1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA
Research in electro-acupuncture anaesthesia
G. Gh. Litarczek, J. J. Ciurea, and S. G. Paca
Abstract An electro-acupuncture anaesthesia was developed and tested with very good result. A number of electrical stimulators
was developed and clinically tested. This method proved to be efficient as the analgesic component of general anaesthesia along with
hypnosis and relaxation accomplished by usual drugs. It avoids the use of any volatile or soluble anaesthetic or analgesic substance
diminishing so the degree of intoxication of the nervous system.
Keywords: electro-acupuncture anaesthesia, electrical stimulation, analgesia.
1. INTRODUCTION
Among the physical and chemical factors used in
medicine, the electrical stimuli are the most currently
used due to their similarity to the natural biological
stimulus.
In addition, electrical stimuli present us with the
following advantages: they are gentle and do not affect
the tissues; they can be used repetitively; they have a
direct and prompt action; they can generate excitation and
inhibitions in any type of cells or tissue; they can be
measured very precisely; they can be applied very
accurately [1].
A neural system is a bioelectrical entity under the
influence of the electrical current. In many diseases, the
electrical stimulation of the neural structures is an
alternative to the drug based therapy.
An alternative to classical general anaesthesia in which
analgesia is based on drugs (volatile anaesthetics or
soluble analgesics), which produce a reversible
intoxication of the nervous system, is electro-
acupuncture anaesthesia (EA) [2]. This method is based
on injections of electrical currents through acupuncture
points. Even not entirely understood, acupuncture and EA
are efficient time proved methods to realize analgesia and
especially surgical analgesia [3].
2. METHOD
The background of EA is the functional integrity of
nervous system, meaning that all anaesthetics and
analgesics can alter central nervous system functions.
The EA is accomplished by acupuncture direct effects
associated with hypnotics and muscular relaxants. The
G. Gh. Litarczek is with the Clinical Hospital Fundeni, Bucharest,
phone/fax: +40-21-630-3816; e-mail: geolitarczek@yahoo.de.
J. J. Ciurea is with the Clinical Hospital Bagdasar-Arseni of
Bucharest, phone: +40-723-741-986; fax: +40-21-332-4229; e-mail:
ciureaj@yahoo.com.
S. S.G. Paca is with the Medical Electronics and Information Group,
University POLITEHNICA of Bucharest, phone: +40-722-854-175; e-
mail: pasca@elmed.pub.ro.
193
EA is more effective when associated with central anti
adrenergic drugs like the 2 agonists.
The main somatosensitive pain input uses C fibres in the
anterolateral spinothalamic tract. The traffic through
these fibres are suppressed during EA most probably by
closure of the gate at metameric level by stimuli coming
through collaterals from A and A inputs produced by
acupuncture high frequency stimulation, as well as by
inhibitory stimuli coming from brainstem periaqueductal
gray nucleus and reticular nuclei stimulated by low
frequency. Stimulation of the hypothalamus determines
-endophine secretion which through blood and liquor
spreads to the central nervous system and other peripheral
systems. The mechanisms are still in a hypothesis level,
and will be discussed later.
Identification of EA points are performed in a traditional
manner (cun measurements) and impedance
measurements by an electronic detector. For head surgery
the election points are IG4/P6(TF5) bilateral +
VB/15/VB20. Both ends of surgical incision must be
stimulated by EA device.
Patients could be conscious during EA (vigil EA) or put
on deep sleep, depending on type of surgery, patient
biological and psychical status, etc Recommended oral
premedication is a benzodiazepine (diazepam or
midazolam associated with clonidine, 0.3-0.5 mg/ Kg
body weight, but not analgesic or opioids. Two
intravenous safe lines are mounted and connected to
infusion syriges.
Two pairs of needles are used at two different
frequencies, high in periphery and low to inject currents
in deep central nervous system. In Figure 1 is shown the
needle electrode placement in an experimental
measurement during anaesthesia.
The electrical stimulation starts from low levels (under
threshold) and is risen up in a progressive manner till
desired effects are obtained.
The next steps are hypnotic injection, intubations and
mechanical ventilation, myorelaxation. Surgery may start
after 30 minutes of stimulation.
 1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA
Figure 1. Anesthesia by electro-acupuncture.
The maintenance of sleep is accomplished by continuous
infusion of midazolam or propofol. Analgesia is
accomplished by EA.
