Clinical study of prevention of urine retention after subabdominal surgery by electro-acupuncture acupoints Yin Ling Quan(SP 9), Zhao Hai(KI 6) with the assistance of subarachnoid acupoint anesthesia

Peng Dengf(彭登发) , Wng Linjun(王联钧)＊, Shi Jingwen(石静纹),Ci Lingling(蔡玲玲), nd Wu Meicho(吴美超)

a: First department of Surgery, National hospital of Tujia and Miao minority Autonomous prefecture Of Hubei Province Enshi city, Enshi 445099, China

b: Dongfang Hospital, the Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100078, China

Clinical study of prevention of urine retention after subabdominal surgery by electro-acupuncture acupoints Yin Ling Quan(SP 9), Zhao Hai(KI 6) with the assistance of subarachnoid acupoint anesthesia

Peng Dengfa(彭登发)a, Wang Lianjun(王联钧)a＊, Shi Jingwen(石静纹)b,Cai Lingling(蔡玲玲)b, and Wu Meichao(吴美超)b

a: First department of Surgery, National hospital of Tujia and Miao minority Autonomous prefecture Of Hubei Province Enshi city, Enshi 445099, China

b: Dongfang Hospital, the Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100078, China

OBJECTIVE:To explore the prevention of urine retention after subabdominal surgery by electro-acupuncture Yin Ling Quan (SP 9),Zhao Hai (KI 6) acupoints with the assistance of subarachnoid acupoint anesthesia by observing the postoperative voiding time and urine volume of postoperative patients undergoing Electroacupuncture plus subarachnoid block anesthesia.

METHODS:60 cases of preoperative expected for subarachnoid block surgery patients were randomly divided into two groups,the treatment group and the control group, with 30 cases in each group. The control group underwent routine subarachnoid anesthesia after surgery without acupuncture treatment group;The treatment group was treated with acupuncture bilateral Yin Ling Quan and Zhaohai acupoints 15 minutes before anesthesia,and then received unilateral electric anesthesia instrument treatment, the intensity of the patient was tolerable (generally 1.5 ～ 2.0mA), and the routine subarachnoid block anesthesia was performed; The first urination time, urine volume, lower abdominal pain and assistant catheterization were recorded in the two groups.

RESULTS:The first postoperative voiding time of the treatment group was significantly earlier compared with that of the control group, there was significant difference (P＜0.05); the amount of urine was significantly more than that of the control group in reservation time, there was significant difference(P＜0.05); the abdominal pain was light in the treatment group,there was significant difference (P＜0.05); the cases of assisted catheterization of the control group were significantly more than those of the treatment group, there was significant difference (P＜0.05).

CONCLUSION:Electro-acupuncture Yin Ling Quan (SP 9),Zhao Hai (KI 6) acupoints with the assistance of subarachnoid acupoint anesthesia could significantly reduce the urine retention after subabdominal surgery in postoperative patients with ubarachnoid block anesthesiau, accelerate the recovery of bladder function and promote early postoperative urination in addition to relieving the abdominal symptoms after operation.

Electro-acupuncture; Yin Ling Quan (SP 9);Zhao Hai (KI 6); Subarachnoid acupoint anesthesia; Urinary retention

Acute urinary retention is a common complication of surgery, which is mostly caused by anesthesia or pain stimulation and manifested as bladder filling,distending pain in lower abdomen and voiding difficulty. In traditional Chinese medicine theory,urinary retention is regarded as “dysuria”, which is induced by organ dysfunction, dysfunction of bladder qi in transformation, clogged watercourse, meridians stasis caused by anesthesia and subabdominal surgery.At the same time, because of anesthesia and surgery,blood loss during the surgery gives rise to spleen and kidney qi deficiency, sinking of middle energizer, rise failure of Qing Yang, subsidence failure of turbid Yin.Therefore, Bladder qi transformation cannot be warmed and invigorated, which causes dysuria. Combination of electro-acupuncture and spinal anesthesia is an easy and effective way to prevent urinary retention after subabdominal surgery, it avoids pain of urinary catheterization during the early period of post-operation,offers a new way to decrease urinary retention and promote bladder function recovery after surgery.

