ACUPUNCTURE ANESTHESIA COMBINES WITH REPEATED SUPERFICIAL CERVICAL PLEXUS BLOCKS

Guo Yongjun, Ma Xiuguang

(Department of Anesthesia, Fifth Hospital of PLA, Yinchuan)

To prevent incomplete analgesia with acupuncture anesthesia, we have added single or repeated superficial cervical plexus blocks on 33 patients undergoing neck and thyroid operations with good results since 1981. Indications and types of surgery included: 17 subtotal thyroidectomies (9 hyperthyroidism, 6 nodular goiter, 2 multiple thyroid tumors), 11 simple thyroidectomies, 2 resections of tumors of the neck, 3 excisions of tuberculous lym-phoid tissues of the neck. Preoperative Pemobarbital Sodium 0.1-0.2 mg or Valium 10-20 mg were given. Choice of anesthesia: Using Hegu and Neiguan point sites to initiate the reaction, we then connect with G6805 acupuncture apparatus. Later we use routine superficial cervical plexus blocks. If the operation is prolonged, we consider continuous blocks by introducing a small catheter into the superior jugular vein which is located slightly above its criss-cross point with the posterior border of the corresponding sternocleidomastoid muscles on both sides. Ordinarily, we inject Procaine 1% and Dicaine 0,25%/mixture 10-12 cc. If the operation is over 2 hours, we inject 4-6 cc of the above mixture. We gave single superficial cervical plexus block anesthesia in 21 cases; repeated blocks in 12 cases. 24 cases (72.7%) did not require auxiliary drugs during operation, among them were 9 subtotal thyroidectomies.

Result of anesthesia. We had no failure in our 35 cases. Skin incising without pain was shown in 31 cases (99.3%): Mobilization of skin flaps and incising muscles without pain, in 30 was shown cases (90.%). Mobilization of thyroid upper or lower poles or its resection without pain, in 22 cases (66.6%). Suturing skin incisions without pain, in 28 cases (84.8%).

Complications of anesthesia: Temporary unilateral recurrent laryngeal nerve block was shown in 2 cases. Postoperative headache for 3-5 days with spontaneous remission, in 3 cases.

Many methods of anesthesia have been used in neck and thyroid surgery and each has its relative merits and demerits. In our 33 cases, the problem of incomplete acupuncture analgesia has been basically solved without encountering serious complications often seen in other methods of anesthesia. Superficial cervical plexus block of the neck could relieve pain of the skin and subcutaneous tissues, muscles and deeper tissues require acupuncture anesthesia. We have used both types, each supplementing the other to reveal their values as follows:

1. No pain in skin incising and mobilization of skin flaps.

2. During operation, auxiliary drugs were reduced to the minimum, leaving the patient awake and capable to cooperate when necessary.

3. Anesthesia complication was comparatively rare.

This is a preliminary report of our few cases. Future observation will continue.