During wake up, midazolam or propofol are stopped.
Electrical stimulation is turned off after the patient is full
conscious.
Local anaesthetics and ketamin (0.30.5 mg/Kg body
weight) are allowed.
One must always use the same points for a certain region
or type of surgery to obtain best effects.
All patients will benefit of a good postoperative pain
control lasting even a few days, with minimal and
frequently without analgesic medication avoiding thus the
unpleasant post anaesthesia events such as nausea,
vomiting bound to high amounts of pain killers, etc
A total number of 219 patients benefit of this procedure.
3. EQUIPMENTS
A block diagram of an Electrical Stimulating System
(ESS) is presented in Figure 1. It is implemented using a
microcontroller that also provides communication with
the user, with a PC and generates the signals for the three
stimulating channels [4].
The output stages have isolated outputs in order to be
connected to the same patient [5]. The duration of the
stimulating pulse is controlled by a digital output of the
microcontroller and its amplitude is established by the
microcontrollers analogue output. The output stage
automatically provides the exponential opposite pulse to
generate a zero mean stimulating signal. The output pulse
voltage and current on each output stage is measured
using a sense amplifier and one analogue microcontroller
input.
ESS is implemented with very low power devices so that
they can be supplied using batteries. This way, the
medical isolation of the system has been easily solved.
194
Figure 2. Block diagram of Electrical Stimulating System.
The stimulation parameters for the tissue are: the injected
currents density, the stimulating pulses duration and the
stimulus rise duration [4], [1].
The excitation appears at the negative electrode [1]
because, in the case of excitation stimuli for a cell, it has
to be either positive inside or negative outside the cell.
The elementary stimulus used is shown in Figure 3.
Figure 3. The electric stimulus.
The mean value of the stimulus is zero in order to prevent
necrosis due to electrolysis of the tissues around the
needle appearing when a prolonged strong stimulation is
used.
The stimulus generated by our system has not only the
rectangular stimulating pulse (negative in Figure 3, as it
is at the negative electrode responsible for the excitation),
but also an opposite exponential pulse having the same
area to obtain the zero mean value [6].
With ESS, the amplitude of the exponential pulse is lower
when the tissue impedance is also lower. This has no
influence whatsoever over the effects of the stimulation,
the opposite pulse extracting only the charges injected by
the exciting pulse [7].
It is preferable to use voltage pulses in stimulation rather
than current pulses. Because of the tissues capacitance
effect, in the case of a current pulse, the voltage across
the tissue takes some time until it reaches its maximum
value, so the human cells start to adapt to the stimulation
 1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA
pulses; while in the case of a voltage wave, the sharp
edges with rapid rise rate and a greater pick in current
value prevent this adaptation, helping to perform a better
stimulation (Figure 4).
Figure 4. Curent vs. voltage pulse stimulus.
Experimentally, we have found that, in order to avoid the
burns and necrosis, high diameter needle electrodes must
be used and the amplitude, the duration and the frequency
of the pulse must be correlated and maintained under
certain limits.
In order to obtain an effective anaesthesia, very high
amplitude is necessary for the stimulation [2], but only
under the above limits (for example, using thick needle
electrodes and having a stimulus of 40 V and 120 Hz, the
duration of the pulse must be under 50 s, whereas for a
stimulus of 40 V and 5 Hz the duration of the stimulus
can be up to 500 s).
The elementary stimulus pulse is repeated in four
stimulation modes illustrated in Figure 5:
Continuous mode a train of elementary pulses at
the same frequency f1;
Discontinuous mode a train of pulses at frequency
f1 followed by a rest period;
Alternative mode two alternate trains of pulses with
frequency f1 and f2;
Discontinuous alternative mode the frequencies of
pulses alternate between f1 and f2, with a period of
rest between each frequency change.
Continuous : | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
f1
| T= 5 sec
Discontinuous : | | | | | | | | | | | | | |
f1
| T= 5 sec
Alternative : | | | | | | | | | | | | | | | | | | | ||||||||||||||||||||||||||||||||||||||||||||||||| | | | | | | | |
f1
| T= 5 sec
Alternative : | | | | | | | | | | |
f1
discontinuous
| T= 5 sec
Figure 5. Stimulation modes.
