U.D.G.N. De Silva , M.De Silva, S, Hettige, H. Jayakodi,
Open international university for complementary medicine (OIUCM)
Correspondence – gayanthi.silva@gmail.com
ABSTRACT
Acupuncture is a healing art in traditional Chinese medicine. Acupuncture has existed for over 2,000 years; its application as an anesthetic began in 1950 in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy, and after that, major and minor surgical procedures took place. Acupuncture Anesthesia is a technique used to induce an anesthetic effect through needling during a surgical procedure. Anesthesia is a state of controlled temporary loss of sensation or awareness that is induced for medical purposes. The risk of complications during or after anesthesia can be divided into major and minor risks. The aims of this research study were to identify surgeries that have been performed under acupuncture anesthesia; acupuncture points were used and identify the efficacy of acupuncture anesthesia. The most used acupuncture points are Hegu, Sanyinjiao, Neiguan, Zusanli, and Taizong. Acupuncture Anesthesia is effective in analgesia, immunomodulation, and organ protection, promising fast recovery, safer without drug-related adverse effects, keeping patient consciousness, and making economics simple. It was beneficial before the surgery, during surgery, and after surgery. Therefore, it is important to review the place of acupuncture in anesthesia to develop this, and it will contribute to healthcare service.
Key words: Acupuncture, Acupuncture anesthesia, Acupuncture points, Analgesia
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INTRODUCTION
Background
The awareness of and interest in complementary and alternative medicine is increasing among patients and health care providers worldwide. The process of acupuncture involves the use of small needles placed at specific points along the energy meridians in the body to regulate the flow of ¨Qi¨ (vital energy) along the pathways to help restore the patient to health. The number of surgeries has been increasing continually in recent years. This led to the emphasis on the importance of anesthesia. Acupuncture anesthesia is a method of inducing an anesthetic effect through needling for a surgical operation. In 1958, the first reported surgery performed with only acupuncture as an anesthetic in China indicated the official beginning of Acupuncture Anesthesia (1). The clinical application of Acupuncture Anesthesia started with small-scale surgical operations and expanded to major surgeries. The acupuncture anesthesia—analgesia was invented by Chinese medical practice according to the function of acupuncture to relive the pain and regulate the physiological functions of the organ.
Justification
Anesthesia is a state of controlled temporary loss of sensation or awareness that is induced for medical purposes. (2) The risk of complications during or after anesthesia can be divided into two types. Death, cardiovascular collapse, respiratory depression, embolism (aair, thrombus, venous, and arterial), hypoxic brain damage, direct nerve damage, aseptic meningitis, and damage to the spinal cord can be classified as major risks and Nausea, vomiting, headache, backache, pain, bleeding, infection, sore throat, and laryngeal damage classified as minor risk. (3) Acupuncture anesthesia applies before surgery for depressive prevention, regulates the physiological function of organs, and reduce the complication before during and after surgery.
OBJECTIVES
1.
Identify the conditions/ surgeries that have been done under Acupuncture Anesthesia.
2.
Find out the most used acupuncture points in Acupuncture Anesthesia.
3.
Identify the efficacy of Acupuncture Anesthesia
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LITERATURE REVIEW
Acupuncture anesthesia is a method of including an aesthetic effect through needling for surgical operation. (4) The clinical application of acupuncture anesthesia started with small-scale surgical operations and then expanded to major surgeries. Acupuncture anesthesia was safe without drug-related adverse reactions. Less bleeding is due to the patient being conscious. Physiological functions of the body, such as the pulse rate and blood pressure, remained consistently stable during anesthesia. Increasing experimental and clinical evidence supports that acupuncture and related techniques are effective in analgesia, immunomodulation, and organ protection. Acupuncture has both anti-hypontensive and anti-hypersentive effcts as well(5)
Mechanism of Acupuncture Anesthesia
Acupuncture anesthesia applies before surgery for depressive prevention and regulates the physiological function of organs and the body and mind. It anticipates the upcoming trauma to the body. This anticipation, anxiety, and stress can decrease the immune system and cause other stress-related symptoms, such as digestive problems and pain. By acupuncture, energy and stress levels were reduced, the immune system was strengthened, and inflammation and pain decreased. Acupuncture anesthesia reduces postoperative pain (pain, vomiting) and has a potential organ (brain, cardiac, muscles, kidney, liver) protective effect. It increases the body’s inflammatory and pain relievers (6). Acupuncture may improve local circulation by dilating blood vessels, which can promote healing and reduce pain in affected areas.
