ACUPUNCTURE ANESTHESIA IN THE RADICAL OPERATION OF THYROID CANCER

Zhou Quanrui, Chen Benlu, Fang Banian

(Fujian Provincial Hospital, Fuzhoit)

The paper enumerates 129 adult cases, 59 male and 90 female, of thyroid cancer, on whom 134 operations under acupuncture anesthesia were performed, and 6 of them received bilateral radical thyroidectomy.

Selection of points

The points selected were divided into three groups. With the first group either body surface or auricular acupuncture was used in 21 operations; the second, both were used in 25 operations; and with the third, body surface and nasal acupuncture were used in 88 operations.

The points for body surface acupuncture were Hegu, Neiguan. If body surface acupuncture was used alone, two or three points near the operative areas should be added. The points for auriculo-acupuncture included Shenmen, Jiaogan, Fei, Jing, and those for nasal needling contained Shuanger, Fei through Xin, Yanhou. The points were used uni-laterally or bilaterally.

Stimulation

The punctured needle stopped when there came needling sensation; it was connected to a G6805 electric acupuncture-anesthetic device for induction, which lasted about half an hour. The frequency of stimulation was 4~10 Hz for body surface acupuncture, 40-100 Hz for auricular and nasal acupuncture. The strength of electric voltage varied according to the endurance of each patient.

Criteria of Gradation

The patients were grouped into four grades according to the effect of acupuncture analgesia, the rate of successful operations and the dosage of analgesics applied. Less than 2mg/kg of Pethidine were used in Grade I and II, less than 3mg/kg in Grade 111, over 3mg/kg in Grade IV; less than 5ml of 0,5-1% Procaine in Grade I, less than 10ml in Grade II, less than 20ml in Grade III, and more than 20ml in Grade IV.

Results

The patients who took points of the first, the second or the third group under the same supplementary analgesics, accounted for 47.6%, 60%, and 85.7% respectively, in Grade I and II.

Statistically, there was no significant difference between the first and the second group, but marked difference was noticed between the third and the second or the first.

The rest with regard to the third group. (32 operations) routinely received 5mg of Haloperidol and the fourth cervical nerve block on the operative side with the mixture of 1% lidocaine and 0.25% Dicaine, 4 or 5ml of which contained 1/200,000 Adrenaline. A very significant difference was shown by the increasing percentage from 33.9% to 78.1% in Grade I before and after the use of drugs, such as Haloperidol.

Experience

The result shows 1) the best effect is produced by body surface acupuncture associated with nasal acupuncture and the points may have relative specificity; 2) the appropriate dosage of non-cortex inhibiting sedatives and analgesics can enhance the effect of acupuncture anesthesia, and relieve the unease of the body from a prolonged operation and a posture of the back-held head; 3) the local nerves should be exposed and cut as soon as possible during the operation so as to reduce the pain; 4) In over-four-hour operations the effect of acupuncture anesthesia may markedly decrease; and 5) clinically, there are many factors which influence the effect of acupuncture anesthesia, often with several of them acting together, so active measures should be taken to maintain a stable acupuncture anesthetic effect.