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Electroacupuncture nalgesia nMaforAbdominal nd Pelvic urgery:

A Randomised tudy

This sludy "\,as resented t the ICMART nd World ConS;ress I SaienlificAcupuncturcheld in Lotldotl n May l986

SummatyProponents f aaupunclure anacsthesia ave enaleato l t :ctkon it as a rcplacement or conventionalanaesthe.sla. his randantised, controlled trial

i n v o l v i n g 2 5 0 can cc r p a t i e n t s u n d e rBo i n gabclominal r pelvic surgcry, has aimed to assess heuse ol eleclroacupuncLure s the sole analges ic, Lt\vit l l in a standard anaesthetic. t v,as ound thatwhile there was littl-. dit'ferencc between the peFopentive requirement or anaesthctic rugs, all then o n a c u p u t i c t L t r e ro u p req Ll i r ed en t an y l ,compared o oDly 5lo oi the electroacupunctLtregroup (P


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METHOD Of ANALCESIA

control group study roupPeFoperative Narcotic EAPost perative Non nafcoiic TENS

post-operatively lable /).

l n b o t h g r o u p s p a t i e n t s ece i v ed h e s amepremedication hour prior o surgery:Flunitrazepam x 10" mg kB',Atropine ulphate0.25 o 0.75m9

(according o weight).In C'oup | aldeqrhe,.a ^ac ndu(ed usinB:

Droperidol O.3mB g'Thiopentone sm9 kgrPancuronium romide 8 x 10'mg kg'Fentanyl x 10'mg kB'

After ntubation atients ere venti lated i th a 10mlkg mixture f oxySen nd nitrous xide FiO,= 0.4)at a rate o{ 12 o 15 nsufflat ions er minute.

ln t he Study Broup, 0 minutes rior o induction,B s t a i n l e s s t e e l , s t e r i l e acu p u n c t u re eed l e s(diameter .4mm, ength 0mm) were nserted o adepth of 5 to 1omm, bilaterally n the following 4acupuncture poinls (Table 2): Eat Shenmen, PC.6,SP6 and C8.39 2.).

Th es e n eed l e s w e re co n n ec t ed t o anelectrostimulator DSM | 500, MCM Laboratories,Paris) el ivering biphasic urrent t a frequency f

40H2, aising he ntensity nti l he subject eporteda sensation ft inSling mean mA).After30 m'nutesof electrostimulation, naesthesia as nduced n anidentical manner o the Control group, using hesame drugs at the same dosage, ut without usingfenfanyl. Patients were also ventilated rn the sameway as hose n the Control Broup. mmediately afteri n d u c t i o n o f an aes t h e s i a h e e l e c t r o s t i m u la t o rcurent was increased o 15mA and the frequencywas modulated.

DufinB surgefy, he anaesthetic equirements ereassessed n both groups ollowing he same l inicalc f i t e r i a : b l o o d p re s s u re n d p u l s e r a t e w e remonitored every smin. Fentanyl, n boih groups,was injected to patients as requiredi per-operativea s s e s s men t a s mad e o f e ach p a i i en t ' s d o s erequirements f anaesthet ic rugs and of /entanyl.

May 1997 Vol 15 Na.1

At the end of the operation n t he Study Srouppatients, wo steri le, onducting electrodes wereplaced either side of the scar and connected o ap re - s e t EN S mach i n e N eu ro D o 4 med t ro n i c ,USA).We made no pharmacological eversal f thecompeti t ive muscle relaxant (pancuronium), opatients were transferred o the recovery ward ande x t u b a t e d h e n c l i n i c a l e v e r s a l , n c l u d i n gspontaneous espirat ion i th a minute volume otmore han 100m1 g' , was evident.

Post operatively, at ients n both groups weregiven non narcotic nalSesics s equired, nd wereinterviewed by a data manager over 5 days. Post-o p e r a t i v e s s e s s m e n t a s mad e o r : q u a l i t y o fi mmed i a t e r eco v e ry, d o s e r e q u i r e m e n t s o fanalgesics, at ient omfort and self assessment fpain, end of post operative leus, and achievementof independence.

A minimum of 125 subjects n each group wasco n s i d e red n eces s a ry o s h o w a s t a t i s t i c a l l y

s i g n i f i c a nt e c r e a s e ro m B0 % o 6 0 % o f p a i nexperienced osi-operatively, ith a probability f 5%.

ResurlsD u r i n g h e p e r i o d r o m N o v e m b e r 1 9 8 3 t oDecember 985, 250 cancer patients ere enteredinto the study.

