Perioperative acupuncture and related techniques

Abstract

Acupuncture and related techniques are increasingly practiced in conventional medical settings, and the number of patients willing to use these techniques is increasing. Despite more than 30 yr of research, the exact mechanism of action and efficacy of acupuncture have not been established. Furthermore, most aspects of acupuncture have yet to be adequately tested. Therefore, considerable controversy remains about the role of acupuncture in clinical medicine. Acupuncture apparently does not reduce volatile anesthetic requirement by a clinically important amount. However, preoperative sedation seems to be a promising application of acupuncture in perioperative settings. Acupuncture may be effective for postoperative pain relief but requires a high level of expertise by the acupuncture practitioner. Acupuncture and related techniques can be used for treatment and prophylaxis of postoperative nausea and vomiting in routine clinical practice in combination with or as an alternative to conventional antiemetics when administered before induction of general anesthesia.

Fig. 1

Functional MRI (fMRI) demonstrating a correlation between activation of specific areas of the brain and corresponding acupoint stimulation predicted by ancient acupuncture literature. dACC = dorsal anterior cingulate cortex; rACC = rostral anterior cingulate cortex; cADD = caudal anterior cingulated cortex; TA = tectal area; A = anterior nucleus; DsF = dorsal superficial nucleus; DM = dosomedial nucleaus; IL = intralaminar nuclei; and CM = centromedian nucleus. PG = caudal inferior parietal lobule, area 7a. Reprinted by permission of the American Academy of Medical Acupuncture.

Fig. 2

Zusanli (ST 36) is one of the most frequently used points for acupuncture analgesia. It is located on the anterior aspect of the leg in the tibialis anterior muscle, 3.0 cun inferior to the lateral depression underneath the knee cup and one fingerbreadth lateral to the tibial crest. Its functions include replenishing energy, regulating the stomach, strengthening the spleen, clearing the channels and invigorating the collaterals, and improving general health. Indications: abdominal distension, diarrhea, and chronic disorders causing general weakness.

Fig. 3

Hegu (LI 4) is one of the most commonly used acupuncture analgesia points. It is located on the dorsum of the hand between the first and second metacarpal bones in the first dorsal interosseous muscle on the radial aspect of the second metacarpal. Its functions include dissipating pathogenic heat, sedating pain, and regulating Qi and blood. Indications include fever, headache, toothache, eye disorders, sore throat, facial hemiplegia, trismus.,

Fig. 4

Side-by-side comparison of two cortical activations (visualized with functional MRI (fMRI)) seen at the mid-line sagittal view caused by pain (left column) and pain with LI 3 meridian acupuncture (right column). ACC = anterior cingulate cortex; δ = response time; Thal = thalamus; M° = Center of mid-sagittal view slice. Reprinted by permission of the American Academy of Medical Acupuncture.

Fig. 5

Auricular acupuncture points used for relaxation and intraoperative anesthetic reduction.

Fig. 6

Circles show the individual concentrations of desflurane required to prevent movement in response to intense electrical stimulation in volunteers with (Acupuncture) and without (Control) electro-acupuncture. Needles were placed at the Zusanli, Yanglingquan, and Kunlun acupuncture points on the legs after induction of anesthesia. Squares show the mean ± SD concentrations with each treatment. The anesthetic requirements did not differ significantly. Used with permission.

Fig. 7

Back shu points (medial line of points). Shu points of the internal organs are located bilaterally 3 cm lateral to the posterior midline. Shu points are associated with the viscera and traditionally have been used for treatment of internal organ diseases. Stimulation of these points may alleviate pain caused by visceral dysfunction.

Fig. 8

Daily consumption of morphine in patients undergoing upper- and lower-abdominal surgery with pre-operative acupuncture at points BL 18-24 and BL 20-26. For upper-abdominal surgery, results were obtained from 50 acupuncture patients (circles) and 48 control patients (squares). For lower-abdominal surgery, data were obtained from the 39 acupuncture patients (circles) and 38 control patients (squares). Data are expressed as means ± SDs. Asterisks (*) indicate statistically significant differences (P < 0.0001) between first and other postoperative days in each group; pound signs (#) indicate statistically significant differences (P < 0.01) from the control group. Used with permission.

Fig. 9

Nei Guan (P 6) point is located 2 cun or about 5 cm above the transverse crease of the wrist between the tendons of m. palmaris longus and m. flexor carpi radialis. The name of the point means “Inner Pass” or “Inner Gate” This point is the connecting luo point of the Pericardium Channel to the Triple Warmer Channel. It is considered one of the major points of the meridian system. Its functions include dissipating pathogenic heat and clearing dysphoria, relaxing the chest and impelling the flow of Qi, reversing the adverse flow of Qi and quelling nausea, regulating the stomach and reducing pain. Besides possible nausea and vomiting, indications for this point include insomnia, amnesia, epilepsy, mania, dysphoria, chest pain, palpitations of the heart, and dyspnea. Nei Guan (P 6) also maintains hemodynamics and enhances cardiac contractility on anesthetized open-chest dogs.

Fig. 10

Point Shaoshang (L 11) is located at the radial aspect of the thumb, 0.1 cun (2.5 mm) proximal to the vallum unguis. Its functions include “restoring Yang and reviving from prostration, clearing the pharynx.” Indications: syncope, sore throat, mania. Shangyang (LI 1) is located at the radial aspect of the index finger, 0.1 cun (2.5 mm) distal to the vallum unguis. Functions include dissipating pathogenic heat, stimulating the mind, clearing the pharynx, sedating pain, high fever, coma, and sore throat.

Fig. 11

Jen Chung (GV 26) is believed to be a “point of resuscitation.” It is located on the upper one-third of the distance between the nose and upper lip. Its functions include “dissipating pathogenic heat and reviving the sensory organs from unconsciousness, sedating pain and calming the spirit.”, Indications include convulsions, loss of consciousness, syncope, heat stroke, hypertension, facial paresis, facial spasm, and aphonia. Yintang (Extra 1) is located between the eyebrows. Indications: headache, vomiting, vertigo, epistaxis, convulsions, and insomnia. ,