MATERIALS AND METHODS

Therapeutic method

According to the inclusion and exclusion criteria,60 cases of patients, who accepted spinal anesthesia during subabdominal surgery inthe 1st surgical department of Enshi center hospital during the period of December 2013 to July 2016, were randomly divided into 2 groups. v treatment group and the control group respectively. Both groups received spinal anesthesia.In the Treatment group: apart from spinal anesthesia,patients were acupunctured into bilateral Yin Ling Quan(SP 9) and Zhao Hai9 (KI 6) for 0.8-1.2 cun with 1.5 cun needles 15min before surgery. Electronaesthesia apparatus were applied unilaterally after patients feeling tingling and (or) distending pain, current intensity were adjusted in the light of patients’ tolerance (usually in the range of 1.5-2.0mA.) Needles are withdrawn 0.5h after surgery.) In the control group: spinal anesthesia were applied alone without electroacupuncture.

Clinical value

Clinical symptoms,signs and general conditions:subabdominal distention or distending pain.Subabdominal distention was graded as following standard1. Grade 0 counted as 0, grade 1 counted as 1, grade 2 counted as 2, grade 3 counted as 3.Subabdominal distention: grade 0-no distention;grade 1-slight distention; grade 2-moderate distention,affecting sleep, but can be relieved by general painkiller(such as Rotundine); grade 3-severe distension, can be relieved by central painkiller (such as pethidine) but not general painkiller. 2. Urination condition after surgery:recording the urinating time after surgery, the total urine volume 2h after surgery, whether urinary catheterization was applied, the extent of symptom improvement after first urination of two groups.

Data processing

①SPSS14.0 was used to process raw data;② Mean±standard deviation （） was applied to describe measurement data, t text was applied to tell if group comparison were signi ficant or nor; ③X2was applied to tell if measurement data were signi ficant or not.

RESULT

Comparison of two groups’ first urination time(table 1)Table 1. Comparison of two groups’ first urination time（）

Comparison of two groups’ first urination time(table 1)Table 1. Comparison of two groups’ first urination time（）

Upon testing,︱t︱=3.37; P＜0.05, their difference is significant. First urination time of the treatment group and the control group is comparable, significant difference can be seen.First urination time of the treatment group is significantly shorter than that of the control group.

?

Comparison of urination time after surgery(table 2)Table 2. Distribution table of urination time after surgery

According to therapeutic effect standard, the comparison of the treatment group and the control group can be seen in table 3Table 3. Comparison of the therapeutic effect of the treatment group and the control group

With respect to therapeutic distribution, degrees of freedom=2, x2=7.94,P＜0.025 according to critical value for x2, which meets the requirement of the test criterion ofP＜0.05, which means it is statistically significant.It can be considered to be significantly different between the treatment group and the control group. The therapeutic effect of the treatment group is significantly superior to that of the control group, the difference was of statistical significance.

Comparison of urine volume 2h after surgery(table 4)Table 4. Comparison of urine volume 2h after surgery（）

Comparison of urine volume 2h after surgery(table 4)Table 4. Comparison of urine volume 2h after surgery（）

Upon T testing, P＜0.05, there is a statistically significant difference between the treatment group and the control group.

?

The total urine volume of the treatment group is explicitly more than that of the control group.

Comparison of catheterization cases after surgery (table 5)Table 5. Distribution table of catheterization cases

It can be indicated in table 5 that there is only 1 case of treatment group gets catheterization, yet 4 cases of control group get catheterization for suffering from anuria and severe clinical symptoms.

Comparison of clinical symptoms (table 6)Table 6. Comparison of clinical symptoms (abdominal distention and pain, sense of urgent urination)

It can be manifested from abdominal distention and pain of table 6, degree of freedom=3, x2=9.66，P＜0.025 according to critical value, which meets the need ofP＜0.05, which means there is a statistical significance and the treatment group suffer less abdominal distention and pain than the control group after surgery; According to the comparison of sense of urgent urination, degree of freedom=3, x2=8.34, 0.025＜P＜0.05 according to critical value, which meets the need ofP＜0.05, which means there is a statistical significance and the treatment group suffer less sense of urgent urination than the control group after surgery.