In the case of active acupuncture point detection we have
used the method of impedance measurement, obtaining
very good results. A constant current is being injected to
the suspect point on the skin, by a sharp narrow headed
electrode, while another large surface electrode should be
held in the patients hand, in order to screen the patients
skin. The voltage between the two electrodes is measured
by a microcontroller analogue input port. A minimum
value indicates detection of an active point.
Measuring the point resistance can be performed in two
ranges: the first one is 0-1 M, while the second range is
0-10 M.
4. RESULTS
Form the total of 219 a number of 13 patients were
neurosurgical. Most of 219 the patients were heart
surgery for replacement of mitral valves (145) and 37
were operated on abdomen. There are 5 scolioses.
All patients presented a good analgesia with no peaks of
high systemic or pulmonary blood pressure and efficient
haematosis. The cardiac output, cardiac index and
systolic index were maintained in physiological range.
A disconnection of stimulation induced a rise in heart rate
and systemic blood pressure followed by an instant come
back after reconnection.
The arousal was fast and without side effects. Analgesia
persisted for more days compared with hours in
classical method. Blood circulation was stable and
physiological parameters were maintained during
anaesthesia. No shivering during wake up was recorded
despite rapid gain of consciousness.
Patients did not recall any events from the time of EA.
Postoperatively they presented a status described as
comfortable and peaceful and some even could ask for
food or television.
5. DISCUSSION
Acupuncture was used 2800 years ago in Chine.
Although it is not completely scientifically understood,
this method proved its efficiency along years. The
amount of drugs is less when compared with classical
method, offering meanwhile better hemodynamic
conditions. Several reports from 1977 to 1980
| demonstrated that acupuncture analgesia is blocked or
reversed by naloxone, an opioid antagonist [8], [9].
| | | | | | | |
f1
| The involvement of the peripheral opioid system in
modulating inflammatory pain has been well
documented. Involvement of peripheral opioid
f2 f1
| mechanisms in electro-acupuncture analgesia is
confirmed by recent experimental studies too.
|||||||||||||||||||||||||||| | | | | | | | | |
f2 f1
|
One study aimed to investigate the possibility of electro-
acupuncture mediated peripheral opioid release. Rats
were injected to induce localized inflammatory pain. The
pain behavioral changes were measured by paw
withdrawal latency to a noxious thermal stimulus. At day
5 of inflammation, rats received a second injection of
saline or opioid antagonists into the inflamed paw,
followed by EA at 30 Hz, 2 mA, and 0.1 ms for 30
minutes. The EA was conducted at acupuncture point
GB30. A control was used in which needles were inserted
at GB30 but no electrical stimulation was applied. Rats
receiving electro-acupuncture showed a significantly
195
 1st International Conference on Advancements of Medicine and Health Care through Technology, MediTech2007,
27-29th September, 2007, Cluj-Napoca, ROMANIA
longer limb retraction time as compared with the control
from 30 minutes to three hours after treatment.
Intraplantar injection of naloxone methiodide, a
peripherally acting opioid receptor antagonist, eliminated
the analgesic effect at 30 minutes after electro-
acupuncture treatment. Intraplantar injection of naloxone
methiodide, a peripherally acting opioid receptor
antagonist, eliminated the analgesic effect at 30 minutes
after electro-acupuncture treatment. Intraplantar injection
of an antibody against beta-endorphin and a
corticotropin-releasing factor antagonist also produced a
reduction in limb withdrowel in rats receiving electro-
acupuncture. These data strongly suggest that peripheral
opioids are released by electro-acupuncture at the
inflammatory site [10].
Nitric oxide (NO) has recently involved in acupuncture
action mechanisms. NO mediates in the gracile nucleus
acupuncture signals through dorsal medullathalamic
pathways. NO-Synthasa catalyzes the transformation of
arginine to NO, which is an endogenous molecule
produced in many cell types including neurons in the
brain [11] [12] [13].
It is important to mention the fact that these results were
obtained with intensity of stimulation tolerated by the
awake animal or patient while the method presented by us
uses a levels of intensity which cannot be tolerated by the
awake patient at the beginning of the procedure but is
well tolerated at the end of the surgical procedure after
the regaining of consciousness.
It is also important to mention that more recent research
added knowledge concerning the mechanism of
acupunctural analgesia by discovering the fact that
acupuncture stimulates the descending inhibitory
pathways originating in different regions of the brainstem
and other high level nervous structures.
