ACUPUNCTURE AGAINST POSTOPERATIVE RESPONSE CAUSED BY SURGICAL TRAUMA

Yang Zhen, Shi Meide, Lu Yuanyuan,

(Experimental Research Department of TCM, Shanghai College of TCM)

Li Chuanqi, Zhu Fengxian, Xiang Liming, Wu Chuande

(Shuguang Hospital, Shanghai College of TCM, Shanghai)

In our study on after-effect of acupuncture, we found the post-operative responses in the patients under acupuncture anesthesia (A.A.) are evidently milder than those under drug anesthesia (e.g. the "post-operative fever" is comparatively lower, its duration shorter, the incisional pain milder, the recovery of intestinal peristalsis earlier, etc.)

In this paper, we selected male patients aged 30-59 years, with same sort of disease, identical in the use of drug, with similar surgical procedures and then divided them randomly into an epidural anesthesia (EA) group (22 cases), an epidural anesthesia combined with acupuncture anesthesia (EA+AA) group (20 cases, after an epidural cathether was inserted in situ, an induction of AA for 15 min was followed, then a routine dose was injected into the epidural space) and an AA group (16 cases) for comparison.

We compared the three groups in electrogastrography (EGG), electrointestinography (EIG), sound recording of intestinal peristalsis and duration of their "post-operative fever," It has been proved that acupuncture possesses a definite physiological efficacy against the post-operative responses caused by surgical trauma, it can also promote the post-operative antitraumatic ability in EA patient.

1. Comparison in duration needed for the initial breaking of wind through anus after operation:

In AA group, the duration needed for the initial breaking of wind through anus after operation was 38.72 hrs. It needed for EA+AA group was 46.69 hrs. That for EA group was 52.9 hrs. (In this paper, the drugs used in EA+AA group and the EA grou pare identical, i.e. 1-2% lidocaine, and the dosages used in the two groups are mainly similar). In comparison the AA group with the EA group, the difference is very significant (P<0.02). In comparison the AA group with the EA+AA group, there is no significant difference (P>0.05).

This demonstrates that acupuncture possesses the physiological efficacy in promoting post-operative recovery of intestinal peristalsis. The same physiological efficacy could also be found in the patient under EA+AA

2. Comparison of "post-operative fever" caused by surgical trauma:

The average duration for "post-operative fever" in AA group was 3.8 days before the body temperature recovered to normal, while that of EA+AA was 4.4 days and that of EA group was 5.4 days. In comparison of the three groups, the difference between the group and the EA group was very significant (P<0.02). While that between the AA group and the EA+AA group had no difference (p>0.05). This demonstrates that acupuncture can shorter the reaction duration of "post-operetive fever." The same phenomenon could also be seen in the patients of EA+AA.

3. Changes of EGG and EIG before and after AA and EA:

After an induction interval of acupuncture, an effective accommodating change could be found in EGG and EIG, i.e., after induction, the EGG and EIG in those patients low in frequency and small in amplitude can be both accommodated to normal level. On the contrary, those with high frequency and large amplitude can be reduced to normal.

If an injection of atropine is given at the induction interval of acupuncture, the function of atropine in depressing the EGG and EIG can be found antagonized.

After EA the changes in frequency and amplitude of EGG and EIG are not evident, compared with that before anesthesia. But it is evidently depressed after an injection of atropine. This demonstrates that acupuncture can effectively acommodate the motility function of gastrointestinal tract and antagonize the depressing action of atropine.

4. A synthetical analysis of post-operative peristaltic sound and EIG:

After operation, the EIG was observed and the peristaltic sound listened continuously at certain intervals. It has been discovered that the average degree of depression in EIG and peristaltic sound of intestine in AA group and EA+AA group were evidently less than those seen after EA. The average time needed for depression in peristaltic sound and EIG before its recovery to normal in the former two groups is shorter than that of EA group.

It demonstrates that acupuncture possesses the physiological efficacy in antagonizing the depressive action upon intestinal peristalsis caused by surgical trauma. This could be one of the main reason why the initial break wind is earlier in AA group.

From the above results, it is proved that acupuncture possesses the physiological efficacy against the responses caused by surgical trauma. The discovery of the fact that the ability of patients in antagonizing surgical trauma could be enhanced with the application of acupuncture in the operation under EA may be of great importance both in the research of principle of AA and its clinical application So it is a problem worth further investigation.