COMBINED ACUPUNCTURE ANESTHESIA IN HYSTERECTOMY

Ma Lihua, Hu Shulan, Wang Kuan, Wang Sulin

(The Third Hospital, Beijing Medical College, Beijing)

Acupuncture anesthesia in hysterectomy has the advantages of minimal physiological disturbances, and quick postoperative recuperation, but in some cases the disadvantages of incomplete analgesia, muscular tightness, intestinal protrusion and visceral traction reaction still hinder some extent to the operative manipulations. Therefore, the combined acupuncture anesthesia has been employed, its effects studied and compared with these of acupuncture anesthesia and those of extradural anesthesia.

The patients were divided into three groups

1. acupuncture anesthesia group, 20 cases. The acupoints selected were bilateral Nei-madian, Sanyinjiao, Ciliao, Wushu, for electrical stimulations.

2. Combined acupuncture anesthesia group, 18 cases, the acupoints used were the same as in the first group excluding Wushu, the extradural tube was inserted upwards between lumbar 2-5, and 5-8ml of 1-1.4% lidocaine were injected before abdominal incision.

3. Extradural anesthesia group, 19 cases. Two tubes were placed, one upwards between lumbar 1-2, one downwards between lumbar 3-4, 8-14ml 2% lidocaine were injected through the upper tube before skin incision. Anesthetic drug was given through the lower tube only after opening the abdominal wall.

Premedication given in the first group was fentanly 0.lmg and properidal (Halope-ridol) 5mg intravenously. In the second and third group dolantine 25-50mg and phenergan 12,5-25mg were given intramuscularly or intravenously. In some cases sodium luminal and scopolamine were used, and dolantine or fentanyl was added during operation if necessary.

Results:

1. In both the combined acupuncture group and the extradural group, the analgesic effect was good, and the visceral traction reaction was slight. There was no intestinal protrusion. The analgesic effect was definitely better than that of the acupuncture group (P<0.05).

2. The anesthetic drug used in extradural group was 1.55 times more than that used in the other two groups, while the premedication in the combined acupuncture group and acupuncture group was 77.1% and 63.9% more than the extradural group respectively.

5. The changes of blood pressure and pulse rate were most marked in the extradural group, mild in the combined acupuncture group, and least in the acupuncture group.

4. Vasopressor were used more frequently and usually in large doses in the extradural group, and in this respect the combined acupuncture group ranked second.

5. In both the acupuncture group and the combined acupuncture group, the patients passed flatus much earlier and analgesic drugs were used much less than in the extradural group.

Clinical practice indicates that the combined acupuncture anesthesia brings forth the regulatory effect of acupuncture on the physiological function of the organism. Therefore it possesses the advantages of stabilizing the cardio-vascular state during operation and promoting a quick postoperative recovery. Since the amount of anesthetic drug used is small, the safety of the procedure is guaranteed.