The data of 233 patients r=113 Control group;l1=120 tudy group) were stat ist ically nalysed 12patients rom the pilot study were withdrawn:2whose randomised nvelopes were lost, 2 for whomsurgery as cancelled, nd 1 who was randomisedt vice). The two groups were statistically matchecl sregards ex, age, weiSht, height and type of surgery

Table 3PATIENT HARACIERISTICS

ControlSroup Studygroup(n=113) (n=120)

Female atients %) ago/, a6Y.Average ge 49 47Averase weisht (kd 62 61Average eight cm) 164 162Pelvic ursery %) 88Y" 88Y"Abdominalsursery %) 12Yo 12Yo

Iable 2POINTS SED OR ACUPUNCTURE NALGESIA2)

Shernen ear pointr nferiorcorner ofbifurcation poinrof

NetSurn PC.6): acupuncture nits of measurement AUMor cun) above wrist, betlveen endons of palmaris ongusand exor a lp i adial is

sa,yinliao (sP6):3 AUM above ip of medial malleoluspostrior o tibial border

Xuanzhon9 C8.39):3 AUM above ateral malleolusbtlveen oster r border offibula and endons fperoneus ons s and brevis

TableTYPEOf SURGERY

conirol group studygroup(n=113) (n=120)

Hynercctomy 32 24Total hysterectomy 11 10

30 41

3 52 4t l

1 7 2 0

Total hysterectomy ith pelvic& aortic ymphadenectomy

aortic ymphadenectomy

1 1 Acupunctu e n Mecl c ne

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(Iables 3 and ,+). Thefe was no difference bet\'veenthe wo gfoups n the anaesthetic ose equifernents( r e l a t e d o b o d y w e i g h t an d d u ra t i o n f s u rg e r y )(Tab l e ) . A ) l t h e p a t i e n t s n t h e C o n t r o l g r o u pfequired erfaryl , whereas nly 7 out of the 120patients n the Study group needed t , and that atvery ow oosaSes,

The anaesthetics efe Biven by 11 anaesthetists ,one of whom anaesthetised 3% of the patients.Th e re w as n o s i g n i f i c a n t i f f e r en ce e t w een i sanaesthetic anagement of either group) and thatof the others.

Pe r i o p e ra t i v e l y a t i e n t s n t h e S t u d y g ro u pfeco v e red p o n t an eo u s es p i r a t i o n P< 0 .0 2 ) n dwere extubated P


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The choice of points used n this rial was specificto the ype of surgery lowerabdominal nd pelvic)and may need o be adapted or other operations.

N o n e o f t h e d ru g s w e u s ed o r an aes t h e s i a sk n o w n o p o s s e s s n a l g e s i c r o p e r t i e s . n b o t hg r o u p s , h e co n cen t r a t i o n f N 2 O p ro v i d ed apotentiat ion f the other drugs, with a negligibleanalgesic ffect uring major urgery.

EA d u r i n g h e s u r8 i ca l e r i o d p ro v i d ed g o o danalgesia nd allowed us o extubate atients n theStudy Sroup n half he t ime required or those nthe Control group, suggesting hat EA affords a saferimmediate ost-operative eriod-

In b o t h g ro u p s t h e r e w ere p a t i e n t s w h ocomplained f post-operative ain, but those n theStudy roup equired ess nalgesia. t first ight hiss eems a co n t r ad i c t i o n , o w ev e r w e t h i n k t h ereduced se of opiate nalgesia l lowedEApatientsto be rnofe alert and aware, and hus o recall anypain experienced nore learly.

We were expecting hat EApatients

ould recovertheir bowel sounds more quickly han Control roupp a t i e n t s , e cau s e p i a t e s a r e k n o w n t o i n h i b i tperistalsis. n fact, there was no statis tical ifferencein recovefy between he Sroups. t may be that post-operative leus s a local effect elated o the surBery,but the endogenous pioids eleased ollowinBEAcertainly act on opiate receptors n the 8ut, andconstipation as been ecorded s a complication facupuncture /6). Howevet we have no explanationo f w h y p a t i e n t s n t h e S t u d y g ro u p reco v e redan d b ecame e l f c a r i n g m o r e q u i ck l y o l l o w i n gs u rg e ry h a n c o n t r o l s , u t b o t h p rac t i c a l l y n deco n o mi ca l l y, t i s p ro b ab l y h e r n o s t m p o r t a n tbeneficial spect f EA n his rial .

ConclusionT h e r e s u l t s o f t h i s i r i a l s u g g es t h a t i n ma j o rabdominal and pelvic surgery, EA is an effectivecomponent f anaesthesia. t is a safe echnique,providing a shorter post operative ecovery ime,with equaily effective ain control o those patientsfeceiving pioid analgesia.

