Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel non-invasive neuromodulation technique. Existing evidence suggested that taVNS improves pain management, sleep quality, inflammatory responses, and gastrointestinal recovery after surgery. This study is designed to test the hypothesis that perioperative use of taVNS may improve quality of recovery in patients after major noncardiac surgery.
Aged ≥18 years but <85 years.
Scheduled for elective or limited-time noncardiac surgery with expected duration ≥2 hours.
Lesions or infections of the auricle skin.
Recent or long-term use of cholinergic or anticholinergic medications.
Neurosurgery.
Expected mechanical ventilation with intubation for ≥1 day after surgery.
Parallel
Transcutaneous auricular vagus nerve stimulation
DeviceTranscutaneous auricular vagus nerve stimulation is performed using earphone-shaped stimulators (tVNS501, Ruishenan Medical Device, Inc. JiangSu, China) on the left tragus areas of the outer ear for a total of 30 min. Using parameters we have identified through systematic review, electrical stimulation (pulse width: 200-300 μs; frequency: 25 Hz; duty cycles: 50%) is initiated at 200% perceptual threshold (PT) which means the minimum amount of electricity required to perceive electrical stimulation on the skin described as a pricking or tingling sensation. All conscious patients will be told they may or may not feel any sensation from the stimulation. The stimulation will be performed between 15:00 and 17:00 on the first day before surgery, at least 30 minutes before the start of surgery and between 08:00 and 10:00 on the first to third day after surgery.
Sham stimulation
DeviceSham stimulation is performed using earphone-shaped stimulators (tVNS501, Ruishenan Medical Device, Inc. JiangSu, China) on the left tragus areas of the outer ear for a total of 30 min. Using parameters we have identified through systematic review, electrical stimulation (pulse width: 200-300 μs; frequency: 25 Hz; duty cycles: 50%) is initiated at 200% perceptual threshold (PT) which means the minimum amount of electricity required to perceive electrical stimulation on the skin described as a pricking or tingling sensation. And the current will be automatically switched off after 15 s. All conscious patients will be told they may or may not feel any sensation from the stimulation. The stimulation will be performed between 15:00 and 17:00 on the first day before surgery, at least 30 minutes before the start of surgery and between 08:00 and 10:00 on the first to third day after surgery.
Quality of recovery scores at 24 hours after surgery
Quality of recovery is assessed using the 15-item Quality of Recovery (QoR-15) Scale. The QoR-15 is a valid, reliable, responsive, and simple-to-use measure that can be applied across a broad range of surgical settings. The scale contains 15 questions that measure five dimensions of patient's health, including: physical comfort, emotional state, physical independence, psychological support, and pain, with scores ranging from 0 (the poorest quality of recovery) to 150 (the best quality of recovery).
Quality of recovery scores at 48 and 72 hours after surgery
Quality of recovery is assessed using the 15-item Quality of Recovery (QoR-15) Scale. The scale contains 15 questions that measure five dimensions of patient's health, including: physical comfort, emotional state, physical independence, psychological support, and pain, with scores ranging from 0 (the poorest quality of recovery) to 150 (the best quality of recovery).
Pain intensity both at rest and with movement after surgery
Pain intensity is assessed with a numerical rating scale (NRS, an 11-point scale where 0=no pain and 10=the worst pain) twice daily (8:00-10:00 am, 18:00-20:00 pm) after surgery.
Subjective sleep quality after surgery
Subjective sleep quality is assessed with a numerical rating scale (NRS, an 11-point scale where 0=the best sleep and 10=the worst sleep) daily (8:00-10:00 am) after surgery.
Opioid consumption within 3 days after surgery
Opioid consumption is converted to intravenous sufentanil equivalent.
Heart rate variability (HRV) before and after each intervention.
Heart rate (HR) is recorded via electrocardiographic (ECG) monitoring during a 50-min period of each intervention, i.e., a 10-min period before, a 30-min period during, and a 10-min period after (sham) intervention. Heart rate variability is calculated offline from analyses of RR intervals.
Depression after surgery
Beck Depression Inventory-II scale (scores range from 0 to 63, with higher score indicating more severe depression) is used to assess the severity of depression.
Anxiety after surgery
Beck Anxiety Inventory scale (scores range from 0 to 63, with higher score indicating more severe anxiety) is used to assess the severity of anxiety.
Incidence of postoperative nausea and vomiting
Occurrence of postoperative nausea and vomiting and use of antiemetic drugs within 3 days after surgery.
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