DISCUSSION

Acupuncture is applied according to the theory of holism in clinical practice. It cures diseases in the aspect of modulating the whole body’s qi function. Whole regulative effect of acupuncture can be described in two ways: first, acupuncture affects multiple organs and systematic functions at different levels at the same time.Such as acupuncture anesthesia not only eases pain,but strengthens relative regulatory mechanisms and decreases surgery interference to physiological function,regulates immunity, quickens the pace of postoperative recovery as well. Second, acupuncture regulates the function of a certain organ by regulating the system the organ belongs to, even the function of each systematic function of the whole body. We picked Yin Ling Quan(SP 9) and Zhao Hai (KI 6) to assist spinal anesthesia according to the basic law of circulation of meridians and collaterals and considering effect on subdominal surgical incision. Yi Ling Quan (SP 9) is an acupoint belongs to Spleen Meridian of Foot-Taiyin, which was recorded to treat diseases of Spleen’s failure to transport dampness in the long history. Compendium of acupuncture and moxibustion volume IX said: “Dysuri

a:Yin Ling Quan (SP 9), Qi Hai (CV 6), San Yin Jiao (SP 6)…and then: Yin Gu (KI 10), Da Ling (PC 7).”Great Collection of Acupuncture Canon, acupuncture rhythm formula said: “Dysuria can be treated by acupuncturing Guan Yuan (CV 4) in Ren channe. Firstly, applies long needle to pierce 8 cun, if the patient senses a feeling of dripping, implement 3-5 times; then acupuncture San Yin Jiao (SP 6) in spleen meridian into 3 cun. Don’t push urine to get down, but acupuncture Guan Yuan(CV 4) first, and knead abdomen, then acupuncture San Yin Jiao (SP 6).” Acupuncture’s time, chapter V said:“Dysuria means being blocked and dripping; small intestine’s Shu, Yin Jiao(used moxibustion for it’s located above bladder ), Yin Ling Quan (SP 9). Zhang Guiqing treated 10 cases with dysuria after delivery or operation by Yin Ling Quan (SP 9) successfully”; Also,Wu Xiuying successfully treated 5 cases with postoperation dysuria; Jiang Yanhui, Zhang Weiyuan treated 36 cases with post-delivery and post-operation dysuria by acupuncturing San Yin Jiao (SP 6), Yin Ling Quan(SP 9), ZhongJi (CV 3), ShenQue (CV 8) assisted with cupping, the total effective rate is 77.8%. Zhao Hai (KI 6) locates in the kidney channel of foot Shaoyin. Foot Shaoyin, which starts from the bottom of minimus of feet, inclines towards center of soles, by way under tuberosity of navicular bones, behind medial malleolus,goes up through shanks, popliteal space, inter-lateral side of thighs, It passes across spine, belongs to the kidneys and winds the bladder. Miraculous Pivot-On Channels pointed out that “kidney channel of foot Shaoyin starts under minumus of feet, inclines towards center of sole, goes out under Ran Gu (KI 2), proceeds along medial malleolus, walks into heels, passes up along shanks, inter-lateral side of popliteal spaces and thighs, runs through spine, belongs to kidneys and winds the bladder. ” It nourishes kidney and essence,excels at relieving urine. As an effective point, it treats urinary retention. Combination of the two points is applied from the beginning of surgery till the first urination. It not only invigorates channels’s qi during operation to relieve block effect of bladder related nerves induced by anesthetics in the process of spinal anesthesia and repressive effect of bladder function,but assists preventing and treating bladder-dysfunctioninduced complications like urinary retention as well. As a part of life science research worldwide, acupuncture anesthesia’s research findings have been approved to be one of five great national medicine scientific researches by WHO. However, there are disadvantages like incomplete anesthesia, muscular tension, irrepressible organic traction reaction of separate acupuncture anesthesia (AA), and as a branch of modern science, no point rules have been discovered in the field of AA or AAA (acupuncture-assist anesthesia). As famous expert Han Jisheng, who studies acupuncture anesthesia,ever said: “The point’s selection rule of acupuncture anesthesia is not certain yet, seas of experiences held different ideas.” Biella et al. inferred acupuncture breaks the balance of various nerves information on thalamus to amend sense of pain and increase pain threshold.Functions of aponeurotic channel are restraining physique, lubricating joints and protecting organs outside, and keeping shape, volume of organ inside. The distribution features determine important instructive effect on AA. It is better to manifest AA takes advantage of aponeurotic channel than anesthesia acupuncture is a development of acupuncture theory. Aponeurotic channel theory is theoretical fundamental of AA, in contrast, aponeurotic channel is the material basis of AA. Since the 90s of 20century, with the development of molecular biology, bispec-trial index (BIS) is applied in clinical anesthetic area to test the depth of sedation.So far, a mass of researches have indicated BIS has good correlation with concentration of many anesthetics including propofol, midazolam, isoflurane, sevoflurane,desflurane11.These clinical applications help step AA to AAA, inform brand-new model of “preoperative induction-intraoperative anesthesia-postoperative analgesia”; It is predicted international medical field will reach a consensus on acupuncture anesthesia with distinct Chinese characteristic. AA is supposed to be popularized and expanded worldwide. Above all,consistent electro-acupuncture of Yin Ling Quan (SP 9) and Zhao Hai (KI 6) assisting spinal anesthesia can prevent patients from suffering from inary retention after subabdominal surgery and promote the procedure of bladder function’s recovery, decrease the time of urination after surgery, reduce post-surgery clinical symptoms, help cut down cases of catheterization,prevent it consequent infection and pain. As a result,it can be indicated that consistent electro-acupuncture of Yin Ling Quan (SP 9) and Zhao Hai (KI 6) assisting spinal anesthesia prevents and cures complication of urinary retention after surgery better than separate spinal anesthesia.

