ACUPUNCTURE ANALGESIA
Acupuncture analgesia ( abbreviated to A.A. ) is an analgesic method built on
the basis of relieving pain and regulating the physiological function of the
human body by needling. The procedure produces an absence of pain by stimulating
certain points when the patient undergoes an operation in full consciousness. It
is considered an important achievement in the successful integration of
traditional Chinese and Western medicine.
1. THE CHARACTERISTICS OF ACUPUNCTURE ANALGESIA
1. Safe in Wide Indications
Extensive clinical practice has proven that acupuncture analgesia is
completely safe. Millions of surgical operations with acupuncture analgesia
have been carried out in China and none of them led to death attributed to
needling. Acupuncture analgesia does not produce any side - effects and
accidents which might happen when drug anaesthesia is employed. What is more,
it does not result in respiratory tract infection, gastrointestinal
dysfunction, abdominal distension and retention of urine. It, therefore, is
more suitable to the aged patients with weak constitution, and the patients
with cardiac, pulmonary, hepatic or renal condition and those who are too sick
to sustain drug anaesthesia.
2. Reduced Physiological Disturbance and Rapid Recovery
As acupuncture functions to regulate the physiological condition of the
human body, doctors are able to take immediate measures with acupuncture
according to the subjective signs of the patient to avoid the physiological
disturbance caused by severe pain. Blood pressure, pulse and respiration rates
during the operation remain relatively stable in most cases. After the
operation, patients ' physiological state remain normal, as manifested in early
regaining of appetite and ambulatory activities, and satisfactory healing of
wound. All these are conducive to an early recovery.
3. Subjective Cooperation of the Patient and Improvement of Operative
Results
The patient under acupuncture analgesia is mentally alert and able to
communicate with the surgeons. This enables the surgeon to judge operative
results as the operation proceeds. During thyroidectomy, for instance, the
patient ' s phonation may be tested ; in total laryngectomy, the swallowing
movement can be checked ; in eye surgery for strabismus, eyeball movement can
be examined ; in amputation of trigeminal sensory root and craniocerebral
operation, the limits of facial anesthetic region can be observed. The close
coordination between the patient and surgeon ensures the desirable operative
results.
Simple Apparatus and Easy to Popularize
Acupuncture analgesia does not require any sophisticated medical
equipment and is not restrained by preferential environment. The only
requisites for success are to observe the patient ' s pain endurance
carefully, select well - indicated cases, locate the points accurately and
puncture skillfully. The practice across the nation has proven that
acupuncture analgesia is more practical in backward regions where emergency
surgery is possibly delayed due to lack of necessary medical equipment.
Acupuncture analgesia was created in the 1950 ' s in China. With
researching for more than twenty years, some noteworthy experiences have
been accumulated. Like any other science and technology, acupuncture
analgesia has a long way to go from imperfection to perfection. Though the
mechanism of acupuncture analgesia has been preliminarily outlined, further
studies are still needed to reach a thorough explanation. Acupuncture
analgesia is able to raise pain threshhold and endurance, but there still
exist some drawbacks, such as incomplete analgesia and muscular tension
which is likely to cause discomforts due to retraction of internal organs in
an introabdominal operation. In this case, administrating a small dose of
anesthetic drug or puncturing some acupoints will relieve the pain and
discomforts of the patients.retraction of internal organs in an
introabdominal operation. In this case, administrating a small dose of
anesthetic drug or puncturing some acupoints will relieve the pain and
discomforts of the patients.
II. PREOPERATIVE PREPARATIONS FOR ACUPUNCTURE ANALGESIA
1. Explanatory Work to the Patient
As the patient under acupuncture analgesia is mentally alert during the
surgical operation, it is essential to consider his attitude toward
acupuncture analgesia and his spiritual behaviour because these may afTect his
physiological function, pain endurance and ability to accept the operation. It
is necessary to let the patient know in detail the characteristics, methods,
process, effects of acupuncture analgesia, the operative procedures, and the
reaction and sensation caused by needling. It is also important to make the
patient mentally relaxed so that he can cooperate with the surgeons to ensure
the successful operative results.
2. Preliminary Test of Needling and Pain Endurance
Before acupuncture analgesia, one or more points may be selected on the
body of the patient for preliminary test of needling. With this, the patient
can experience the needling sensation, free his nervousness from acupuncture
analgesia and adapthimself to the needling stimulation. On the other hand,
when he knows the tolerance of the patient, the surgeon can decide the method
and intensity of stimulation in the operation. Also, physical or chemical
stimulation can be applied to measure the patient ' s pain endurance. Anyway,
the purpose of pain endurance test is for precise determination of the
stimulation intensity in acupuncture analgesia.
3. Practice of Deep Breathing
Instruct the patient under thoracic - abdominal operation to practise slow,
deep abdominal breathing before operation. It can relieve stuffiness of the
chest, heavy sensation and dyspnea after the chest is opened up. In abdominal
surgery, deep breathing helps to ease the patient of the muscular spasm,
nausea and vomiting caused by retraction of internal organs.
