ACUPUNCTURE ANESTHESIA AND COMBINED ACUPUNCTURE ANESTHESIA IN WAR SURGERY

Zhang Renhui, Liu Xin'an, Liang Wanjun, Xia Li, Chen Huifang, Ouyang Fang

(Department of Anesthesia, General Hospital of Guangzhou Unit of PLA, Guangzhou)

Acupuncture anesthesia has been used in selective surgery or trauma-emergency and rich experience has been accumulated, nevertheless, we have not found any report of acupuncture anesthesia in war surgery. For this reason, we summarized 50 cases of war casualties who underwent surgery under acupuncture anesthesia or combined acupuncture anesthesia. The cases were divided into two groups: acupuncture anesthesia group, 38 cases and combined acupuncture anesthesia group, 12 cases. The wounded were not selected before surgery. All the wounded underwent limb surgery except four cases who underwent surgery of head, neck and back,

The acupoints of acupuncture anesthesia group were selected as follows: Futu and Jiquan (or Quchi and Jiquan) for upper extremity surgery, Zusanii and Chengshan for lower extremity surgery, Sibai and Yifeng (or Quchi and Hegu) for surgery of head and neck, Quchi and Jiquan (or Hegu, Fengchi and Sibai) for surgery of multiple injury. 0.5%-1% iprocaine solution was used as a local anesthetic in 36 cases from 38 cases before surgery' started. Acupuncture anesthesia was thought failure, if the amount of procaine solution was more than 30 ml. Dolatine was used in seven cases and the dosage was 50-75 mg. The result from our data showed that it is certain for acupuncture anesthesia to be used in war surgery. In the series of 38 cases the successful rate was 86.8% identical with that reported by civilian hospital. According to the operative areas, the effect of acupuncture anesthesia in head and neck was excellent, the effect in arms was better than in legs, and the effect in multiple injuries was poor. For the cases who had inflammation and swelling of the wound, 1% procaine solution was better than 0.5% procaine solution as a local anesthetic.

Our experience indicates that the effect o anesthesia will be better if some local anesthetic was used before skin-incision, however, when the wounded complained of his pain, the local anesthetic would need more and the effect of anesthesia would be still poor too. Since acupuncture anesthesia does almost not interfere physiological function and it is safer than other anesthesia, blood pressure and heart rate of the cases in this group did not show significant change during surgery.

Combined acupuncture anesthesia group involved 12 cases who underwent lower extremity surgery. The injuries of the wounded were complicated and acupuncture anesthesia was very difficult. The acupoints of this group included Chongmen and Huantiao or Zusanii and Chengshan. An epidural lumbar puncture was performed in all cases before needling, and 5 ml mixture of 1% xylocaine and 0.15% pamocaine was given, then aonther 5 ml was injected through the epidural catheter in five minutes. The mixture would be given again, if needed, till satisfactory anesthesia was obtained. The combined acupuncture anesthesia would be thought failure, if the amount of the mixture was more than 16ml. 4 cases of this group needed less than 10 ml 5 needed 11-15 ml, 3 needed more than 16 ml, and the successful rate of this group was 75%. Not only satisfactory analgesia was obtained, but also the advantage of acupuncture anesthesia was kept in this group including 3 failed cases.

1. The wounded was very sensitive to pain because of inflammation of the wound and overstrain of the nervous system, so acupuncture anesthesia was more difficult. The application of combined acupuncture anesthesia not only improved the effect of analgesia but also kept the advantage of acupuncture anesthesia.

2. It is generally agreed that the effect of acupuncture anesthesia in trauma-emergency of limbs is better than in selective surgery of limbs, and the effect of acupuncture anesthesia in the distal of limbs is better than in the proximal. It could not be proved in our cases. We consider that it may be due to inflammation and swelling of the wound.

3. Blood pressure and heart rate of the wounded of above-mentioned two groups were as stable as it was before surgery, and blood pressure of 1 or 2 who received combined acupuncture anesthesia with epidural anesthesia raised a little. According to the analysis, one of the reason is that the dosage of local anesthetics used was less and the other reason is that needling can regulate the physiological functions of the organism. As a result, combined acupuncture anesthesia showed the advantage of acupuncture anesthesia that it is safer than other anesthesia and the physiological functions were almost not interfered.

4. Combined acupuncture anesthesia is one of the better choices for the cases whose operations can not be performed under local anesthesia alone or who suffer from complicated diseases and need undergo complicated procedure of surgery, for inhalation and epidural anesthesia might lead to risk for the latter. Thus, the complications of anesthesia might be decreased and also beneficial to the rehabilitation.