Page 16 - CASA Bulletin of Anesthesiology 2019 Vol 6 No 5

CASA Bulletin of Anesthesiology

under block and sedation, acupuncture is particularly well suited for intraoperative care . This
author is not performing “acupuncture anesthesia” as much as using it as part of a multimodal
solution for pain control as a greater goal of achieving opioid sparing protocol in the perioper-
ative period . Additionally, the auricular protocol used also helps with anxiety and post-opera-
tive nausea/vomiting . The protocol used is the Auricular Trauma Protocol developed by Joseph
Helms and his team, modified specifically for pain (two added points of insula and vagus) (12).
Given the limited time frame of surgery and the desire to create maximum effect from one acu-
puncture session, electricity is added to the Shen men and hypothalamus needles at 30 hertz .
If the procedure is for an acute trauma such as an ACL repair, the electricity is left for only 30
min . Conversely if the surgical procedure is for a more chronic state, such as a total knee re-

placement for chronic knee arthritis, the needles are left for 60 min. The goal is to stimulate the
needles for a period of time as to maximize the needle effects, but not to overdo it and cause a
depletion . Once the time is up, the needles are removed, and any residual heme is cleaned . In
the experience of this author, patients are not aware of the needles inserted after sedation despite
the fact that 100% of them exhibit behaviors of physiological awareness of the needle insertion
– movement upon needle insertion in the ear. It is unclear whether acupuncture initiated after
induction of general anesthesia has any great effect because the cortical activity of the brain is
compromised during needle insertion . There have been no studies found by this author in En-
glish looking at isolated intraoperative acupuncture effects in patients under spinal or peripheral

nerve blocks and sedation . I believe this is the next step for research .

In my experience, patients undergoing total knee replacements who have intraoperative
EAA, are able to take less narcotics and over just “feel good .” At the very least, there has not
been any adverse reaction . Anecdotally, the responses from patients range from minimal effect
to patients who have had, for example multiple knee arthroscopies prior to having their knee
replacement, who have said that they have never felt better after surgery . It is true that they re-
ceive a multimodal approach to analgesia as well as anesthesia, however, given the increased
complexity and invasiveness of a TKR vs a knee scope, there is some validity to their reports .
At the very least, patients’ satisfaction has been increased, which arguably does help with their
post-operative pain control .

Acupuncture still remains controversial in some circles, but the fact that its gaining popu-
larity, along with other non-pharmacologic methods of treatment, it is very important that anes-
thesiologist, who are perioperative physicians, be aware of such methodologies and be able to
provide/refer to these modalities for their patients. In our current need to contain and fight the
opioid epidemic, it shouldn’t be and alternative/eastern medicine approach versus a convention-
al/western medicine approach . It should be both a fully integrative approach .

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