Electro-acupuncture analgesia in major abdominal surgery

Advocates of acupuncture treatment for anesthesia have long suggested that it may be used as a replacement for conventional anesthesia with a claimed effective rate of 90 per cent (1). Indeed, it has been historically for anesthesia (2). A randomised, controlled study involving 250 cancer patients undergoing abdominal or pelvic surgery aimed to assess the use of electroacupuncture as the sole analgesic within a standard anaesthetic(3). Data collected from 233 of the patients (120 in the electroacupuncture treatment group, 113 in the control group and the remaining 12 patients were withdrawn for various reasons including lost randomised envelopes and cancelled surgery). The two groups were statistically matched as regards weight, sex, age, height and type of surgery.

Whilst there was no difference between the two groups in the anaesthetic dose requirements (related to body weight and duration of surgery), all of the patients in the control group required fentanyl whereas only 7 out of the 120 patients in the treatment group (i.e. 5%) needed it, and then at much lower doses than the control group. Furthermore, patients in the treatment group recovered spontaneous respiration and were extubated more quickly than patients in the control group. 74.1 per cent of patients in the treatment group recovered within 30 minutes following surgery compared to 55 per cent in the control group, and patients in the treatment group were extubated an average of 36 minutes earlier than those in the control group.

Transcutaneous electrical nerve stimulation (TENS) was used for post-operative pain relief in the treatment group, while the control group received non-narcotic analgesics. There was no significant difference in the number of patients complaining of pain, but the requirement for additional pain relief was less in the TENS group.

Finally, the return to normal self-caring was significantly improved in the acupuncture group. The researchers suggest that "practically and economically this is probably the most important beneficial aspect of electro-acupuncture demonstrated by this study".

(1) Groupe recherche en anesthésie par acupuncture (1972) L’anesthesie par acupuncture. Ann Anesth Franc XIII,4;627-34.

(2) Beijing Children Hospital (1975) A clinical analysis of 1,474 operations under acupuncture anesthesia among children. Chinese Medical Journal 1;5:369-74.

(3) Poulain P, Pichard Léndri E, Laplanche A et al. Electroacupuncture analgesia in major abdominal and pelvic surgery: A randomised study. Acupuncture in Medicine May 1997 vol. 15 No 1, 10.

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Acupuncture used to alleviate postoperative pain after total knee replacement
The benefits of acupuncture in alleviating pain are now well recorded, however a recent German study gave an interesting insight to the possible applications in post-operative pain.

In a randomised placebo-controlled single-blind trial with cross-over involving fifty patients, researchers monitored the analgesic effects of single-point acupuncture with manual stimulation of the needle. The patients were randomly selected to either an acupuncture treatment group or a placebo treatment group. Those patients in the acupuncture group received a single-session, single-point acupuncture treatment using manual stimulation of the needle. A special distal point for knee pain located on the homolateral arm according to the principles of traditional Chinese acupuncture was used. The patients in the placebo group (control group) were given a simulated acupuncture treatment where the needle was not actually inserted into the patient. 

The patients’ levels of pain were assessed before and after treatment using the visual analogues and the reduction of postoperative pain in the acupuncture group was found to be highly significant when compared to the placebo group. Furthermore, the results of pain reduction during the 24 hours following the treatment revealed that the acupuncture treatment’s analgesic effects lasted for several hours at a time.

Acupuncture against postoperative pain after total knee replacement - A
placebo-controlled trial on immediate effects. Aktuelle Rheumatologie (Germany) , 1995, 20/4 (131-134)

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Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer
Researchers at the Research Center on Pain, Zhong Shan Hospital, Shanghai Medical University investigated the effects of Chinese herbs (TCM), ear-acupuncture (EA) and epidural morphine (M) used to relieve postoperative pain and abdominal distension in sixteen male patients suffering with primary liver cancer. 

In a double blind, randomized study , the patients received (2 mg or more) of morphine before the peritoneum was sutured. TCM (administered orally ) and ear-acupuncture were given 24 hours after operation. 50-100 mg of pethidine was given when the pain intensity on a scale of (0-100) exceeded 50-70. 

The researchers used various parameters to monitor the efficacy of the treatments including plasma leucine enkephalin (LEK) levels , the total dosage of narcotics administered in the five days following their operation, the patients’ scale rating of pain and pain relief (0 - 100) , abdominal distension, urinary retention, constipation, etc. 

The results revealed that those patients who received TCM (along with the other therapies) fared better than those patients who were given a TCM placebo. The TCM, EA, and M reduced the use of narcotics by 650, 450 and 550 mg respectively when compared with placebo. The effects of TCM and M were of statistical significance . Both TCM and EA minimized abdominal distension and urinary retention, while M prolonged them. As compared with the placebo, TCM and EA also accelerated restoration of normal bowel movements.

Li QS; Cao SH; Xie GM; Gan YH; Ma HJ; Lu JZ; Zhang ZH. Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Research Center on Pain, Zhong Shan Hospital, Shanghai Medical University. Chin Med J (Engl) (CHINA) Apr 1994, 107 (4) p289-94

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