Perioperative acupuncture and related techniques

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.     

Acupuncture analgesia: I. The scientific basis

Acupuncture has been used in China and other Asian countries for the past 3000 yr. Recently, this technique has been gaining increased popularity among physicians and patients in the United States. Even though acupuncture-induced analgesia is being used in many pain management programs in the United States, the mechanism of action remains unclear. Studies suggest that acupuncture and related techniques trigger a sequence of events that include the release of neurotransmitters, endogenous opioid-like substances, and activation of c-fos within the central nervous system. Recent developments in central nervous system imaging techniques allow scientists to better evaluate the chain of events that occur after acupuncture-induced stimulation. In this review article we examine current biophysiological and imaging studies that explore the mechanisms of acupuncture analgesia.     

Akupunktur in der Orthop?die

Large randomized controlled trials have shown the effectiveness of acupuncture in comparison to various control treatments for low back pain, osteoarthrosis, shoulder pain, tension type headache, and migraine. For most of these diseases the cost-effectiveness of acupuncture has been proven. A few smaller controlled trials exist for tennis elbow and osteoarthrosis of the hip. The use of acupuncture for other locomotive disorders is based on textbook literature and expert opinion. Current data show that acupuncture is a relatively safe method. Internationally several guidelines for chronic low back pain have integrated acupuncture. In Germany acupuncture has been reimbursed by the state insurance system for chronic low back pain and osteoarthritis since 2007 and the estimated costs are between EUR?300-700 million annually. Acupuncture is offered by at least 12,000 medical doctors and acupuncture is mostly used for locomotive disorders.     

An advanced clinical trial with laser acupuncture anesthesia for minor operations in the oro-maxillofacial region

For the purpose of improving acupuncture and acupressure anesthesia, laser acupuncture as a new type of controlled anesthetic method has been used since 1979. A beam from a 2.8-6 mW helium-neon laser apparatus (Model CW-12, Chengdu Thermometer Factory) was delivered and focused to a red spot on the selected skin point of the patient. The laser was used instead of the routine acupuncture and acupressure anesthesia. This paper reports the clinical laser trial of 610 cases (562 cases of difficult exodontia and 48 cases of various minor operations in the oro-maxillofacial region). The effect of analgesia was satisfactory. No sedatives or analgesics were administered before or during operations. The helium-neon laser apparatus, selection of laser irradiating acupuncture points, distance, and duration of irradiation and clinical observations are described.     

Acupressure-acupuncture antiemetic prophylaxis in children undergoing tonsillectomy.

BACKGROUND: Acupuncture or acupressure at the Nei-Guan (P.6) point on the wrist produces antiemetic effects in awake but not anesthetized patients. The authors studied whether a combined approach using preoperative acupressure and intra- and postoperative acupuncture can prevent emesis following tonsillectomy in children. METHODS: Patients 2-12 yr of age were randomly assigned to study or placebo groups. Two Acubands with (study) and two without (placebo) spherical beads were applied bilaterally on the P.6 points; non-bead- and bead-containing Acubands, respectively, were applied on the sham points. All Acubands were applied before any drug administration. After anesthetic induction, acupuncture needles were substituted for the beads and remained in situ until the next day. All points were covered with opaque tape to prevent study group identification. A uniform anesthetic technique was used; postoperative pain was managed initially with morphine and later with acetaminophen and codeine. Emesis, defined as retching or vomiting, was assessed postoperatively. Ondansetron was administered only after two emetic episodes at least 2 min apart. Droperidol was added if emesis persisted. RESULTS: One hundred patients were enrolled in the study. There were no differences in age, weight, follow-up duration, or perioperative opioid administration between groups. Retching occurred in 26% of the study patients and in 28% of the placebo patients; 51 and 55%, respectively, vomited; and 60 and 59%, respectively, did either. There were no significant differences between the groups. Redness occurred in 8.5% of acupuncture sites. CONCLUSION: Perioperative acupressure and acupuncture did not diminish emesis in children following tonsillectomy.     

针刺在腹腔镜手术围手术期的临床应用进展

背景 大量的研究成果表明针刺具有多种临床疗效,包括减少麻醉药物的用量、镇痛、减轻恶心呕吐等.针刺现如今已被应用于围手术期,在腹腔镜手术中也有应用. 目的 主要概述针刺在腹腔镜手术围手术期的临床应用进展. 内容 针刺应用于腹腔镜手术围手术期的主要临床疗效有:减少麻醉药物的使用、维持术中血流动力学的稳定、减轻术后疼痛、减少术后恶心呕吐(post operative nausea and vomiting,PONV)的发生及其严重程度、减轻术后的烦躁反应等. 趋向 针刺具有很好的疗效,且生理干扰小、使用安全,可以被很好地应用于腹腔镜手术的围手术期.     

