Acupuncture (SSP Therapy) Practical Use For Anesthetic & Plastic Surgery (Pain-Sedation & Swelling)

Takehiro Shirakabe (MD), Yukio Shirakabe (MD) from Osaka Shirakabe Clinic, Masayoshi, Hyodo (MD), Osaka Medical College, Osaka, Japan.

Acupuncture anesthesia has been under research in China from about 1960, and in 1971, during President Nixon's trip, it was widely publicised internationally.  Initially, many doubted the truth of these reports, but further investigation has proven their possibility.

In the past few years, we have made various attempts at applying acupuncture anesthesia to our field.  In surgery such as mammaplasty, in some cases, the anodynic effect was strong yet allowed the patient to talk with the surgeon during the operation.  But in some cases the effect was very weak.  As a result, we found that it has the drawback of differing greatly among individuals.

From the viewpoint that anesthesia must be 100% effective, we almost gave up trying to use the Chinese method of acupuncture anesthesia which requires much experience and technique.

However, reviewing the patients' progress, the acupuncture group showed that the presurgery sedative effect and post surgery anodynic effect and swelling conditions were markedly better compared with the control group.  In this group, there is remarkable decrease of the necessity of using pain relief medicine, tranquiliser and antiphlogistic.  The patients who underwent the secondary operation reported that they felt comfortable and less nervous compared with the first operation.

Here I present methods, results and late data of the acupuncture anesthesia with some discussion.

Applying Point and Materials

Among the 365 acupuncture points which are located on the meridian lines, we chose two points, which are called "Hoku" located at the junction between the thumb and the index finger, and "Tu-sanri" located below the middle of the line connecting the tuberositas tibiac and caput fibulac on both lower legs, as these points don't interfere with the surgery area. (Fig 1)
 
 

At first we used a twisting needle, but there were some drawbacks.  For example, twisting the needle could not be continued over a long period of time because some patients become frightened when the needle was inserted, and the needle could become dislodged with body movement or when touched by clothing worn during surgery.  To solve these problems, although less effective, we adopted a silver-plated cone-shaped electrode (Silver Spike Point (SSP)) invented by Hyodo, and the discontinuous low-frequency current, Lauss-MX-1001 and Lauss Anesty-6 (Professor Hyodo & Dr. Shirakabe's model) which is the improved one of the Lauss MX-1001.

Various experiments showed that these devices raised the pain threshold as markedly as the method of twisting needles.

METHOD

Thirty minutes before surgery, the SSP electrode was set over the "Hoku" and Tu-sanri" points with the condition shown on Table 1, and the electricity was applied. (Table 1)  When the volume of VP-P voltage was gradually increased, twitching began.  With the elapse of time, the pain threshold rose and this was maintained.  The minimum time of electricity appliction was one hour and the maximum was until the end of the operation.
 
 

The electricity application is continued for 30 minutes per day for two days after surgery depending on the case.

RESULTS

You can see the differences in swelling of post-operation below in Fig 4 below.

We chose the post-operative data of double-eyelids, rhinoplast, and surgery of the face.  In these cases, we can see the differences more clearly because no bandages suppress the area after surgery. (Fig 5 & Fig 6)

We set some conditions for consistency.  The same anesthesia, the same operation method, and the same doctor must be required to handle one kind of operation, and the same doctor did the questioning and grading for six months.

Out of seven symptoms of the 1571 cases in a year, we obtained data from 623 cases of SSP and used 500 cases as control. (Fig 7)

We have the result that 74.3% of the acupuncture group showed the pre-surgery sedative effect and post-surgery anodynic effect, and swelling conditions were markedly better, while in the control group the percentage was 20.2%.  (In post-surgery swelling, the data for the acupuncture group and control was 46% and 7.4% respectively. (Fig 8)
 
 

Fig 9 shows these results in graph form.  The difference can clearly be seen. (Fig 9)
 
 

In SSP cases the time of starting pain is 5.9 hours after the operation, and in the control it is 4.1 hours.  The use of pain relief medicine in SSP group is 59%, and in the control it is 80%.  According to Hyodo, the first gas passed out after ventrotomy was after about 44.3 hours on the average in SSP cases, but in the control cases it was 69.3 hours.  Thus the use of SSP works very effectively to the patients mentally and physically.

DISCUSSION

Acupuncture is a type of scientific stimulation treatment of which we cannot explain rationally, but the experience has shown its positive effects.

To explain its effects, we have at present two hypothesis.

One is modulation of pain, mental and physical.  When there are two points of pain, the stronger one will cancel the weaker one.  Thus, if strong stimulation is applied, it can cancel other pain sensations.  The other hypothesis deals with endorphins, which are morphine-like substances located in the central nervous system.  They are Methionine-encephalin, Leucine-encephalin, a-endorphin, ß-endorphin and r-endorphin.  In 1975, Huges (USA) and others proved that -endorphins work effectively.

When a needle is inserted into an acupuncture point, the stimulation goes through the meridian line into the central nervous system and causes the secretion of endorphins which have the same anodynic effect as an injection of morohine.  During acupuncture or SSP, administration of naloxone, an antagonist of morphine, causes disappearance of the anodynic effect. (Fig 10)

SUMMARY

The low-frequency electrode variation of acupuncture treatment which has been used mainly in pain clinics now shows that it can be applied in our field as it contributes to pre-surgery sedative effect and anodynic effect during surgery, and good post-surgical progress.  We will try hard to establish the effectiveness of acupuncture anesthesia.

ACKNOWLEDGEMENTS

Part of this paper was presented at the 2nd Academic Central Seminar of SSP (in Tokyo, August 1979), the 6th Curso de Cirugia Plastica Y Estetica (in Spain, September 1979), and the 23rd Congress of Japan Plastic Surgery (in Nagasaki, April 1980).

To conclude this paper, I would like to express my gratitude to Dr. Wataru Hyodo of Department of Anesthesia of Osaka Medical College, my secretary Mr Hayao Okamoto and the rest of the staff who made a great effor t for a long period of time summing up the data.
 

References:

Huges, J., Smith, T. W., Kosterlitz, H. W., Fothergill, L. A., Morgan, B. A., and Morris, H. R., Identification of two related pentapeptides from the brain with potent agonist activity, Nature 258, London, 1975 p577-579.

Masayoshi Hyodo, New Acupuncture Treatment for Pain (in Japanese) 1978.

Masayoshi Hyodo & Toshikatsu Kitade, Silver Spike Point Electro Therapy (in Japanese) 1978.

Masayoshi Hyodo, Anesthesiology (in Japanese) 332-334, 1979.

Reproduced with permission from Nihon Medix, Japan.