ACUPUNCTURE ANAESTHESIA IN POSTERIOR ROUTE CERVICAL SPINE OPERATIONS

Wang Sulin, Ma Lihua, Hu Shulan, Wang Kuan
(The Third Hospital, Beijing Medical College, Beijing)

Acupuncture Anesthesia was used in 38 cases of posterior route cervical spine surgery. 29 patients were male and 9 female. The age ranged from 14 to 70.
The operations performed included decompressive laminectomies for cervical spondylosis, vertebral canal stenosis and ossification of the posterior longitudinal ligament in 27 cases; wiring fixation of spinous processes and bone grafting for atlantolaxial dislocation and subluxation in 8 cases and removal of spinal cord tumor (epidural and subdural) in 3 cases.

Acupoints were bilateral Hegu and Waiguan with electrical stimulation of 3-4 Hz. and the induction time 20 minutes.

Additional Medication: Scopolamine 0.3 mg and sodium luminal 0.2 g were given inlramuscularly an hour before surgery, and haloperidol 2.5-5.0 mg and dolantin 50 mg or fentanyl 0.1 mg were given intravenously through the Murphy's drip 10 minutes before the operation. The average amount of 0.5% procaine used for local anaesthesia was 35 ml. The duration of operation averaged 3 hours and 55 minutes.

In 5 cases local anaesthesia without acupuncture was used as controls. The premedication used was identical with that of acupunctural anaesthesia. The average amount of 0.5% Procaine used was 88.4 ml. The duration of operation averaged 3 hours and 5 minutes.

Analgesic Effect: Adrenaline was added to the local anaesthetic before skin incision for hemostasis and enhancing analgesic effect. The incision of the skin is basically painless. An average of 43.8 ml of 0.5% procaine was used in cases of local anaesthesia and 18,3 ml in cases of acupunctural anaesthesia, which corresponded to 42% of the local anaesthetic used-in cases where local anaesthesia alone was used.

Patients were sensitive to pain during elevation of periosteum of the spinous processes and laminae, during which 58% of the patients with acupunctural anaesthesia and only 20% of those with local anaesthesia did not suffer pain.
During closure of the skin, 48.2% of the patients with acupunctural anaesthesia and 40% of the patients with local anaesthesia alone had no pain.

Discussion:
1) It is feasible to use acupuncture for posterior route operations on the cervical spine as a safe and simple method of anaesthesia. In cases of incomplete analgesia, certain amount of local anaesthetic may be used in addition to acupuncture. The amount of local anaesthetic used in our series corresponded to 40% of that used in cases where IOCE. anaesthesia alone was used- The patient was conscious, under which condition immediate results of the operation could be studied and injury to the nerve prevented, and the patient could complain what he was suffering.
2) Patients should be instructed to practise abdominal respiration preoperatively. Attention should be paid to the management of the respiratory system during the operation. Oxygen could be given and assisted respiration used whenever necessary.
3) Posterior route operation takes longer time and causes more bleeding. Attention
should be paid to the blood pressure, pulse rate and the amount of blood loss, which should be corrected promptly by infusion or/and transfusion.