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1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,

27-29th September, 2007, Cluj-Napoca, ROMANIA

Research in electro-acupuncture anaesthesia


G. Gh. Litarczek, J. J. Ciurea, and S. G. Paca

Abstract An electro-acupuncture anaesthesia was developed and tested with very good result. A number of electrical stimulators
was developed and clinically tested. This method proved to be efficient as the analgesic component of general anaesthesia along with
hypnosis and relaxation accomplished by usual drugs. It avoids the use of any volatile or soluble anaesthetic or analgesic substance
diminishing so the degree of intoxication of the nervous system.
Keywords: electro-acupuncture anaesthesia, electrical stimulation, analgesia.

1. INTRODUCTION EA is more effective when associated with central anti


adrenergic drugs like the 2 agonists.
Among the physical and chemical factors used in
medicine, the electrical stimuli are the most currently The main somatosensitive pain input uses C fibres in the
used due to their similarity to the natural biological anterolateral spinothalamic tract. The traffic through
stimulus. these fibres are suppressed during EA most probably by
closure of the gate at metameric level by stimuli coming
In addition, electrical stimuli present us with the through collaterals from A and A inputs produced by
following advantages: they are gentle and do not affect acupuncture high frequency stimulation, as well as by
the tissues; they can be used repetitively; they have a inhibitory stimuli coming from brainstem periaqueductal
direct and prompt action; they can generate excitation and gray nucleus and reticular nuclei stimulated by low
inhibitions in any type of cells or tissue; they can be frequency. Stimulation of the hypothalamus determines
measured very precisely; they can be applied very -endophine secretion which through blood and liquor
accurately [1]. spreads to the central nervous system and other peripheral
systems. The mechanisms are still in a hypothesis level,
A neural system is a bioelectrical entity under the and will be discussed later.
influence of the electrical current. In many diseases, the
electrical stimulation of the neural structures is an Identification of EA points are performed in a traditional
alternative to the drug based therapy. manner (cun measurements) and impedance
measurements by an electronic detector. For head surgery
An alternative to classical general anaesthesia in which the election points are IG4/P6(TF5) bilateral +
analgesia is based on drugs (volatile anaesthetics or VB/15/VB20. Both ends of surgical incision must be
soluble analgesics), which produce a reversible stimulated by EA device.
intoxication of the nervous system, is electro-
acupuncture anaesthesia (EA) [2]. This method is based Patients could be conscious during EA (vigil EA) or put
on injections of electrical currents through acupuncture on deep sleep, depending on type of surgery, patient
points. Even not entirely understood, acupuncture and EA biological and psychical status, etc Recommended oral
are efficient time proved methods to realize analgesia and premedication is a benzodiazepine (diazepam or
especially surgical analgesia [3]. midazolam associated with clonidine, 0.3-0.5 mg/ Kg
body weight, but not analgesic or opioids. Two
2. METHOD intravenous safe lines are mounted and connected to
infusion syriges.
The background of EA is the functional integrity of
nervous system, meaning that all anaesthetics and Two pairs of needles are used at two different
analgesics can alter central nervous system functions. frequencies, high in periphery and low to inject currents
in deep central nervous system. In Figure 1 is shown the
The EA is accomplished by acupuncture direct effects needle electrode placement in an experimental
associated with hypnotics and muscular relaxants. The measurement during anaesthesia.

The electrical stimulation starts from low levels (under


G. Gh. Litarczek is with the Clinical Hospital Fundeni, Bucharest, threshold) and is risen up in a progressive manner till
phone/fax: +40-21-630-3816; e-mail: geolitarczek@yahoo.de. desired effects are obtained.
J. J. Ciurea is with the Clinical Hospital Bagdasar-Arseni of
Bucharest, phone: +40-723-741-986; fax: +40-21-332-4229; e-mail:
ciureaj@yahoo.com.
The next steps are hypnotic injection, intubations and
S. S.G. Paca is with the Medical Electronics and Information Group, mechanical ventilation, myorelaxation. Surgery may start
University POLITEHNICA of Bucharest, phone: +40-722-854-175; e- after 30 minutes of stimulation.
mail: pasca@elmed.pub.ro.

