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Using A
Twitch Monitor For
Jue Yin/Shao Yang Energetic Solution
To Prevent Postoperative Nausea
Andrea Ligeti, MD
Edward W. Herron, Jr., MD
Georgia A. Morgan First, BS
Randall C. Cork, MD
ABSTRACT
Background The PC 6 acupuncture point has been used to prevent
postoperative nausea. In addition, the muscle twitch monitor has been
used by anesthesiologists to assess muscle relaxation.
Objective To evaluate the muscle twitch monitor connected to
PC 6 and PC 7 acupuncture points for prevention of postoperative nausea.
Design, Setting, and Patients Thirty-nine female patients scheduled
for laparoscopic surgery were randomly allocated to an acupuncture (n=24),
or a control (n=15) group. For the acupuncture group, muscle twitch
monitoring was done at both a commonly used location (temporalis muscle)
and at the PC 6 and PC 7 points with a TE 5 tack.
Main Outcome Measures After the surgical procedure, the anesthesiologist
evaluated utility of the PC 6/PC 7 configuration of the twitch monitor
for intraoperative twitch assessment, and nurses in the post-anesthesia
care unit monitored the incidence of postoperative nausea.
Results The PC 6/PC 7 twitch location was associated with significantly
less postoperative nausea in the acupuncture group (17% vs 60% in controls;
P<.01) with no decrease in efficacy of the clinical twitch monitoring.
Conclusion The muscle twitch monitor may be used to decrease
the incidence of postoperative nausea.
KEY WORDS
Postoperative Nausea, Neuromuscular Blockade, Twitch Monitoring, Jue
Yin, Shao Yang
INTRODUCTION
The effectiveness of stimulation of the PC 6 acupuncture point has been
demonstrated in the prevention of postoperative nausea.1 However, to
our knowledge, an intraoperative energetic approach using the readily
available twitch monitor has not been attempted. A twitch monitor is
an electrical stimulating device commonly used by anesthesiologists
for assessing the effect of muscle-relaxing drugs.2 Intraoperative use
of the twitch monitor has been limited to assessing the degree of muscle
relaxation with observation of muscle twitch response. However, when
electrical stimuli are applied to appropriate acupuncture points, Qi
may be moved. The purpose of this study was to integrate the use of
the muscle twitch monitor to both evaluate muscle relaxation and stimulate
the PC 6 and PC 7 acupuncture points.
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| Figure
1a. Placement of control electrodes over the temporalis muscles.
The magnitude of the muscle contraction after a twitch stimulus
indicates to the anesthesiologist the degree of neuromuscular blockade
induced by administered muscle relaxants during anesthesia. The
subject is one of the co-authors (G.A.M.F.). |
Figure
1b. Placement of the negative electrode (black) at PC 6 and
the positive electrode (red) at PC 7 on the inner forearm. This
proposed alternative placement continues to provide a monitor of
neuromuscular blockade while, in conjunction with a TE 5 tack, providing
energetic input to decrease the risk of postoperative nausea. |
METHODS
After approval by the institutional review board and obtaining patients'
informed consent, females scheduled for abdominal laparoscopic surgery
were randomly assigned to 1 of 2 groups. In the control group, muscle
twitch stimulation was performed in a normal fashion for this procedure,
with the electrodes placed over the temporalis/frontalis muscles (Figure
1a). In the acupuncture group, in addition to normal placement on the
temporalis/frontalis, a 2nd twitch monitor was applied and muscle twitch
electrodes were placed along Jue Yin of 1 arm only, negative at PC 6,
positive at PC 7 (Figure 1b). To complete the n/n+1 energetic circuit,6
an acupuncture tack was placed along Shao Yang at TE 5. (The acupuncture
points used in this study are illustrated in Figure 2a and Figure 2b,3
and placement of the electrodes at PC 6 and PC 7 is shown in Figure
1b [the control electrode placement is shown in Figure 1a].The complete
treatment plan for this study is illustrated in Figure 3.3)
Muscle twitch
was monitored in both groups with a supramaximal stimulus at 10-second
intervals.2 After each procedure, the anesthesiologist assessed the
twitch-monitoring utility of the PC 6/PC 7 lead placement compared with
standard lead placement at the temporalis/frontalis muscles. In the
post-anesthesia care unit, a nurse blinded to treatment group asked
each patient if she felt nauseous. Data were analyzed using x2 analysis
and the t test. Significance was set at P<.05.
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| Figure 2a |
Figure 2b |
RESULTS
Thirty-nine females were randomized: 15 to the control group and 24
to the acupuncture group. There were no differences between groups in
age (mean [SEM], 33 [2] years), weight (87 [4] kg), height (161 [1]
cm), history of diabetes (1 in each group), history of smoking (9 control,
7 acupuncture), or history of post-anesthesia nausea (3 control, 2 acupuncture).
