Qiu Weiliu, Lin Guochu, Yuan Wenhua, Liu Shixum, Ha Qi, Fan Baohua Chen Shaodong, Liu Yugui, Shen Jiannan, Ma Guizhen, Lu Juying (Ninth People's Hospital of Shanghai Second Medical College)
From May, 1966 to November, 1977, we performed 1,802 oro-maxillo-facial operations using acupuncture anesthesia (selecting distal points according to the course of the channels and retaining the needles after 'Deqi', i.e. the normal needling reaction) with a success rate of 92.43% (1,662/1,802) and a failure rate of 7.57% (136/1,802). 73.68% cases (1,328/1,802) had excellent analgesic effect.
This paper analyses the impact of the following factors on the analgesic effect of acupuncture anesthesia: the sex and age of the patient, the prescription of points, the method of needle stimulation, the duration of operation, the site operated and the forming of anesthetists and the surgical team. The following problems are discussed:
1. 'Deqi' is the key to success of acupuncture anesthesia, but there are different opinions about how to keep it. Most authors in our country believe that it requires an uninterrupted needle stimulation of different degrees of intensity, hence they adopt the pulsating electric stimulation method in most clinics. However, our data show that once 'Deqi' is achieved, the retaining of needles, without any electric or hand stimulation, can provide sufficient amount of stimulation for an oro-maxillofacial operation. Experimental studies in which convergent light was focused on the rabbit nose for a pain test showed that the reaction time was 24.4 seconds in the retaining needle group as compared to 13 seconds in the control group. The 190% prolongation of reaction time is statistically significant (P<0.05). This clearly testifies to the prolonged analgesic effect of simple needle retaining after 'Deqi' Further-more it seems to show more precisely the role of acupuncture in anesthesia by excluding the cooperative analgesic effect of electric stimulation.
2. With regard to the mechanism of acupuncture anesthesia, there are two schools: the nerve segment theory and the Jing-Luo (channels and collaterals) theory. We are partisans of the second school, the conception of which is supported by the following data of ours:
a. In 1,779 (98.7%) of our 1,802 cases, we selected distal points according to the course of channels, with a success rate of 92.43% (1,665/1,779) and 73.68% cases (1,318/1,779) had excellent analgesic effect, this fully testifies to the effectiveness of the selection of distal points according to the course of channels.
b. In a case of temporo-mandibular arthroplasty for ankylosis, on inserting needles to points selected according to the course of channels, the patient immediately opened his mouth from 2mm to 35mm in width, thus a surgical operation avoided.
c. Sodium iodide{125} isotopic scanning on sensory propagation conduction study of Jing-Luo Channels showed high uptake of sodium iodide{125} along Pericardium Channel pathway points of a patient perfectly obedient to acupuncture anesthesia.
All these data proved the objective existence of Jing-Luo phenomenon, though its morphological aspect has not been completely understood up to now.
3. Individual variability of analgesic effect: It is generally agreed that the older the patient, the more favorable the analgesic effect. The anlgesic effect is comparatively more reliable in soft tissue operations than in bony structure operations. The site operated, the type and extent of operation, the technical complexity and the duration of operation are all determinant factors on the analgesic effect.
4. Incompleteness of analgesia: This is the key problem waiting for resolution. Skilled anesthetists and a trained surgical team have achieved a higher success rate. This shows that the mastery of some special skills might compensate this disadvantage to some extent.
5. Advantages of acupuncture anesthesia in oro-maxillo-facial operations: It is a safe method with reduced embarrassment of physiological functions which promotes early recovery. It is especially useful in plastic surgery to take the place of local anesthesia in order to avoid temporary distortion of tissue.
Owing to the incompleteness of analgesia and the undue stretching reaction, acupuncture anesthesia is now used only in medium-sized operations such as parotidectomy, excision of submaxillary gland, temporo-mandibular arthroplasty and buccolabial operations. It may also be used in unilateral radical neck dissection in selected patients.
From May, 1966 to November, 1977, we performed 1,802 oro-maxillo-facial operations using acupuncture anesthesia (selecting distal points according to the course of the channels and retaining the needles after 'Deqi', i.e. the normal needling reaction) with a success rate of 92.43% (1,662/1,802) and a failure rate of 7.57% (136/1,802). 73.68% cases (1,328/1,802) had excellent analgesic effect.
This paper analyses the impact of the following factors on the analgesic effect of acupuncture anesthesia: the sex and age of the patient, the prescription of points, the method of needle stimulation, the duration of operation, the site operated and the forming of anesthetists and the surgical team. The following problems are discussed:
1. 'Deqi' is the key to success of acupuncture anesthesia, but there are different opinions about how to keep it. Most authors in our country believe that it requires an uninterrupted needle stimulation of different degrees of intensity, hence they adopt the pulsating electric stimulation method in most clinics. However, our data show that once 'Deqi' is achieved, the retaining of needles, without any electric or hand stimulation, can provide sufficient amount of stimulation for an oro-maxillofacial operation. Experimental studies in which convergent light was focused on the rabbit nose for a pain test showed that the reaction time was 24.4 seconds in the retaining needle group as compared to 13 seconds in the control group. The 190% prolongation of reaction time is statistically significant (P<0.05). This clearly testifies to the prolonged analgesic effect of simple needle retaining after 'Deqi' Further-more it seems to show more precisely the role of acupuncture in anesthesia by excluding the cooperative analgesic effect of electric stimulation.
2. With regard to the mechanism of acupuncture anesthesia, there are two schools: the nerve segment theory and the Jing-Luo (channels and collaterals) theory. We are partisans of the second school, the conception of which is supported by the following data of ours:
a. In 1,779 (98.7%) of our 1,802 cases, we selected distal points according to the course of channels, with a success rate of 92.43% (1,665/1,779) and 73.68% cases (1,318/1,779) had excellent analgesic effect, this fully testifies to the effectiveness of the selection of distal points according to the course of channels.
b. In a case of temporo-mandibular arthroplasty for ankylosis, on inserting needles to points selected according to the course of channels, the patient immediately opened his mouth from 2mm to 35mm in width, thus a surgical operation avoided.
c. Sodium iodide{125} isotopic scanning on sensory propagation conduction study of Jing-Luo Channels showed high uptake of sodium iodide{125} along Pericardium Channel pathway points of a patient perfectly obedient to acupuncture anesthesia.
All these data proved the objective existence of Jing-Luo phenomenon, though its morphological aspect has not been completely understood up to now.
3. Individual variability of analgesic effect: It is generally agreed that the older the patient, the more favorable the analgesic effect. The anlgesic effect is comparatively more reliable in soft tissue operations than in bony structure operations. The site operated, the type and extent of operation, the technical complexity and the duration of operation are all determinant factors on the analgesic effect.
4. Incompleteness of analgesia: This is the key problem waiting for resolution. Skilled anesthetists and a trained surgical team have achieved a higher success rate. This shows that the mastery of some special skills might compensate this disadvantage to some extent.
5. Advantages of acupuncture anesthesia in oro-maxillo-facial operations: It is a safe method with reduced embarrassment of physiological functions which promotes early recovery. It is especially useful in plastic surgery to take the place of local anesthesia in order to avoid temporary distortion of tissue.
Owing to the incompleteness of analgesia and the undue stretching reaction, acupuncture anesthesia is now used only in medium-sized operations such as parotidectomy, excision of submaxillary gland, temporo-mandibular arthroplasty and buccolabial operations. It may also be used in unilateral radical neck dissection in selected patients.
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