围术期针刺应用的穴位选择现状分析

背景 针灸应用于包括疼痛在内的多种疾病历史悠久,近年来,针刺应用于围术期得到广泛重视,而针刺应用于围术期的关键是合理选穴. 目的 对近年来针刺在围术期应用中穴位选择的理论依据及临床应用进展进行回顾和总结,为针刺在围术期应用的后续研究提供借鉴. 内容 对针刺在围术期应用中穴位选择的理论依据和临床应用进展进行综述. 趋向 目前,针刺在围术期应用的穴位选择存在局限性,随着其应用方法的不断完善,针刺在围术期的临床应用效果必将得到提高.     

A Mathematical Model for the Instigation and Transmission of Biological and Neural Signals in Response to Acupuncture

Acupuncture has been in clinical practice in China for thousands of years and its analgesia effect is worldwide accepted. However, the mechanism of acupuncture effect is not well understood. The study focuses on signaling pathways induced by acupuncture, analyzes the cooperative action of the acupoints' structure and the associated chemical mediators during acupuncture, establishes a mathematical model clarifying the roadmap of electroneurographic signal startup and transmission mechanism induced by acupuncture, quantitatively analyzing the response in acupoints to acupuncture. These work contributes to reveal the activation and transmission mechanism of neural signals induced by acupuncture from systems biology perspective, lays the foundation for the integration of acupuncture theory and modern science and further guides the clinical treatment and experimental research of acupuncture.     

耳穴贴压在肩袖损伤住院患者关节镜术后早期疼痛管理中的应用

目的探讨耳穴贴压在肩袖损伤住院患者关节镜术后早期疼痛管理中的应用效果。 方法选取2018年1月至2019年10月在北京大学人民医院创伤骨科行肩关节镜治疗的肩袖损伤患者共84例,对照组42例采取常规镇痛措施;观察组42例在常规镇痛的基础上于入院后给予患者进行耳穴贴压。采用视觉模拟评分法（visual analogue scale,VAS）评估两组患者术后24 ~ 72 h的疼痛改善情况。 结果观察组术后48 h的静息VAS评分和活动VAS评分较术后24 h的VAS评分改善均优于对照组,差异均有统计学意义（P<0.05）;观察组术后72 h的静息VAS评分和活动VAS评分较术后24 h的VAS评分改善均优于对照组,差异均有统计学意义（P<0.05）。 结论中医耳穴贴压能有效辅助减轻肩袖损伤住院患者关节镜术后的早期疼痛,操作简便,值得在临床推广。     

Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-Cesarean section pain relief

Background: Nausea and vomiting are important side effects following administration of epidural morphine for post-Cesarean section pain relief. Stimulation of the P-6 (Neiguan) acupoint is a traditional Chinese acupuncture modality used for antiemetic purpose; it has been found to be effective. The aim of this study was to evaluate the antiemetic effect of P-6 acupressure in parturients given epidural morphine for post-Cesarean section pain relief.
Method: In a randomized, double-blind and controlled trial, sixty parturients receiving epidural morphine for post-Cesarean section pain relief were investigated. Parturients were allocated to receive the acupressure bands or placebo bands on the P-6 acupoint bilaterally before the administration of spinal anesthesia and were observed over a 48-hour study period.
Results: The incidence of nausea and vomiting was significantly decreased from 43% and 27% in the control group, to 3% and 0% in the acupressure group, respectively ( P <0.05).
Conclusion: The results demonstrate that prophylactic use of acupressure bands bilaterally on the P-6 acupoint can significantly reduce incidence of nausea and vomiting after epidural morphine for post-Cesarean section pain relief.     

针刺麻醉的临床应用及前景展望

针刺麻醉是一种以针刺调动人体自身抗痛为特征的麻醉技术,自上世纪50年代开始应用于临床以来,几乎各种类型的手术均采用过针刺麻醉,就针刺麻醉的作用机制、针药复合麻醉、针刺综合麻醉进行了深入的研究和探讨,取得了重要成果。进入21世纪,随着分子生物学和麻醉理论技术的发展,对针刺镇痛机理的研究业已达到分子水平,临床上,也由针刺麻醉（acupuncture anesthesia,AA）发展到针刺辅助麻醉（acupuncture-assisted anesthesia,AAA）,形成了“术前诱导-术中麻醉-术后镇痛”的全新模式。     

Acupressure-Acupuncture Antiemetic Prophylaxis in Children Undergoing Tonsillectomy

Background: Acupuncture or acupressure at the Nei-Guan (P.6) point on the wrist produces antiemetic effects in awake but not anesthetized patients. The authors studied whether a combined approach using preoperative acupressure and intra- and postoperative acupuncture can prevent emesis following tonsillectomy in children.