4. Preoperative Plan of Acupuncture Analgesia
The close cooperation between the acupuncturists, surgeons and nursing
staff is indispensable for successful operation with acupuncture analgesia.
The patient ' s psychological state, case history and focus of infection should
be brought to thorough analysis and discussion. Prediction of the problems
possibly occurring under operation and corresponding emergency measures will
guarantee a safe operation on a fully conscious patient.
III. PRINCIPLES OF SELECTING POINTS FOR ACUPUNCTURE ANALGESIA
Since it is through stimulating certain particular acupoints of the body
that the acupuncture analgesia works, it is important for the operators to be
well versed in the appropriate needling stimulation as well as the accurate
point location. The commonly used methods in selecting points are summarized
as follows :
1. Selecting Points According to the Theory of Meridians
Traditional Chinese medicine holds that the twelve regular meridians
connect interiorly with the zang - fu organs and exteriorly with the four limbs.
Each of the meridians has its own pathway and connects with the other in view
of the exterior - interior relationship. The method of selecting points along
the meridians is therefore based on the concept embodied in the theory of the
meridians " where a meridian traverses, there is a place amenable to
treatment. "
2. Selecting Points According to Syndrome Differentiations.
Traditional Chinese medicine emphasizes the concept of the organic
integrity of the human body. When any portion of the body is diseased, various
symptoms and signs may be manifested through the meridians connecting with
that portion. In acupuncture therapy, it is important to apply the theory of
zang - fu organs and theory of meridians to syndrome differentiations, so is it
in acupuncture analgesia. Before selecting the points, symptoms and signs of a
disease must be differentiated and then their relation with the zang - fu organs
and meridians be found out. Attention should also be paid to the patient ' s
responses that may be elicited in the operative procedure. For example, in the
chest operation, the patient is likely to experience palpitation, shortness of
breath and anxiety in the preoperative period or during the operation.
According to the theory of traditional Chinese medicine, these symptoms are
caused by the disturbance of heart qi. Thus, Ximen ( P 4 ) and Neiguan ( P 6 ) are
usually selected to tranquilize the heart, sedate the mind and regulate the
heart qi.
3. Selecting Points According to Segmental Innervation
Clinical practice and scientific experiments with acupuncture analgesia
show that the nervous system is involved in pain suppression and physiological
regulation of acupuncture analgesia. In other words, the functional integrity
of nervous system is a prerequisite to produce needling sensation and
analgesic effect. Based on the relation of the segmental innervation between
the puncturing site and the operative site, there are three ways to select
points, i.e. 1 ) selecting points in the adjacent segmentation, or in an area
that is supplied by the same spinal nerve or an adjacent nerve that supplies
the operative site : 2 ) selecting points in a remote segmentation, that is in
an area not supplied by the same or adjacent spinal nerve of the operative
site ; 3 ) stimulating the nerve trunk within the same segmentation, that is to
stimulate directly the peripheral nerve which supplies the operative site. For
instance, Hegu ( Li4 ) and Neiguan ( P 6 ) are points of the adjacent
segmentation in thyroidectomy, while Neiting ( S 44 ) and Zusanii ( S 36 ) are
points in the remote segmentation. Futu ( Li18 ) is regarded as a point for
direct stimulation of the cutaneous cervical nerve plexus, known as
stimulating the nerve trunk within the same segmentation. The implication of
selecting points in the adjacent and remote segmentation in acupuncture
analgesia is different from that of selecting the neighboring and distal
points in acupuncture therapy. The latter only denotes the relative distance
between the location of the points chosen and the affected area to be treated.
Selecting points far from the affected site is known as the method of
selecting distant points, while selecting points near the affected site is
known as the method of selecting adjacent points. Neither method is related to
segmental nerves of the puncturing site and operative site. For example, for
analgesia in thyroidectomy, Hegu ( Li4 ) and Neiting ( P 6 ) are chosen as
adjacent points according to segmental innervation ; but from the point of view
of the relative distance between these points and the operative site on the
neck, they are considered as distant points.
4. Selecting Auricular Points
This is to select the corresponding auricular areas according to the
operative site and its involved internal organs. For example, auricular
Stomach Point is chosen for subtotal gastrectomy. Auricular points are also
selected according to the theory of zang - fu organs. For instance, " the
lung dominates skin and hair ; and Lung Point is often chosen in various
operations ; while the kidney dominates the bone, " and Kidney Point is
often selected in orthopedic surgery.
Moreover, reaction spots on the auricle may be selected as well. When an
internal organ or area of the body is affected, some reaction spots with
tenderness, reduction of electro - resistance, deformation of auricular
structure and discoloration may occur on the corresponding auricular areas.
These reaction spots may be chosen for acupuncture analgesia.
According to therapeutic experience, Ear - Shenmen and Inferior Crus, i.e.
Sympathetic Nerve Point are effective for sedation and pain suppression. They
are therefore widely used in auricular acupuncture analgesia.
IV. MANIPULATION TECHNIQUES
Based on the arrival of qi, hand - manipulation and electro - pulsating
stimulation are commonly used in acupuncture analgesia.
