A review of the use of acupuncture as the sole source of anesthesia for patients undergoing cesarean delivery in China reviewed 12 years of experience with success rates of 92% to 99%. Blood pressure, heart rate, and respiratory rate remained stable throughout the surgery, which is a significant advantage over pharmaceutical anesthesia (113). Although it is unlikely that acupuncture will readily be used as the only source of anesthesia in this country, it demonstrates the effectiveness of this approach and encourages its consideration as an adjunct. In one randomized controlled trial in patients undergoing upper-and lower-abdominal (gastrointestinal) surgery, acupuncture was given 2.5 cm lateral to the spine before induction. Postoperatively, patients who received the acupuncture had decreased postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses. Supplemental morphine use dropped by 50%, and postoperative nausea was reduced by 30%. Cortisol and epinephrine levels were reduced 30% to 50% during the recovery phase and the first postoperative day (114). Several studies specifically looking at nausea and vomiting in women undergoing gynecologic surgeries showed benefit in both acupuncture and acupressure (115–117).
Table 13.13 Commonly Used Botanicals and Vitamins and Their Possible Effects in the Surgical Patient
In a sham-controlled trial, the intensity of transcutaneous acupoint electrical stimulation (TAES) was studied in women undergoing lower-abdominal surgery. In patients receiving high-intensity TAES (9–12 mA), there was a 65% decrease in analgesia requirement, decreased duration in patient-controlled anesthesia therapy, and decrease in nausea, vomiting, and pruritus (118).
In Germany, auricular electrically stimulated anesthesia is frequently used. Review of one randomized controlled trial in patients anesthetized with desﬂurane with and without auricular acupuncture revealed significantly reduced anesthetic requirement (the amount of anesthesia required to prevent purposeful movements) (119).
Acupuncture warrants further investigation as an adjunct to anesthesia in gynecologic patients. Even simple adjuncts, such as the use of acupressure bands or electroacupressure bands, are reasonable to support as they are safe and showed some efficacy in decreasing nausea and vomiting postoperatively.
Mental preparation for surgery results in psychological, physiologic, and economic benefit. Higher levels of anxiety are associated with a greater risk of complications, depression, and increased need for anesthesia, decreased immune function, and a longer time to heal. Many different physiologic aspects are affected, including decreased chemotaxis and phagocytosis and decreased inﬂammatory factors such as cytokines. One study examining wound healing took healthy dental students and made a standardized scalpel incision in the palate at two times: one right before examinations and one during summer vacation. The incisions in these healthy students took 3 days (40%) longer to heal during times of stress versus times of decreased stress (120). The power of the spoken word was explored as long ago as 1964, when a study randomized patients to a preoperative visit characterized by sympathetic, caring, and informative communication versus an interchange characterized by cursory remarks. The patients receiving the sympathetic preoperative visit required half the pain medicines and had a two-and-a-half-day decreased hospital stay (121).