2)	-0.1	-0.3	0.1	0.22
Fatigue	(group = 1) × (time = 3)	-0.4	-0.7	-0.2	0.003
	(group = 1) × (time = 2)	-0.6	-0.9	-0.3	< 0.001

Group = 0 and Time = 1 as the references.