Anaesthesia & Accupucnture.

[Guest BluePin]

Any discussion and / or use of this seen in Canadian hospitals?

 

Seems to be well used in the orient, appearing in the US (Stanford), and UK...

 

Edit: ...and that should be acupuncture, not accupucnture

[justletmein]

Acupuncture is still considered to be "alternative medicine" in Canada.

 

It is practiced by members of a professional order who complete a specific training program (in Quebec anyway) - Acupuncturists are recognized as licensed practitioners and are reimbursed by most insurance plans.

 

In my opinion, it has absolutely nothing to do with anesthesia.

In china and other countries where acupuncture is popular, it is used to 'restore energy flow' in the body. It is a therapeutic treatment which can be used for pain, stress, digestive problems..... the list goes on.

 

I have seen a few studies where they have tried acupuncture-assisted anesthesia with varying results. You should also know that in the majority of acupuncture effectiveness studies show that the effectiveness is about 50%, but so is the effectiveness of the placebo - so you be the judge. It works when the patient thinks its working.

Put it this way.... There is no real evidence that it works, so I think it all depends what you believe.

Personally, I think its all BS.

[jaegwon]

I think you should be a bit careful in making a blanket statement about the effectiveness of acupuncture. That's a bit like saying 'drugs work/don't work'. Of course, in Eastern and alternative medicine settings, it's used in many ways, the success of which is often likely grounded in placebo effect. However, its also possible that in some cases there are underlying mechanisms that we don't understand yet. In terms of evidence-based medicine, I'm not completely up on the literature, but I do know that recently there have been some pretty good studies demonstrating the effectiveness of acupuncture in treating pain.

 

Main point: acupuncture, like other non-allopathic therapies is often BS (as you said), but probably not all the time

[justletmein]

I think you should be a bit careful in making a blanket statement about the effectiveness of acupuncture. That's a bit like saying 'drugs work/don't work'. Of course, in Eastern and alternative medicine settings, it's used in many ways, the success of which is often likely grounded in placebo effect. However, its also possible that in some cases there are underlying mechanisms that we don't understand yet. In terms of evidence-based medicine, I'm not completely up on the literature, but I do know that recently there have been some pretty good studies demonstrating the effectiveness of acupuncture in treating pain.

 

Main point: acupuncture, like other non-allopathic therapies is often BS (as you said), but probably not all the time

 

 

Not making a blanket statement. Just my personal opinion based on my experience and my knowledge of the literature.

 

I believe that acupuncture does have some effectiveness and I know that there is some scientific basis for why it does... but the bottom line is it is not reliable and definitely not well understood - therefore it has no business (for now) in modern medicine and especially not anesthesia.

[ploughboy]

Although absence of evidence does not indicate evidence of absence, personally I would prefer to receive a bit of midaz, a *lot* of fentanyl, some propofol and the anaesthetist's choice of inhalational agent. But that's just me.

 

I don't know that acupuncture has been trialed in the operative setting, but here's uptodate's take on acupuncture in general...

 

 

Summary — These studies suggest that there is little difference in the effects on pain between acupuncture and sham acupuncture.

 

One likely explanation for the results is that both acupuncture and sham acupuncture moderate pain through a strong placebo effect. An alternate possibility is that sham needling at nonacupuncture points to minimal depths has physiologic effects on pain. Against this latter possibility is the result of another randomized trial that examined the effects of acupuncture and sham acupuncture on postoperative nausea and vomiting [62]. This trial used a sham device that did not penetrate the skin and still found similar effects with acupuncture and sham acupuncture.

 

As discussed above, it is difficult to know whether acupuncture constrained by the requirements of a clinical trial has the same efficacy as when it is performed according to the practitioner's preferences. However the marked superiority of acupuncture and sham acupuncture over untreated controls demonstrates the strong effects of treatment seen even under study conditions.

[Satsuma]

Hey BluePin

 

Were you asking about using acupuncture during anesthesia...in the OR setting?

 

I am not aware of anyone using this technique and it would not be the standard of practice.

 

As you probably know, anesthesiologists are often involved with "pain medicine"...so dealing with pts who have chronic pain for a bunch of reasons. I would not be surprised if there were anesthesiologists incorporating acupuncture into their pain practice.

 

Although I do not know any anesthesiologists who use acupuncture, I do know of a neurologist who uses acupuncture and a family doc who does.

 

There is special training for acupuncture for those who already hold a medical degree. (which ends up being less long than if you went straight to be an acupuncturist...however, I cannot recall how long it is)

[Guest BluePin]

Hey BluePin

 

Were you asking about using acupuncture during anesthesia...in the OR setting?

 

I am not aware of anyone using this technique and it would not be the standard of practice.

 

As you probably know, anesthesiologists are often involved with "pain medicine"...so dealing with pts who have chronic pain for a bunch of reasons. I would not be surprised if there were anesthesiologists incorporating acupuncture into their pain practice.

 

Although I do not know any anesthesiologists who use acupuncture, I do know of a neurologist who uses acupuncture and a family doc who does.

 

There is special training for acupuncture for those who already hold a medical degree. (which ends up being less long than if you went straight to be an acupuncturist...however, I cannot recall how long it is)

 

Ya, OR setting. This sort of thing: http://www.china.org.cn/english/health/237046.htm

 

AFAIK, it is becoming reasonably well accepted for use in pain management:

 

http://www.chinapost.com.tw/health/surgical%20news/2008/06/02/159207/Acupuncture-used.htm

http://www.stanfordhospital.com/clinicsmedservices/clinics/complementarymedicine/medicalacupuncture

 

Crazy? Maybe. But then the dutch have been experimenting with the use of hypnosis in the OR setting for some time...

 

http://lib.bioinfo.pl/pmid:9926024

[ploughboy]

Ya, OR setting. This sort of thing: http://www.china.org.cn/english/health/237046.htm

 

If I understand this correctly, they claim to have done an off-pump CABG with an LMA, spontaneous breathing and only an unquantified "small amount" of IV anaesthetic (plus the accupuncture, of course).

 

*boggle*

 

I'd prefer to see this in a peer-reviewed journal, not as a press release, and with an n>1.

[leviathan]

If I understand this correctly, they claim to have done an off-pump CABG with an LMA, spontaneous breathing and only an unquantified "small amount" of IV anaesthetic (plus the accupuncture, of course).

 

*boggle*

 

I'd prefer to see this in a peer-reviewed journal, not as a press release, and with an n>1.

 

I'd use my right to opt out of this study, thank you very much.

[Satsuma]

for the OP and anyone else interested...just accidentally came accross this acupuncture program at MAC

 

http://www.acupunctureprogram.com/

This program meets the Accreditation Criteria for The Royal College of Physicians and Surgeons of Canada, The College of Family Physicians of Canada and the American Medical Association PRA Category 1. Our program fulfils the training requirements or is recognized by the Acupuncture Council of Ontario, British Medical Acupuncture Society, Canadian Academy of Medical Acupuncture, College of Chiropractors of Ontario, College of Massage therapists of Ontario and College of physiotherapists of Ontario. The program is also recognized by the Worker Safety and Insurance Board (WSIB) of Ontario and many other major insurance companies for payments to Acupuncture Providers.