Acupuncture in Obstetrics and Anaesthesia

• The aims of the present thesis (I-V) were to evaluate the analgesic and adverse effects of manual acupuncture for low-back and pelvic pain during pregnancy (I) and for labour pain (II-III), and also to study the effects of low-frequency electro acupuncture (EA) on clinical physiological responses to skin incision in anaesthetized patients (IV-V). Acupuncture in obstetric patients (I-III) Manual acupuncture in obstetric patients was found to relieve pain in one prospective randomised (I) and two retrospective (II-III) studies. Low-back and pelvic pain intensity during pregnancy was decreased by acupuncture (I), and parturients receiving acupuncture required fewer of the other analgesic modalities than the women in the control group (II-III). Neither patients in the acupuncture group nor their infants suffered from substantial adverse effects (I-III). These findings are in agreement with results obtained by other research groups investigating acupuncture during pregnancy and labour, but future studies are desirable to establish the role of acupuncture in obstetrics. Acupuncture in anaesthetized patients (IV,V) In contrast to the beneficial effects of acupuncture referred above (I-III), two prospective, randomised, placebo-controlled and double-blind studies (IV,V) revealed that low-frequency EA in anaesthetized patients did not attenuate but instead facilitated clinical physiological response to skin incision. Patients given EA required a higher steady state concentration of sevoflurane to abolish physiological reactions to skin incision (IV). Furthermore, when exposed to the same steady state concentration of sevoflurane, more acupuncture than control patients responded to surgery with movements of head or limbs, dilation of pupils or divergence of eye axes (V). Similar results have not been reported elsewhere, although combined high- and low-frequency EA in anaesthetized volunteers was recently reported to have no effect on the response to painful stimulation. In our study, the depth of anaesthesia was not influenced by acupuncture, since the A-line ARX index reflecting AEP activity was found to be similar in the two groups (V). Future studies of the possible mechanisms underlying this effect of EA under general anaesthesia are desirable.

• Popular Abstract in Swedish I motsats härtill ökade patienternas reaktioner på hudsnittet i magen om de fått akupunktur under narkosen innan operationen började. I våra prospektiva randomiserade undersökningar på patienter som skulle opereras i buken (IV-V) jämförde vi akupunktur med låtsas-akupunktur under pågående narkos. Det visade sig att om patienterna fått akupunktur efter nedsövningen, behövde de antingen mer narkosmedel i början av operationen (IV), eller också reagerade de aningen kraftigare på hudsnittet i magen (IV). Akupunktur tycks inte förstärka sövda patienters reaktioner vid inledningen av en operation genom att minska narkosdjupet, eftersom vi registrerade samma elektriska aktivitet i hjärnan som svar på ljudstimulering under narkosen oavsett om patienterna fått akupunktur eller ej (V). Dessa är de första kontrollerade undersökningarna av akupunktur som genomförts på patienter under narkos, och vi har ännu ingen fullt tillfredsställande förklaring till våra resultat. Nya undersökningar behövs för att kunna klarlägga hur akupunktur verkar i samband med narkos.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Nyckelord

Anestesiologi

intensivvård

auditory evoked potentials

intensive care

Anaesthesiology

sevoflurane

surgery

minimal alveolar concentration

inhalation

electric stimulation

obstetrics

delivery

childbirth

tender points

maternaty care

anesthesia

analgesia

labor

pregnancy

acupuncture

pain

Publikations- och innehållstyp

dok (ämneskategori)

vet (ämneskategori)