Dexmedetomidine Combined With Transcutaneous Vagus Nerve Stimulation (taVNS) Can Reduce the Incidence of PTSD in Trauma Patients After Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

Dexmedetomidine 0.1μg/kg/h: During the period from the commencement of anesthesia to the conclusion of surgery, Group A received dexmedetomidine (specification: 200μg/2mL, diluted with normal saline to 50mL, resulting in a final concentration of 4μg/mL) administered intravenously at a maintenance dose of 0.1μg/kg/h

tavns: On the basis of the identical dexmedetomidine medication as Group A, Group B received additional taVNS intervention: after cleaning the skin of the cavum concha tympanicum of the subjects by trained and qualified medical staff, electrodes were pasted, and stimulation parameters were set at a frequency of 20Hz and a pulse width of 250μs, with fixed intensity stimulation (if the electrode fell off, it was re-pasted to make up for the duration; if the subject could not tolerate it, the intervention was terminated)

Study summary

Emergency trauma surgery patients, due to the dual stress effects of sudden trauma events (such as car accidents, falls, engineering accidents) and surgical trauma, have a significantly higher incidence of post-traumatic stress disorder (PTSD) compared to the general population. This disease, characterized by intrusive memories, avoidance behaviors, negative changes in cognitive emotions, and increased arousal, not only severely hinders patients' postoperative psychological recovery and reduces their quality of life, but may also prolong hospital stays, increase the risk of readmission, and impose a heavy medical and economic burden on families and society. Dexmedetomidine, as a highly selective α₂-adrenergic receptor agonist, possesses sedative, anxiolytic, analgesic, and sympatholytic effects. By regulating the locus coeruleus-norepinephrine system, it can alleviate perioperative stress responses, reduce postoperative anxiety and delirium incidence. In recent years, multiple studies both domestically and internationally have confirmed its potential to prevent PTSD by inhibiting the encoding and consolidation processes of trauma-related memories. In randomized clinical trials, administering dexmedetomidine during and after surgery has been shown to reduce the incidence of PTSD in trauma patients. However, when used alone, some patients still develop PTSD, indicating room for improvement in preventive efficacy. Additionally, there are risks of adverse reactions such as hypotension and bradycardia, which limit its application in certain populations.

As a non-invasive vagus nerve stimulation technique, transcutaneous vagus nerve stimulation (taVNS) exerts its effect by stimulating the vagus nerve branches in the cavum concha. It has the advantages of simple operation, high safety, and can be implemented during the perioperative period. It has been proven to regulate the stress response and emotional processing of the central nervous system, reduce stress response scores, and has the potential for perioperative analgesia. However, there is limited research on its early prevention after emergency trauma surgery, and no exploration of synergistic effects with dexmedetomidine. Currently, there is no clinical research on the use of dexmedetomidine combined with taVNS for the prevention of post-traumatic stress disorder (PTSD) in patients undergoing emergency trauma surgery at home and abroad. Existing research mostly focuses on single drugs or single neuroregulation techniques, and there are limitations such as small sample size, short follow-up time, and uncontrolled confounding factors such as perioperative pain and delirium, making it difficult to meet the clinical demand for efficient and safe PTSD prevention schemes.

Eligibility

Primary outcome measure(s)

• One month after surgery, the incidence rate, symptom scores, and decrease amplitude of PTSD in both groups were assessed using CAPS-5 — One month post-surgery
  One month after surgery, a blinded evaluator assessed the incidence of PTSD in both groups using the CAPS-5 scale (based on DSM-5 criteria) (requiring the presence of 1 intrusion item + 1 avoidance item + 2 cognitive and emotional negative alterations + 2 arousal reaction symptoms, lasting for ≥1 month and affecting function). The CAPS-5 score (0-80 points, with higher scores indicating more severe symptoms) and the decrease in score compared to the preoperative baseline (less than 20 points, indicating no symptoms) were simultaneously recorded.

Trial sites (1)

More Affiliated Hospital of Nantong University trials in China

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