ORTHOPEDIC OPERATIONS OF EXTREMITIES UNDER ACUPUNCTURE ANESTHESIA

Xu Cheng

(National Cooperative Group of Acupuncture Anesthesia for Orthopedics)

From Jan. to Oct. 1982, Orthopedic operations on the extremities of 90 patients were performed under acupuncture anesthesia. Among them 57 patients were operated on soft tissue of upper limbs and 33 patients were treated by semilunar cartilagectomy. Prescription I, Tianding and Jiquan on affected side were selected for operations of upper limbs. Prescription II, Huantiao and Chongmen on affected side were used for operations on lower limbs. Electrical stimulation was from 576-D acupuncture apparatus with a frequency of 6000/sec. Electric current strength is limited according to the tolerance of the patient. Pethidine 1-1.5 mg/kg by intravenous instillation were used as premedication. Results of acupuncture anesthesia obtained in operations on soft tissue of upper limbs and semilunar cartilagectomy. Rate of success were 89.5% and 87.9% respectively (P<0,05). Some experiences:

I. There was a significant relationship between effects of acupuncture anesthesia and patient's tolerance to needling. The better the tolerance, the better the anesthesia effect. In 71 cases with good tolerance to needling there was 94.4% success rate, while 19 cases with bad tolerance was observed to have only 68.5% success rate (P<0.05).

II. In this study the acupoints were selected according to near segmental distribution of nerves. It is important that the patient must feel numbness radiated to the operation area. Care should be taken to avoid needle inserted directly into the nerve trunk. Otherwise, there would be two kinds of disadvantages. In the first place, nerve would be injured, though it is reversible demonstrated in some animal experiments. Secondly, if electric impulses stimulates directly into nerve trunk, limb constraction may be so strong that it interferes with the operation. When needle is inserted directly into the nerve trunk, the needle must be withdrawn a little. It doesn't affect the effect of acupuncture anesthesia.

III. In a part of this cases morphine 2mg and NS 2ml by acupoint injection were used as premedication. It was noted that by using such a method a little dose of supplementary drugs was required and the effect of acupuncture anesthesia could be enhanced. Because only a few case were observed this method should await further research hereafter.