Methods: Patients 2-12 yr of age were randomly assigned to study or placebo groups. Two Acubands with (study) and two without (placebo) spherical beads were applied bilaterally on the P.6 points; non-bead- and bead-containing Acubands, respectively, were applied on the sham points. All Acubands were applied before any drug administration. After anesthetic induction, acupuncture needles were substituted for the beads and remained in situ until the next day. All points were covered with opaque tape to prevent study group identification. A uniform anesthetic technique was used; postoperative pain was managed initially with morphine and later with acetaminophen and codeine. Emesis, defined as retching or vomiting, was assessed postoperatively. Ondansetron was administered only after two emetic episodes at least 2 min apart. Droperidol was added if emesis persisted.

Results: One hundred patients were enrolled in the study. There were no differences in age, weight, follow-up duration, or perioperative opioid administration between groups. Retching occurred in 26% of the study patients and in 28% of the placebo patients; 51 and 55%, respectively, vomited; and 60 and 59%, respectively, did either. There were no significant differences between the groups. Redness occurred in 8.5% of acupuncture sites.     

Acupuncture in diseases of the locomotor system. Status of research and clinical applications

Acupuncture has been used for over 2000 years for a wide variety of complaints with minimal side effects. Based on the experience in Chinese medicine and the anticipated positive effects, acupuncture has been widely accepted in Western medicine as well. Some clinical evidence supports the efficacy of acupuncture treatment, but randomized controlled trials have been conducted for only a few of all possible locomotive disorder indications, and the results have been equivocal. Other indications have not yet been systematically studied, and application is based on clinical experience and consensus among practitioners. One of the outcomes on which consensus appears to exist is that 10-20 sessions are generally necessary, and that initial improvement can be expected to occur by the 10th treatment. Rigorous trials should be conducted to improve clinical validity and provide scientific proof of the efficacy of acupuncture. Clinical trials like the German Acupuncture Trials (gerac), funded by the German health insurance companies, have been launched with the aim of furthering knowledge in this area.     

Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery

BACKGROUND: Acupuncture and acupressure have previously been reported to possess antiemetic effect. We wanted to investigate the "true" and placebo effect of acupressure in prevention of postoperative nausea and vomiting (PONV). PATIENTS AND METHODS: Sixty women undergoing outpatient minor gynaecological surgery were entered into a double-blind and randomised study. One group received acupressure with bilateral stimulation of P6 (A), a second group received bilateral placebo stimulation (P) and a third group received no acupressure wrist band and served as a reference group (R). PONV was evaluated as number of patients with complete response (no PONV), nausea only or vomiting. In addition, the need for rescue antiemetic medication and nausea after 24 h was registered. RESULTS: Complete response was obtained in 11, 11 and 9 patients in groups, A, P and R, respectively. Nine, 7 and 6 patients had nausea before discharge home, and 1, 1 and 8 patients were nauseated (8 vs 1 patient: P < 0.05) 24 h after operation in A, P and R groups, respectively. When compared to placebo acupressure (2 patients vomited and 5 needed rescue), significantly (P < 0.05) fewer needed rescue antiemetic medication after acupressure at P6 (no vomiting or rescue medication). When compared to the observation group (5 vomited and 4 needed rescue antiemetics), significantly fewer vomited after acupressure (P < 0.05) CONCLUSION: In patients undergoing brief gynaecological surgery, placebo effect of acupressure decreased nausea after 24 h but vomiting and need of rescue antiemetics was reduced only by acupressure with the correct P6 point stimulation.     

Acupuncture and spinal cord medicine

BACKGROUND: The National Institutes of Health has concluded that the potential value of acupuncture justifies expanding its use into conventional medicine and studying it further. METHODS: Literature review of acupuncture as it pertains to spinal cord medicine. RESULTS: Acupuncture has been used to treat a number of spinal cord injury (SCI)-related conditions, including motor deficits, pain, spasticity, and syringomyelia. CONCLUSION: Acupuncture shows promise as an intervention in the treatment of SCI-related conditions. Further research, carried out in careful and systematic fashion by qualified practitioners of acupuncture in concert with spinal cord medicine specialists, is needed.     