Acupuncture point selection
Acupuncture points and mode of stimulation may significantly affect the outcome of acupuncture. The needling points that easily produce a strong De-Qi sensation through to provide better efficacy. (7)
Needling technique.
To achieve a good effect of acupuncture, it is crucial to obtain De-Qi during needling.
De-Qi refers to a specific sensation of soreness, numbness, 8, and heaviness around the acupuncture point after the needle is inserted to a certain depth. At the same time, the acupuncturist may also feel tenseness and tightness around the needle. If the De-Qi sensation cannot be obtained at the needle insertion, manual manipulation of the needle by lifting trusting and rotating is performed until it is achieved. (8)
METHODOLOGY
.
The present study was planned as a Conceptual study. Study about the Acupuncture Anesthesia will be mainly conducted by articles through searches, using the search terms Acupuncture, Anesthesia, efficacy of Acupuncture Anesthesia; surgeries have done under Acupuncture Anesthesia, Acupuncture points used to Acupuncture Anesthesia, and Mechanism of Anesthesia. Compiled clinical studies and review articles relate to acupuncture anesthesia. Ten journal articles regarding “Acupuncture Anesthesia” were filtered
DISCUSSION
The main objective is developing acupuncture anesthesia as the substitution of chemical anesthetic drugs. These effects are clinically important because higher doses are generally related to higher risks of morbidity, longer duration of recovery, and higher costs. The physiological functions of the body, such as pulse rate and blood pressure, remained stable during acupuncture anesthesia.
Analgesic and Immune function
Acupuncture is effective in analgesia. Gentle acupuncture stimulation induces the “De-qi” feeling and activates the gate control system in the spinal cord to relive the pain. When the needles are twisted up and down repetitively, the deep tissues, particularly muscles, are locally injured, and inflammatory mediators are released. LI 4 (Great Eliminator/Aspirin Point) and St 44 are the best analgesic points that are mentioned in TCM.
The immune function is disturbed by surgical trauma. It is believed that acupuncture anesthesia plays its immunomodulatory role through local immunity. (37)
Organ protection
By effectively managing pain, acupuncture can reduce stress responses in the body, which, in turn, may help protect organs from stress-related damage. Acupuncture can lower levels of stress hormones like cortisol and adrenaline. This reduction can mitigate the risk of stress-induced damage to organs, particularly the heart and kidneys. Acupuncture can enhance circulation and promote better oxygenation of tissues, which is crucial during surgery and recovery. Improved blood flow helps maintain organ function and vitality. Acupuncture has been shown to reduce inflammation. This can be particularly beneficial in preventing organ damage related to excessive inflammation during surgical stress. Acupuncture has been used as an adjunct to traditional anesthesia, helping to reduce the number of anesthetic drugs needed, which can lead to fewer side effects, less pain, and quicker recovery times.
Acupuncture may protect kidney function during surgeries by improving renal blood flow and reducing the incidence of acute kidney injury.
P6 is the most used for postoperative nausea and vomiting, prophylaxis, and treatment. Stimulation of P6 could be a non-pharmacological alternative to antiemetics. Pain management during dental procedures, helping patients who may be anxious about conventional anesthesia.
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According to the TCM theory, the De-Qi sensation indicates a good response to acupuncture. Both manual and electrical stimulation can achieve the De-Qi sensation. The mechanism behind different stimulation techniques may be different. Electrical stimulation, including frequency and intensity, is important to the effect.
Timing of stimulation
According to the TCM theory, the onset of the acupuncture effect is 15–30 minutes. And acupuncture during anesthesia may not be comparable with that in conscious patients. And it is important to establish the right acupuncture point using the De-Qi sensation to enhance the efficacy. (38)
CONCLUSION
Study has been concluded in the following outcome
•
Acupuncture anesthesia involves needling some acupuncture points to reduce or even avoid the use of anesthetics to improve the performance and effects of surgeries.
