Jin Defang, Zhou Rongxing, Gao Lida (Hospital of Sichuan Medical College)
50 patients with tumours in the sellar area were operated upon under electrical acupuncture anesthesia from January 1975 to May 1978. The analgesic effects were excellent or good (Grade I or II) in 44 cases and fair (Grade III) in 5 cases. There was one failure (Grade IV). The total rate of Grade I and II was 88%.
The acupuncture points selected in 37 of the 50 cases were Zuanzu, Yuyao, Ermen and Shangguan. In 10 cases, the point used was Quanliao, and in the remaining 3, other points were needled.
The patients' responses, particularly those exhibited during the main surgical procedures were closely observed. Although the operations were uneventfully performed, there were, however, complaints of pain at scalp incision and wound suturing in about 1/5 of the cases. These indicate that pain abatement is incomplete, and that the effect of acupuncture on the scalp is as unstable as that on the skin in other kinds of operations.
Moreover, while tumours were being exposed and removed, some of the patients experienced nausea or vomiting. To prevent these undesirable responses, the authors have taken measures, including the reasonable application of manitol to reduce intracranial pressure, meticulous drain of CSF from the lateral fissure cisterna, avoidance of cautery if the case permits, prevention of contact with the dura mater at the base of frontal cerebral fossa, abstention from touch on the olfactory sulcus and cribriform plate, protection against retraction of the frontal lobe, and prevention of anoxia and hypotension, etc. Owing to these measures, the incidence of nausea and vomiting has been lowered. If these symptoms do occur, they may be alleviated by needling the points such as Neiguan, Hegu and Jianshi.
As the points (Zuanzu, Yuyao, Ermen and Shangguan) were in the vicinity of the nerve trunks near the operation field, the landmarks for needling were quite clear to the acupuncturist. After switching on the stimulator, sensation of numbness in the innervated areas was induced, and the pain thresholds of the related areas were elevated on examination. This shows that definite analgesic effect, though unstable on the scalp, is produced by acupuncture.
Since the patients were perfectly conscious during operation, many of them appreciated an improvement in their impaired visual power immediately after the pressure on the optical chiasma was removed by eradication of the tumour. Consequently acupuncture anesthesia was, as a rule, willingly accepted by the patients.
It is well known that pituitary has the function of releasing endorphins which act on morphine receptors and result in morphinelike biological effect of analgesia during acupuncture. In the present series, however, most of the 42 cases of pituitary tumours were chromophobic adenomas with manifestations of hypopituitarism. Hence determinations of endorphin levels before and after operation as well as during acupuncture would be conducive to the integration of clinical and fundamental studies, or to the explanation of the mechanism responsible for acupuncture anesthesia.
50 patients with tumours in the sellar area were operated upon under electrical acupuncture anesthesia from January 1975 to May 1978. The analgesic effects were excellent or good (Grade I or II) in 44 cases and fair (Grade III) in 5 cases. There was one failure (Grade IV). The total rate of Grade I and II was 88%.
The acupuncture points selected in 37 of the 50 cases were Zuanzu, Yuyao, Ermen and Shangguan. In 10 cases, the point used was Quanliao, and in the remaining 3, other points were needled.
The patients' responses, particularly those exhibited during the main surgical procedures were closely observed. Although the operations were uneventfully performed, there were, however, complaints of pain at scalp incision and wound suturing in about 1/5 of the cases. These indicate that pain abatement is incomplete, and that the effect of acupuncture on the scalp is as unstable as that on the skin in other kinds of operations.
Moreover, while tumours were being exposed and removed, some of the patients experienced nausea or vomiting. To prevent these undesirable responses, the authors have taken measures, including the reasonable application of manitol to reduce intracranial pressure, meticulous drain of CSF from the lateral fissure cisterna, avoidance of cautery if the case permits, prevention of contact with the dura mater at the base of frontal cerebral fossa, abstention from touch on the olfactory sulcus and cribriform plate, protection against retraction of the frontal lobe, and prevention of anoxia and hypotension, etc. Owing to these measures, the incidence of nausea and vomiting has been lowered. If these symptoms do occur, they may be alleviated by needling the points such as Neiguan, Hegu and Jianshi.
As the points (Zuanzu, Yuyao, Ermen and Shangguan) were in the vicinity of the nerve trunks near the operation field, the landmarks for needling were quite clear to the acupuncturist. After switching on the stimulator, sensation of numbness in the innervated areas was induced, and the pain thresholds of the related areas were elevated on examination. This shows that definite analgesic effect, though unstable on the scalp, is produced by acupuncture.
Since the patients were perfectly conscious during operation, many of them appreciated an improvement in their impaired visual power immediately after the pressure on the optical chiasma was removed by eradication of the tumour. Consequently acupuncture anesthesia was, as a rule, willingly accepted by the patients.
It is well known that pituitary has the function of releasing endorphins which act on morphine receptors and result in morphinelike biological effect of analgesia during acupuncture. In the present series, however, most of the 42 cases of pituitary tumours were chromophobic adenomas with manifestations of hypopituitarism. Hence determinations of endorphin levels before and after operation as well as during acupuncture would be conducive to the integration of clinical and fundamental studies, or to the explanation of the mechanism responsible for acupuncture anesthesia.
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