针灸促进骨折愈合机制的研究进展

针灸对促进骨折愈合有着显著的疗效,具有疏通经络、调和气血、消肿散淤等作用,然而其机制仍然未完全阐明。随着研究的不断深入,近年来发现针灸促进骨折愈合的机制涉及调节细胞生长因子表达水平,激活WNT/β-catenin等信号通路,改善局部的血液循环,影响骨中矿物元素的含量,调节内分泌系统,促进骨细胞的分化与增殖,促进成骨细胞的增生与激活和影响骨细胞凋亡等多方面。针灸促进骨折愈合的机制非常复杂,尚处于动物实验和细胞水平,本文对以上研究进展进行综述总结。     

穴位按压腕带缓解术后恶心呕吐随机对照试验的Meta分析

目的评价穴位按压腕带作用于内关穴缓解成人术后恶心呕吐的效果。方法检索MEDLINE、CNKI等数据库,纳入所有相关的随机对照试验(RCT),采用RevMan5.0分析数据。结果共纳入9个RCT。相对于安慰剂对照组,试验组即穴位按压腕带作用于内关穴可以有效减少术后呕吐的发生率(RR=0.50,95%CI:0.37~0.66,P<0.01)。而对于术后恶心的发生率,试验组和安慰剂对照组的差异无统计学意义(RR=0.85,95%CI:0.72~1.00,P>0.05)。结论术后护理中应用穴位按压腕带作用于内关穴可以有效缓解术后呕吐,而缓解术后恶心作用不显著,需要今后的研究者进行更加可靠的RCT试验进一步研究和探讨。护理人员可以引进穴位按压腕带进行有效性和适用性的研究。     

P6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery

Nausea and vomiting are major adverse effects during spinal anesthesia for cesarean delivery. Stimulation of the P6 (Neiguan) acupoint is a traditional Chinese acupuncture technique used for effective antiemetic purposes. In this study, we evaluated the antiemetic effect of P6 acupressure in parturients during spinal anesthesia for cesarean delivery. In a randomized, double-blind, controlled trial, 110 parturients scheduled for elective cesarean delivery were enrolled in the study. Thirty minutes before initiation of spinal anesthesia, parturients were randomized to acupressure bands or placebo bands bilaterally on the P6 acupoint and nausea and vomiting were observed over the study period. There were no statistically significant differences in maternal characteristics. Incidence rates for intraoperative nausea were 64% (acupressure group) and 71% (control group) (P = 0.416), with an incidence of intraoperative vomiting of 22% (acupressure group) and 27% (control group) (P = 0.506). The results suggest that prophylactic use of acupressure bands bilaterally on the P6 acupoint failed to prevent nausea and vomiting during spinal anesthesia for cesarean delivery.     

针灸刺激和光疗的微循环反应

背景据报道针灸和光照疗法有镇痛和改善微循环的作用。然而,尚未见直接研究周围血管变化的报道,包括客观评估或定量研究。我们以直视下观察小动脉血流量对针灸刺激和光疗的反应对这些方法的效果进行评估。方法用40只家兔,将兔耳室置入兔耳廓内,固定于解剖显微镜下。以显微镜摄像头选定小动脉进行观察。静脉注射戊巴比妥,行气管插管并保持自主呼吸。将家兔随机分为针灸组（n=10）、近红外线灯照射组（即灯照组,n=10）、低功率近红外激光照射组（即激光组,n=10）和无照射组（即对照组,n=10）。针灸组将针灸针于耳廓留置20分钟;灯照组以1540mW红外线灯照射1秒继之停顿4秒,再重复操作;激光组以60mW激光连续照射。灯照组和激光组,均用接触探头照射耳廓（取与针灸相同部位）10分钟。针灸或照射之前和之后60分钟测定小动脉直径和血流速度。以血流速度乘以血管横截面积计算出血流速率。结果与治疗前（100％）比较,针灸组小动脉直径增大至131％±14％（P〈0．005）,灯照组增大至129％±19％（P〈0．005）,激光组增大至128％±11％（P〈0．005）。针灸刺激结束后20分钟,光照和激光照射结束后10分钟达到最大值。这3组与对照组比较后显示小动脉直径显著增加（P〈0．005）。血流速度和血流量变化与小动脉直径变化相似。治疗效果在刺激和照射结束后持续40～50分钟。结论针灸刺激和光疗直接增加外周小动脉直径并加快血流速度。全身和局部副作用最小的针灸刺激和光照治疗能改善微循环,可成为外周循环不良所致疾病的有效辅助治疗方法。     

Acupuncture treatment for a patient with diffuse axonal injury

Acupuncture has been used as a therapeutic technique in China, Japan and East Asia. Recently, it is used to treat neural injuries. We describe a 6-year-old boy with consciousness disturbance and heavy muscle spasticity of extremities due to severe diffuse axonal injury (DAI) in whom acupuncture treatment for 6 months alleviated these symptoms remarkably. Acupuncture treatment may be effective to improve consciousness disturbance and heavy spasticity of DAI.