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1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA

Figure 2. Block diagram of Electrical Stimulating System.

The stimulation parameters for the tissue are: the injected


currents density, the stimulating pulses duration and the
Figure 1. Anesthesia by electro-acupuncture. stimulus rise duration [4], [1].

The maintenance of sleep is accomplished by continuous The excitation appears at the negative electrode [1]
infusion of midazolam or propofol. Analgesia is because, in the case of excitation stimuli for a cell, it has
accomplished by EA. to be either positive inside or negative outside the cell.

During wake up, midazolam or propofol are stopped. The elementary stimulus used is shown in Figure 3.
Electrical stimulation is turned off after the patient is full
conscious.

Local anaesthetics and ketamin (0.30.5 mg/Kg body


weight) are allowed.

One must always use the same points for a certain region
or type of surgery to obtain best effects.

All patients will benefit of a good postoperative pain


control lasting even a few days, with minimal and
frequently without analgesic medication avoiding thus the
unpleasant post anaesthesia events such as nausea,
vomiting bound to high amounts of pain killers, etc

A total number of 219 patients benefit of this procedure. Figure 3. The electric stimulus.

3. EQUIPMENTS The mean value of the stimulus is zero in order to prevent


necrosis due to electrolysis of the tissues around the
A block diagram of an Electrical Stimulating System needle appearing when a prolonged strong stimulation is
(ESS) is presented in Figure 1. It is implemented using a used.
microcontroller that also provides communication with
the user, with a PC and generates the signals for the three The stimulus generated by our system has not only the
stimulating channels [4]. rectangular stimulating pulse (negative in Figure 3, as it
is at the negative electrode responsible for the excitation),
The output stages have isolated outputs in order to be but also an opposite exponential pulse having the same
connected to the same patient [5]. The duration of the area to obtain the zero mean value [6].
stimulating pulse is controlled by a digital output of the
microcontroller and its amplitude is established by the With ESS, the amplitude of the exponential pulse is lower
microcontrollers analogue output. The output stage when the tissue impedance is also lower. This has no
automatically provides the exponential opposite pulse to influence whatsoever over the effects of the stimulation,
generate a zero mean stimulating signal. The output pulse the opposite pulse extracting only the charges injected by
voltage and current on each output stage is measured the exciting pulse [7].
using a sense amplifier and one analogue microcontroller
input. It is preferable to use voltage pulses in stimulation rather
than current pulses. Because of the tissues capacitance
ESS is implemented with very low power devices so that effect, in the case of a current pulse, the voltage across
they can be supplied using batteries. This way, the the tissue takes some time until it reaches its maximum
medical isolation of the system has been easily solved. value, so the human cells start to adapt to the stimulation

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1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA

pulses; while in the case of a voltage wave, the sharp Measuring the point resistance can be performed in two
edges with rapid rise rate and a greater pick in current ranges: the first one is 0-1 M, while the second range is
value prevent this adaptation, helping to perform a better 0-10 M.
stimulation (Figure 4).
4. RESULTS

Form the total of 219 a number of 13 patients were


neurosurgical. Most of 219 the patients were heart
surgery for replacement of mitral valves (145) and 37
were operated on abdomen. There are 5 scolioses.

Figure 4. Curent vs. voltage pulse stimulus. All patients presented a good analgesia with no peaks of
high systemic or pulmonary blood pressure and efficient
Experimentally, we have found that, in order to avoid the haematosis. The cardiac output, cardiac index and
burns and necrosis, high diameter needle electrodes must systolic index were maintained in physiological range.
be used and the amplitude, the duration and the frequency
of the pulse must be correlated and maintained under A disconnection of stimulation induced a rise in heart rate
certain limits. and systemic blood pressure followed by an instant come
back after reconnection.
In order to obtain an effective anaesthesia, very high
amplitude is necessary for the stimulation [2], but only The arousal was fast and without side effects. Analgesia
under the above limits (for example, using thick needle persisted for more days compared with hours in
electrodes and having a stimulus of 40 V and 120 Hz, the classical method. Blood circulation was stable and
duration of the pulse must be under 50 s, whereas for a physiological parameters were maintained during
stimulus of 40 V and 5 Hz the duration of the stimulus anaesthesia. No shivering during wake up was recorded
can be up to 500 s). despite rapid gain of consciousness.