W e t h e r e f o f e eco mmen d h i s co mb i n a t i o n felectroacupuncture ith conventional , on-opiate

anaesthesia, art icularly n the elderly and thosewith respiratory nsuffciency.

P Poulain MD, E Pichad Ldand MDF Montange MD, J Truffa-Bachi MD

Service d'Anesthesie, nstitut Gustave-Roussy

A Laplanche MD, J BouzyDepa tement de B ostati stiques et d' Ep dem ologie

Inst u C ustave- o ussyRue Camille Desmoulins

91805 Villejuif Cedex, France

1. Eei j ing h i ldren ospi ta l 1975) cl in ical nalys ls f 1 ,474operations nder ac p ncture anaesthesia mon8 children.Chinese Medical Jaumal. 1 s): 369 7 4

2. Cheng X ed i9a7J Chinese acupuncture nd moxibustion.

May 1997 Val 15 Na.1

ForeiSn anguages res, BeijinA:11O ,491 5233 . C r a i g F , H e s t e r B ( 1 9 8 6 ) T h e u s e o t p e r i o p e r a t i v e

e l e c t r o a c u p u n c t r e n p o s t o p e r a t i v e a l n r e l i e f . n lPrcceedinss of the 2nd wo.ld Congrcss ol SclentificAcquncture, Lo.don: 69

4. Clennie mithK (1986) t imulat ion rcduced nalger ia orm a j o r o n l s 1 8 e r y n e l d e r l y p o o r r i s k p a t i e n t s . n :Prc.eedings of the 2nd World Congress of ScientificAcupu nctu e, Lordon : 6A

s. Crolpe de recherche n anesth6s p acupunctlre 1972)fanesthesie par acupunctwe. Ann. Anesth. Fnn?. XIll (4).627-34

6. Huguenard (1972) Acupunciure Hano pour ablar iond'un nodule hyroidien. Ann. Anesth. ran9. Xt . (,t).63s-7

7. Han S, Xie CX (198a) Dynorphin: mpor tant ediator orelectroacupunctore nalgeria n the spinal cord ofthe rabbit.

8 . Lefevre e t a l . (19a4) EffeG d'une 6 lectros t imulat ionacupunclurale ur 'analgsie er er post opratoire u couuce a chlr rg du re in . AAressol e .25(11) :1231-6

9. Lewith CT, Machin D (1983) On the evalual ion f thecl nicaleffecc of acupunctute. ain. 16.111-27

l0 .Mortel laro , Ci ' r l iano MC, Percol la , F iocco S,Balsamo

c , P u l v i r e n t i C , Ve r o u x C ( 1 9 8 6 ) A c u p u n c t u r eelec roanal8esia n general surgery. n: Proceedings f the2nd warld Canlress ofScientific Acupuncture, Londo^: sa

11. Mortella.o N, Testuzza , La Rosa V Cosentifo F, Franco S,Pulvirent i , Ciul iano MC (1986) cup ncture nalses ia nradiosurBical reatment or oral cavi ty neoplas ias - n :Praceedings f the 2nd Warld ConBrcss f Scient i f icAcu pu nctu re, tondan | 59

12.Van Nghi N (1973) cupuncture nes thes ia oncerning heflBtfiftycases conducted ln ttance. Anerican Journal ofChinese Medicine. 1. 1 35-42

l3 .Niboyet J . L 'aneshds ie a r acupundu.e . Maison Neuve,

14. Panerai E, Martinl A, Abbate D, vlllani R, De Benedittis C(1983) P-endorphin , ecenkephal in nd 0l ipotropin inchronic pain and electroacupunctur . dvatces n PainResearch nd Iherapy, Volume 5. Raven Press, New York.

ls .Robi l lard , Vai l ly B, Dahlet M, Frankhauser , Muller A,Dupeyre (1983) Afalgs ie lectr ique er oprato irc arvoie per et transcltanee. tude n double aveugle. Ann. Fr.Anesk. R4anim.2-3:190

16. Schou CD (1984) Acupuncture or mis.aine reduces owelacIiviIy. loDrnal af Neurclagy, Neurcsurgery and Psychiaty.47(3) :317

THEASSOCIATION FBRITISH ETERI ARYACUPUNCTURE

invites new mernbersEnquiries please lo:

fhe President, Mr tohn Nicol otfhe 'e.retary, ME li tEwd

East Park Coa'a.gc, Hand('6t sussex RE , 5BD

Acupuncturc n Medicine

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doi: 10.1136/aim.15.1.10 1997 15: 10-13Acupunct Med

P Poulain, E Pichard Landri, A Laplanche, et al. study

randomisedabdominal and pelvic surgery: aElectroacupuncture analgesia in major

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