1. Hand Manipulation
This is the basic stimulative method. Even if electro - stimulation is
applied, it is also started with hand manipulation. The electro - apparatus is
not employed until the patient feels the needling sensation. Hand manipulation
is to lift - thrust and twist - rotate
2. Electric Stimulation
After the desired needling response is obtained by the hand manipulation,
the outlet of the electric acupuncture apparatus is attached to the handle of
the filiform needle, and the current will get through to the body. Clinically,
the electric pulsating is divided into continuous, sparse - dense and
intermittent three kinds, mostly in the form of biphasic spike or rectangular
wave 0.5 to 2 msc. in width. But biphasic sinusoid or irregular sound wave may
also be used. The frequencies of electric pulse are of two kinds : two to eight
times per second and forty to two hundred times per second. The stimulation
force should be adjusted according to the patient ' s tolerance. Generally,
acupuncture analgesia requires powerful stimulation which may be increased
gradually up to the highest limit, the one which the patient can stand. Each
time of continuous electro - stimulus can not be too long, in case it produces
too much stimulation to destroy patient ' s needling sensation. If a longer
electro - stimulus is needed, the intermittent electric pulsating can be
selected. The stimulation should be started from zero and added to the desired
level gradually and when it is turned down, it should be reduced slowly. It is
not advisable to produce abrupt stimulus, which may make the patient
unbearable.
3. Induction and Retaining of the Needle
Needling or electric stimulation manipulated on the selected points for a
desirable length of time prior to the operation is known as induction. The
intensity of needling stimulation should be proper and induction period is
about twenty minutes, or longer if the result of pain endurance test is unfavorable.
By means of induction, the patient may adapt himself to the stimulus of
acupuncture analgesia. At the same time, it can also regulate the function of
various internal organs of the body, preparing the patient for surgical
operation. At certain operative stages when the operative stimulus is mild,
hand manipulation may be stopped or the current for electric stimulation cut
off. This is so called retaining of the needle. Before the operation proceeds
to a stage of vigorous stimulation, it is necessary to restart the hand
manipulation or electric stimulation so as to maintain and strengthen the
analgesic effect.
IV. ADJUVANT
In order to enhance the effect of acupuncture analgesia and guarantee the
operation to go on smoothly, some adjuvant in small doses should be given to
almost every case of acupuncture analgesia. Though some operation with
acupuncture analgesia can be done without the help of any adjuvant, the
analgesia effect will be more favorable if small doses of adjuvant are
administered before or during the operation.
1. Adjuvant for preoperative administrations : Usually Dolantin is given
intra - muscularly or dropped intravenously fifteen to thirty minutes prior to
an operation, generally 50 mg dose each time for adults, and 0.5 mg each kg
body weight for children. When necessary, Promethazine ( Phenergan ) is added at
the same time, 25 mg for adults, and 0.5 mg each kg body weight for children ;
or Chlorpromazine ( Wintermin ) 12.5 mg for adults, and 0.5 mg each kg body
weight for children.
Atropine and Hyoscine ( Scopolamine ) are used in order to keep the
respiratory tract unblocked. Atropine is given 0.5 mg for adults, and 0.01 mg
each kg body weight for children subcutaneously or intramuscularly ; Hyoscine
is given 0.3 mg for adults subcutaneously or intramuscularly with the
exception of the aged and infants.
2. Adjuvant during operations : Some proper adjuvant are given according to
different stages of operations and different reactions the patients show. Adjuvant
for local analgesia are mainly administered, for instance, - Neocaine ( Procaine
Hydrochloride ) , Lidocaine ( Xylocaine ) , Dicaine ( Pantocaine ) , etc., for local
infiltration and blockage. The amount of the adjuvant being used should be as
small as possible so as to lessen patients ' discomforts. Heavy doses of some
sedatives will not only do harm to the health of the patient, but also cause
unconsciousness or hypnotism. The patient will be unable to communicate and
cooperate with the surgeons, and thus the result of the acupuncture analgesia
and the operation will be affected.
VI. REMARKS
1. Because the patient is fully conscious during the operation under
acupuncture analgesia, surgeons should preoperatively make the whole procedure
of the operation known to the patient so as to gain the patient ' s cooperation.
Surgeons should have an amiable attitude, well - prepared measures, observing
blood pressure, pulse and respiration rate attentively during the operation,
and reducing the patient ' s discomforts as far as possible.
2. The patient ' s chief complaint should be attended during the operation.
When discomfort occurs, appropriate measures should be taken in time to
relieve it, and the patient should be comforted to maintain his confidence.
The amount of the adjuvant should be proper, either overdose or under dose is
harmful to the patient ' s health or to the proceeding of the operation.
3. In order to promote the effect and lessen the sub cortex bleeding, an
appropriate dosage of physiological saline with the addition of a little
adrenal may be used subcutaneously in the incision region before the skin
incision in some operations.
4. Patients may regain appetite and ambulatory activity soon after an
operation under the guidance of the medical workers besides general nursing
care, and those are conducive to an early recovery
Clinical trials
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