The elementary stimulus pulse is repeated in four Patients did not recall any events from the time of EA.
stimulation modes illustrated in Figure 5: Postoperatively they presented a status described as
Continuous mode a train of elementary pulses at comfortable and peaceful and some even could ask for
the same frequency f1; food or television.
Discontinuous mode a train of pulses at frequency
f1 followed by a rest period; 5. DISCUSSION
Alternative mode two alternate trains of pulses with
frequency f1 and f2; Acupuncture was used 2800 years ago in Chine.
Discontinuous alternative mode the frequencies of Although it is not completely scientifically understood,
pulses alternate between f1 and f2, with a period of this method proved its efficiency along years. The
rest between each frequency change. amount of drugs is less when compared with classical
method, offering meanwhile better hemodynamic
Continuous : | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | conditions. Several reports from 1977 to 1980
f1
| T= 5 sec | demonstrated that acupuncture analgesia is blocked or
reversed by naloxone, an opioid antagonist [8], [9].
Discontinuous : | | | | | | | | | | | | | | | | | | | | | |
f1 f1
| T= 5 sec | The involvement of the peripheral opioid system in
modulating inflammatory pain has been well
Alternative : | | | | | | | | | | | | | | | | | | | ||||||||||||||||||||||||||||||||||||||||||||||||| | | | | | | | | documented. Involvement of peripheral opioid
f1 f2 f1
| T= 5 sec | mechanisms in electro-acupuncture analgesia is
confirmed by recent experimental studies too.
Alternative : | | | | | | | | | | | |||||||||||||||||||||||||||| | | | | | | | | |
f1 f2 f1
discontinuous
| T= 5 sec |
One study aimed to investigate the possibility of electro-
Figure 5. Stimulation modes. acupuncture mediated peripheral opioid release. Rats
were injected to induce localized inflammatory pain. The
In the case of active acupuncture point detection we have pain behavioral changes were measured by paw
used the method of impedance measurement, obtaining withdrawal latency to a noxious thermal stimulus. At day
very good results. A constant current is being injected to 5 of inflammation, rats received a second injection of
the suspect point on the skin, by a sharp narrow headed saline or opioid antagonists into the inflamed paw,
electrode, while another large surface electrode should be followed by EA at 30 Hz, 2 mA, and 0.1 ms for 30
held in the patients hand, in order to screen the patients minutes. The EA was conducted at acupuncture point
skin. The voltage between the two electrodes is measured GB30. A control was used in which needles were inserted
by a microcontroller analogue input port. A minimum at GB30 but no electrical stimulation was applied. Rats
value indicates detection of an active point. receiving electro-acupuncture showed a significantly

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1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA

longer limb retraction time as compared with the control At last, patients satisfaction was represented by comfort
from 30 minutes to three hours after treatment. and peace which is a strong point of this method.
Intraplantar injection of naloxone methiodide, a
peripherally acting opioid receptor antagonist, eliminated 6. CONCLUSION
the analgesic effect at 30 minutes after electro-
acupuncture treatment. Intraplantar injection of naloxone The anaesthesia by electro acupuncture is lately
methiodide, a peripherally acting opioid receptor recognized and has proven its usefulness through its
antagonist, eliminated the analgesic effect at 30 minutes advantages against the traditional drugs anaesthesia.
after electro-acupuncture treatment. Intraplantar injection
of an antibody against beta-endorphin and a This method proved to be efficient as an alternative
corticotropin-releasing factor antagonist also produced a during years. It provide with good analgesic effects and
reduction in limb withdrowel in rats receiving electro- no respiratory and circulatory change. The wake up is
acupuncture. These data strongly suggest that peripheral fast, without shivering and analgesia persists for days.
opioids are released by electro-acupuncture at the
inflammatory site [10]. Better equipments and larger number of cases should be
Nitric oxide (NO) has recently involved in acupuncture the next step in this research.
action mechanisms. NO mediates in the gracile nucleus
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