ACUPUNCTURE ANAESTHESIA EPIDURAL BLOCK AND COMBINED ACUPUNCTURE ANAESTHESIA FOR PROSTATECTOMY

Cai Baoxian, Zhuang Xinliang, Hua Huijuan, Wang Zhendi, Chen Shoulin, Xu Guigen

(Shanghai First People's Hospital, Shanghai)

In this paper, the analgesic effects and hemodynamic changes of three anesthetic methods for prostatectomy were compared. They are acupuncture anaesthesia, epidural block, and combination of acupuncture anesthesia with minimal doses of epidural block,

I. Analgesic effect. Incidences of pain occurrence during seven operative procedures including excision of skin, digital separation of the prostate gland were compared. Degrees of pain are divided into four grades; painless, slight, moderate and severe pain. In acupuncture group pain occurred in 70% of the cases, of which 11.4% were moderate pain and 3% severe. In epidural block group, pain was noted in 11.4% of the cases, all having slight pain. Amount of local anaesthetic solution used was 15.2 (8-20) ml in each patient. In the combined acupuncture anaesthesia group, the local anaesthetic solution given was 4.1 (3-5) ml, only 27% of that used in the epidural block group. The pain occurrence rate in the later is less than in the acupuncture anaesthesia group, being 57.1%, and no one was severe.

II. Hemodynamic changes. In the epidural block group, cardiac output was reduced by 11%, cardiac rate increased 11% and mean arterial pressure fell S%. In the acupuncture anaesthesia group, changes were not marked while in the combined acupuncture anaesthesia group no distinct changes occurred except for a reduction of cardiac output by 7%. During operation the least change occurred in the epidural block cases. In those cases under acupuncture anaesthesia increased cardiac rate and elevation of mean arterial pressure were seen, particularly during digital separation of the prostate gland. Similar changes occurred in the combined acupuncture anaesthesia cases, but with less amplitude; no abrupt changes of blood pressure and cardiac rate were encountered upon digital separation of the prostate gland. Postoperatively, all the three group had depression of mean arterial pressure; the most marked was in the epidural block cases, being 12%. Analyzing the relation of pain with the cutaneo- and musculo-electric changes and the variation of plethysmograph, respiratory waves, blood pressures and cardiac rate shows that the musculoelectric discharges value of the brow muscle has the maximal coincidence rate to the pain with only pseudo-deviation. Other physiological indices have also high coincidence rate with the pain but are influenced by multiple factors and giving more pseudodeviations. Synchronous changes of several indices usually imply moderate or severe pain.