CESAREAN SECTION UNDER ACUPUNCTURE ANESTHESIA

Acupuncture Anesthesia Research Group, Beijing Obs and Gyn Hospital

A study on the method of using supplementary medication was carried out for further improving the efficacy of acupuncture anesthesia (AA). In cases of planned cesarean section under acupuncture anesthesia, the effect of A.A. with the use of various dosage of local anesthetics for abdominal wall and different types of general analgesics were observed.

1. The relationship between the efficacy of A.A. and the dosage of local anesthetics used.

According to our A.A. routing, 50 mg of pethidine was given intravenously 10 minutes preoperatively. Various dosage of 0.5% procaine was used locally in 3 groups: Group I, no local anesthetics was used as control in 102 cases; Group II, 10 ml was given in 39 cases and Group 111, 25-30 ml injected subcutaneously into the skin incision and at the upper, middle and lower points on the fasia for local block in 73 cases. According to the clinical grading, the efficacy of A.A. showed that Grade I were 29.4%, 33.3% and 46,6% in groups 1 to 3, respectively, P<0,05. The excellent rates were 78.4%, 66.7% and 86.3% respectively, P<0.05. It showed the efficacy of A.A. is signifcantly improved in those with a perfect local block on the abdominal wall.

2. Different kinds of analgesics were given in cases with 0,5% procaine 23-30 ml locally for the skin incision. It again divided in to 4 groups: 1) with pethidine 50 mg i.v. after delivery of baby; 2) 50 mg i.v. 10 min. before operation; 3) pethdine 50 mg and phenergan 25 mg i.v. 4) or pethidine 50 mg and haloperidol 5 mg i.v. 10 min preoperatively. The efficacy of A.A. blood pressure and pulse during operation and occurence of asphyxia of newborn were compared.

AA. excellenct rates of the 4 groups were 76.5%, 86.5%, 86.1% and 88.6% and Grade I rates were 47.1%, 46%, 47.2%and 42,9% respectively, P>0.05. There was no significant difference.

The incidence of neonatal asphyxia in each group was 5.9%, 5.4%, 8.5% and 2,9% respectively. They were all due to the obstetrical factors such as, overterm pregnancy, intrauterine distress, etc.

The blood pressure raised up in pethidine group when the baby was being delivered and during suturing of the uterus. The blood pressure lowered when the baby was being delivered in haloperidol group, and was stable in pethidine & phenergan group. In all cases the pulse rate increased during delivery of the baby and the amount of blood loss was within 200 ml.

The results showed that at present incomplete abatement of pain on the abdominal skin is an important factor that affects the excellent rate of cesarean section under A.A. However, its efficacy can obviously be improved by using supplementary local anesthesia for abdominal wall to attend perfect block with the routine A.A. procedure. Thus the characteristic of A.A. will still be maintained.