Applied neurophysiology is a must nowadays for
identification of targeted structure and for preservation of
their integrity during neurosurgery and mainly functional
neurosurgery. EA is recommended due to its
compatibility with neuromonitoring of different pathways
in central nervous system. Compared to classical drug
anaesthesia, the medication must be stopped during
neuromonitoring.
Patients are waking up very fast but they do not shiver
due to pain. The possibility to revert this effect by
naloxon could explain the mechanism of action of EA.
The event of disconnection induced a rise in heart rate
and systemic blood pressure due to nociceptive
mechanisms on visceral structure. This was corrected as
soon as EA was re-established. No other proof could be a
better evidence of EA.
Patient is able to tolerate a very high level of stimulation
during wake up which was not possible at the start of EA.
A mechanism of adaptation is probably involved and its
study is beyond the purpose or this presentation.
196
At last, patients satisfaction was represented by comfort
and peace which is a strong point of this method.
6. CONCLUSION
The anaesthesia by electro acupuncture is lately
recognized and has proven its usefulness through its
advantages against the traditional drugs anaesthesia.
This method proved to be efficient as an alternative
during years. It provide with good analgesic effects and
no respiratory and circulatory change. The wake up is
fast, without shivering and analgesia persists for days.
Better equipments and larger number of cases should be
the next step in this research.
7. REFERENCES
[1] Paca S., Strungaru R., Ungureanu M., Modular System for
Neural Analysis and Stimulation, Proceedings of The 15th
International Conference on Control Systems and Computer
Science CSCS15, Bucharest, Romania, vol. 1, pp. 55-58, 2005.
[2] Litarczek G., Gertrude Hrovescu, Popa A., Locul
acupuncturii n anestezia chirurgical modern, Chirurgia, Vol.
XXXV, nr. 5, pp. 393-400, 1986.
[3] Birch S.J., Felt R.L., Understanding Acupuncture,
Brookline, Massachusetts: Paradigm Publications, 1999.
[4] Ciurea J., Paca S., Sztojanov I., Sistem pentru tratamentul
comei prelungite prin stimulare electric, Realizri n domeniul
electronicii profesionale, ICSITE, Bucureti, 1718 octombrie,
pp. M13-M17, 1996.
[5] Strungaru R., Cojocaru V., Paca S., Aparat pentru
stimularea punctelor de acupunctur, Brevet de invenie nr.
87505 OSIM din 21.03.1985.
[6] Litarczek G., Cndea V., Popa A., intoiu I., Stngaciu V.,
Hipnoanalgezia prin hiperstimulare electric n puncte de
acupunctur, ca metod anestezic n chirurgia pe cord
deschis, Chirurgia, Vol. XXXVII, nr. 1, pp. 63-73, 1988.
[7] Ciurea J., Constantinovici Al., Simoca I., Perin R., Mircea
D., Pasca S., Brain Electrical Stimulation Therapy in Patients
With Prolonged Consciousness Disturbances - Pilot Study,
Romanian Neurosurgery, Romanian Academy, New Serie VII,
No. 1-2, January-December , pp. 119-126, 1998.
[8] Cheng R.S.S., Pomeranz B.H., Electro-acupuncture
analgesia is mediated by stereospecific opiate receptors and is
reversed by antagonists of type1 receptors, Life Sci, vol. 26,
631638, 1980.
[9] Mayer D.J., Price D.D, Raffi A., Antagonism of acupuncture
analgesia in man by the narcotic antagonist naloxone, Brain
Res, vol. 121, pp. 368372, 1977.
[10] Zhang G.G., Yu C., Lee W., Lao L., Ren K., Berman B.M.,
Involvement of peripheral opioid mechanisms in electro-
acupuncture, Neurosci Lett, vol. 354(1), pp. 50-53, 2004.
[11] Moncada S., Higgs E.A., Endogenous nitric oxide:
physiology, pathology and clinical relevance, Eur J Clin Invest,
vol. 21, pp. 361374, 1991.
[12] Bredt D.S., Snyde S.H., Nitric oxide, a novel neuronal
messenger, Neuron, vol.18, pp. 3-11, 1992.
[13] Sjolund B.H., Eriksson M.B., The influence of naloxone on
analgesia produced oxide synthase (nNOS)/NADPH diaphorase
(NADPHd), Explore (NY), vol. 1(5), pp. 365-371, 2005.