Every anesthesiologist rated the PC 6/PC 7 placement of the stimulator
leads as equivalent in utility for assessing muscle relaxation to the
temporalis lead placement. There was significantly less postoperative
nausea in the acupuncture group compared with the control group: 60%
(9/15) in the control group vs 17% (4/24) in the acupuncture group (P=.01).
DISCUSSION
Abdominal laparoscopy is associated with a high incidence of postoperative
nausea.4 Also, CO2 insufflation of the abdomen necessitates the use
of neuromuscular blockers to relax the abdominal musculature.5
Dundee and colleagues1
illustrated the use of a single PC 6 tonification to reduce postoperative
nausea. However, an energetic approach, using 3 needles for an n/n+1
approach for tonification of Jue Yin and dispersion of Yang along Shao
Yang, had not been attempted. The Jue Yin and Shao Yang energy axes
in the body6 are illustrated in Figure 4. Placement of needles, electrical
stimulation, or application of pressure at specific points along these
energy axes redirects the flow of energy and produces the tonifying
or healing effect. All 3 principal energy channels, including the 12
Meridians,6 are are located in a symmetrical bilateral fashion along
the sagittal axis of the body.
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| Figure 3 |
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| Figure 4 |
The rationale
for using only upper-body points in this approach is their accessibility
to the anesthesiologist during a surgical procedure. However, the lower-body
points could also be used. With the same n/n+1 approach,6 this could
involve placement of additional Yin and Yang points on the lower Jue
Yin/Shao Yang energy channel.
CONCLUSION
An energetic n/n+1 Jue Yin/Shao Yang therapeutic input program can be
integrated with a muscle twitch monitor placed along the Jue Yin axis
to decrease the incidence of postoperative nausea and, at the same time,
provide clinical utility in the monitoring of muscle twitch. In this
manner, a standard monitoring device regularly used by an anesthesiologist
may be employed as a therapeutic device to decrease the risk of postoperative
nausea.
REFERENCES
-
Dundee
JW, Ghaly RG, Bill KM, et al. Effect of stimulation of the P6 antiemetic
point on postoperative nausea and vomiting. Br J Anaesth. 1989;63:612-618.
-
Leonard
PA, Whitter TB, Sokoll MD. Monitoring neuromuscular blockade. In:
Longnecker DE, Tinker JH, Morgan GE, eds. Principles and Practice
of Anesthesiology. 2nd ed. St Louis, Mo: Mosby; 1998:907-922.
-
Helms
JM, Malmquist K. Acupuncture Energetics. Version 2.03.1. Berkeley,
Calif: Medical Acupuncture Publishers; 1998.
-
Watcha
MF, White PF. Postoperative nausea and vomiting: its etiology, treatment,
and prevention. Anesthesiology. 1992;77:162-184.
5. Nord HJ. Complications of laparoscopy. Endoscopy. 1992;24:693-700.
-
Helms
JM. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995.
AUTHORS'
INFORMATION
Dr Andrea Ligeti and Dr Edward W. Herron, Jr., are Clinical Assistant
Professors, and Dr Randall C. Cork is Professor and Chair in the Department
of Anesthesiology at Louisiana State University (LSU) Health Sciences
Center in Shreveport, Louisiana. Dr Cork is also Director of the Pain
Management Service. Ms Georgia A. Morgan First is Research Coordinator
in the Department of Anesthesiology, LSU Health Sciences Center, Shreveport,
Louisiana.
Andrea Ligeti, MD
Dept of Anesthesiology
Louisiana State University Health Sciences Center
1501 Kings Highway,
Shreveport, LA 71130
Phone: 318-675-7195 o Fax: 318-752-8845
Edward W. Herron,
Jr., MD
Dept of Anesthesiology
Louisiana State University Health Sciences Center
1501 Kings Highway,
Shreveport, LA 71130
Phone: 318-675-7195 o Fax: 318-752-8845
Georgia A. Morgan
First, BS
Dept of Anesthesiology
Louisiana State University Health Sciences Center
1501 Kings Highway,
Shreveport, LA 71130
Phone: 318-675-7195 o Fax: 318-752-8845
Randall C. Cork,
MD, PhD*
Dept of Anesthesiology
Louisiana State University Health Sciences Center
1501 Kings Highway,
Shreveport, LA 71130
Phone: 318-675-7195 o Fax: 318-752-884 o Email: rcork@lsuhsc.edu
*Address all
correspondence to Dr Cork at above address.
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