TEAS Enters the Preoperative Window for Thoracoscopic Surgery Anxiety
Preoperative anxiety remains common before video-assisted thoracoscopic surgery, where fear, sleep disruption, and physiologic stress can compound the burden of a cancer workup or pulmonary nodule evaluation. In this protocol, investigators are testing whether transcutaneous electrical acupoints stimulation can reduce that anxiety before the first incision is made. The concept is clinically appealing because the intervention is noninvasive, repeatable, and already used in pain control settings, yet its effect on anxiety in this surgical population has not been established.
The study is designed as a single-center, randomized, sham-controlled trial in the cardiothoracic surgery department of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine in China. Ninety-two eligible patients with pulmonary nodules measuring at least 8 mm and scheduled for VATS will be assigned in a 1:1 ratio to active TEAS or sham TEAS. The protocol centers on a narrow but practical preoperative question: can a brief, repeated neuromodulatory intervention alter the emotional and physiologic state of patients before thoracoscopic surgery?
Anxiety before surgery is not a cosmetic concern. In thoracic procedures, heightened stress can intensify analgesic requirements, slow rehabilitation, and extend hospitalization through a cascade of pain amplification, sympathetic activation, and poorer sleep and coping. The trial is built around that chain of events, asking whether a short course of peripheral electrical stimulation can blunt it before it takes hold.
Three Days of Stimulation Before Surgery
Participants in both groups will receive daily interventions starting 3 days before surgery and continuing once per day for three consecutive days. The sham-controlled structure is central to the design because it helps separate a true biologic or psychologic effect from expectation, attention, and procedural ritual. In a field where subjective symptoms can shift easily with reassurance alone, a sham comparator is essential.
The primary endpoint is change in the generalized anxiety disorder scale score from baseline to the day before surgery. That choice keeps the focus on a clinically relevant interval: the narrow preoperative period in which anxiety often peaks and when a bedside intervention would need to prove itself. If the active arm lowers anxiety more than sham, the result would support the idea that targeted sensory stimulation can influence the preoperative stress response rather than merely distract patients.
Neurochemical Signals Will Be Tracked Alongside Symptoms
Secondary outcomes extend beyond anxiety scores and move into the biology of stress and analgesia. Investigators will measure serum concentrations of 5-hydroxytryptamine, norepinephrine, and gamma-aminobutyric acid. Those markers map onto a plausible mechanistic pathway: norepinephrine reflects sympathetic arousal, serotonin participates in mood regulation, and gamma-aminobutyric acid is tied to inhibitory signaling and anxiolytic tone. If the biochemical profile shifts in parallel with symptom reduction, the trial may help explain how TEAS exerts its effects rather than leaving the intervention as a purely empirical maneuver.
The protocol also includes several recovery-related endpoints. Intraoperative anesthetic consumption will be recorded, along with time to postoperative chest tube removal, postoperative pain, and length of postoperative hospital stay. Each of those measures has a direct bedside meaning. Lower anesthetic use may signal reduced stress reactivity or altered pain processing during surgery; earlier chest tube removal and shorter hospitalization would suggest a smoother postoperative course; better pain control could mean less rescue medication and easier mobilization.
One sentence captures the clinical wager: a short preoperative intervention may influence both emotion and recovery.
Why the Trial Design Matters in Thoracic Surgery
VATS is less invasive than open thoracic surgery, but it still sits at the intersection of respiratory discomfort, fear of cancer, and postoperative pain. Patients are not simply undergoing a procedure; they are often navigating an anxiety-heavy pathway around pulmonary nodules and possible malignancy. A low-risk intervention that can be delivered repeatedly before surgery has obvious appeal in that setting, especially if it can reduce both distress and downstream resource use.
The use of a sham group strengthens the protocol because it addresses one of the most persistent problems in procedural anxiety research: expectancy effects can be powerful, especially when patients receive hands-on care over several days. By comparing TEAS directly with a sham intervention, the study is positioned to identify whether electrical stimulation itself adds value beyond the experience of treatment.
The trial is also tightly bounded. It is single-center, which improves consistency but limits breadth. All participants come from one cardiothoracic service, and the sample size is 92, so the study is meant to test feasibility and signal rather than settle the question for every thoracic surgical population. The investigators will use SPSS version 21.0 for analysis, and adverse events will be recorded as part of the safety assessment.
Safety Monitoring and Ethical Oversight
Safety in this protocol is straightforward but necessary. Even interventions perceived as gentle require surveillance when they are applied repeatedly in the lead-up to surgery. Recording adverse events will help determine whether TEAS can be delivered without creating new discomfort or logistical burden in the perioperative setting.
Ethics approval was granted by the Ethics Committee of the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine, under approval number 2021-023. The trial is registered as NCT04895852. Results are intended for publication in peer-reviewed journals, which should place the findings into the larger body of perioperative care literature whether the primary endpoint is positive, neutral, or mixed.
What this protocol does not yet answer is whether the intervention will translate into meaningful reductions in anxiety, anesthetic exposure, pain, or hospital stay once the trial is complete. Those outcomes remain the central test, and the study is built to determine whether a brief preoperative course of TEAS can change the trajectory of thoracoscopic surgery care in a measurable way.