•
The clinical application of acupuncture anesthesia is used for small-scale surgical operations as well as major surgeries. Most of the surgeries have been performed under acupuncture combined with anesthetics.
•
Acupuncture points have been selected according to the condition and relevant meridians. The most used acupuncture points are Hegu (LI 4), Sanyinjiao (Sp6), Neiguan (P6), Zusanli (St 36), and Taizong (Liv 3).
•
Acupuncture anesthesia features safety, effectiveness, and convenience. Promising fast recovery when acupuncture anesthesia is applied, patients can be conscious during the operation; their blood pressure, heart rate, and respiration are steady. They may be cooperative with surgeries, which is helpful for observation of the conditions. Adverse reactions caused by the anesthetic can be prevented in addition to organ protection, and patients recover fast after surgery with acupuncture anesthesia.
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1.
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2.
Wikipedia ,https://wikipedia.org/wiki/ Anesthesia, (Accessed )
3.
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4.
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5.
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6.
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7.
Z. Lu, H. Dong, 2015, Preoperative acupuncture modulation ;more than anesthesia, British journal of anesthesia, 115(2), (183-193)
8.
Anna Lee, 2006, Acupuncture and Anesthesia, Best practice and Research Clinical Anaesthalogy, vol 20(2) p 303 – 314)
9.
LI Yu,MA Wu, 2008, Comparison of the efficacy of Acupuncture anesthesia with different frequency stimulation for thyroid surgery, Guangdong Medical Journal, (8)
10.
Yang Qiong- huai, MA Wu, 2008, The Clinical study of acupuncture assisted anesthesia in gynaecologic laparoscopy surgery, Guangdong Medical Journal
11.
Xu Tian,2009,Clinical Observation on the Effect of Acupuncture assisted anesthesia for mixed Haemorrhoids surgery, (6)
12.
Amripal Sidu, 2017, Electro acupuncture – Assisted Craniotomy on an awake patient, Journal of Acupuncture and Meridian, studies, vol 10(1)
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P.A.Christensen, M. Rotne, 1993, Electro acupuncture in anesthesia for Hysterectomy,Britsh journal of Anesthesia, 71,p 835-838
14.
Jiang Pan ,2017, Effects of Tooth extraction under acupuncture anesthesia,
15.
Jia Zhou, 2011, Acupuncture anesthesia for open heart surgey, International journal of Cardiology, 150,(1)p 12-16
16.
David Wa Chu, 2003,Acupuncture anesthesia in Inguinal Hernia repair, ANZ Journal of surgery, vol 73, (3)
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17.
Zhongguo Zhong xi,2011, The Application of electro acupuncture combine with sevoflurane anesthesia in neuron surgery, Chinese journal of Integrated Traditional medicine ,1 p1181-1186
18.
Zhou Hong, Tong Wenpu,2001, Clinical study on the Application of Acupuncture Anesthesia to Pulmonary Operation under vedio Thoracoscope,26,(3) p171-171)
19.
Ibid., p 27
20.
Ibid., p 29
21.
Zappol L. 2013, Acupoint index
22.
Prof Anton Jayasooriya ,Acupuncture (Fourteen channels), Medicina Alternativa, 16th edition, p41
23.
Ibid., p51
24.
Ibid., p57
25.
Ibid., p59
26.
Ibid., p65
27.
Ibid., p77
28.
Ibid., p86
29.
Ibid., p93
30.
Ibid., p105
31.
Ibid., p111
32.
Ibid., p119
33.
Ibid., p131
34.
Ibid., p143
35.
Ibid., p147
36.
Ibid., p149
37.
Jing Wang and Yu Wan,2015, Acupuncture mechanisums : Anesthesia analgesia and protaction on organ function, world journal of traditional Chinese medicine, vol 1, p 53- 64
38.
Z. Lu, H. Dong, 2015, Preoperative acupuncture modulation ;more than anesthesia, B anesthesia, British journal of anesthesia, 115(2), (183-193)