1 Zhao JN. Clinical observation on prevention from abdominal adhesions with the Tongfu Xiere mixture.Guangzhou: Guangzhou Univ Chin Med, 2000.

2 Chen RX. The basic characteristics of acupuncture and the relationship between age and acupuncture. J Jiangxi Univ Tradit Chin Med, 2008, 20(4):56-57.

3 Zhang GQ. Experience for treating postpartum and postoperative urinary retention by acupuncture. Acupuncture Research, 1997(3).

4 Wu XY. Treating 5cases of postoperative urinary retention by acupuncture. Nei Mongol J Tradit Chin Med,1995(S1):45.

5 Jiang YH, Zhang WY. Treating postpartum and postoperative urinary retention by acupuncture plus firemethod. J Clinical Acupuncture and Moxibustion,2000(9):20-21.

6 Shi XM. Acupuncture. Beijing: China Press of Tradit Chin Med, 2002:75-76.

7 Shi HY. Acupuncture anesthesia development study. J Practical Tradit Chin Inter Med, 2008, 22(8):74-75.

8 Liu YY, Leng DY, Li YL, et al. Effects of electroacupuncture on plasma catecholamine level in patients undergoing subtotal thyroidectomy. Chin J Tissue Engineering Research, 2006, 10(27):88-90.

9 Han JS. Where will acupuncture anesthesia to go? From AA to AAA. Chin J Pain Med, 1996(1):1-5.

10 Biella G, Sotgiu M L, Pellegata G, et al. Acupuncture produces central activations in pain regions. Neuroimage,2001, 14(1):60.

11 Ibrahim A E, Taraday J K, Kharasch E D. Bispectral index monitoring during sedation with sevoflurane, midazolam,and propofol. Anesthesiology, 2001, 95(5):1151-1159.

12 Shu SH, Ma SQ. Efficacy of Clonidine on circulation of thyroid surgery before and after cervical and catecholamine reaction. J Clinical Anesthesiology, 1998(6):350-351.

*Corresponding author:Email: 382921261@qq.com

(Accepted: February 25, 2017)