Acupuncture as a Method of Surgical Anesthesia

General Considerations

Although acupuncture has been practiced in China for more than 3,000 years, acupuncture anesthesia for surgical purposes was only developed and first used in 1958. It is an achievement that stems directly from a meaningful interaction between traditional Chinese medical practices and modern Western theories of neurophysiology and neuroanatomy.

In the late 1950s, Chinese medical workers began to question whether or not acupuncture, which had traditionally been used to relieve symptomatic pain, could also be used to block pain during surgical procedures. This line of inquiry led to the development of techniques now referred to as acupuncture anesthesia or, more correctly, analgesia. The first successful operation performed using this technique was a tonsillectomy for which the Ho Ku (84, CO 4) point located between the first and second metacarpals was chosen. Reports of its successful use in surgery of the head, neck, chest, abdomen, and extremities soon followed. As a result of extensive procedures performed on some thousands of patients over the ensuing 20 years, the techniques for inducing analgesia were considerably refined; they have been made simpler and safer, and their results have become more effective. Various recent reports indicate that between 15 and 25% of all surgery in China’s major hospitals is now performed using acupuncture anesthesia. A success rate approaching 90% has been reported.

From the time it was first introduced in 1958 until the end of 1973, it is estimated that approx-imately 600,000 surgical procedures using acupuncture anesthesia were performed in China alone. Regardless of whether or not the given statistics are accurate, this new development in the way acupuncture can be used in association with both major and minor surgery can be seen as the beginning of a new chapter in the history of medicine-one which is providing a new impetus for studies into the role acupuncture should play in the delivery of optimum medical care in Western societies as well as in China.

Since the introduction of ether, Western physicians have come to depend heavily on pharma-cological agents for inducing anesthesia, in spite of their many adverse effects upon patients both during and after surgery. Acupuncture now offers a relatively safe and simple alternative for accom-plishing the same results-painless surgery-while avoiding adverse side effects altogether. It is more convenient to perform, for it requires no elaborate equipment, and is thus inexpensive to deliver. During surgery, patients are fully awake and can cooperate with their surgeons. Since the side effects associated with chemical anesthesia are eliminated, patients have a much easier time in the immediate post-surgery period as well as suffer less from the effects of surgical trauma. Their convalescence is briefer and they are usually ambulatory much earlier than when undergoing conventional anesthesia. They are able to eat and drink normally much earlier and rarely require prolonged intravenous feeding. There are no cardio-respiratory, pulmonary, or electrolyte complications compared to those experienced by patients who receive general chemical anesthesia.

Selection of Patients

Acupuncture anesthesia requires the understanding and cooperation of the patient, both before and during surgery. For this reason, very young chil­dren and elderly persons may not always be the best candidates for this type of anesthesia. However, because of the overall safety and lack of com-plications associated with it, it may often be the preferred method in certain older patients for whom conventional anesthesia is considered too risky or is otherwise contraindicated. Reports of acupuncture anesthesia used for surgery performed on children of 1 day to 14 years of age do, in fact, indicate that it was less successful than conventional anesthesia in approximately 5-10% of cases. Apprehensive, tense, and anxious patients are also likely to be poor candidates.

Preoperative Preparation

It is essential that prior to surgery patients be given an explanation of what procedures will be performed and how the acupuncture anesthesia is to be  achieved. This helps them gain the confidence necessary to enable them to cooperate actively during the surgery itself. Since patients are fully conscious the entire time, their sensory and motor functions remain normal. Special instruction in abdominal breathing, for instance, for patients about to undergo chest or abdominal surgery can ensure their cooperation during the operation and help reduce chest compression, discomfort, or shortness of breath.

A needling test is also worthwhile. A few selected points should be needled so that a patient may experience the Teh Chi sensation and be relieved of anxiety and apprehension about the pain involved. It is particularly helpful to perform such tests on those who have had no prior experience with acupuncture.

Principles of Point Selection

There are a number of ways in which point selection is done:

According to the Meridian Theory

Those known as the Ching Mo Meridians provide the pathways along which the Teh Chi effect flows and on which the classical points are located. These meridians connect the internal organs with points either on or just below the skin, so that each point is considered to have a very specific relationship to a specific organ. Points located along the appropriate organ-associated meridians are chosen according to the organs involved in the surgery. This approach is illustrated by the traditional saying: “Wherever the Ching Mo pathways pass, there lie places amenable to treatment.” The same principle applies when selecting points for acupuncture anesthesia. In abdominal surgery, for example, acupuncture points lying on the Stomach and Spleen Meridians should be used.

By Anatomical Region

Point selection by anatomical region requires that local and adjacent points be selected along or near the incision. In head surgery, for example, Feng Chih (207, GB 20) and Tou Wei (150, ST 8) are the most commonly used points; for wrist and hand surgery, Ho Ku (84, CO 4), Nei Kuan (68, HG 6), Tung Li (76, HT 5), and Hou Hsi ( 126, SI 3) are the most often used points.

Based on Previous Experience

Stimulation at Nei Kuan (68, HG 6) is effective for chest conditions and is therefore commonly used in thoracic surgery. Stimulation at Tsu San Li (178, ST 36) is effective for treating problems of the gastrointenstinal tract. Tsu San Li (178, ST 36) is a preferred point for use in cases of abdominal surgery.

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