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Requirements and Acupoint Specificity in Ophthalmic Acupuncture Anesthesia

I. Requirements for the Surgeon in Ophthalmic Acupuncture Anesthesia

Due to the anatomical characteristics of the eye, such as the rich nerve supply, sensitive perception, delicate surgical procedures, small surgical field, limited operational space, and the fact that the surgery is performed under the direct vision of the patient, which can easily cause tension, the requirements for the surgeon in ophthalmic acupuncture anesthesia are higher than those in local anesthesia. Every action should strive to be steady, accurate, gentle, and quick, reducing unnecessary surgical stimulation and improving surgical skills, which is beneficial for enhancing the effectiveness of acupuncture anesthesia. Preoperative detailed explanations to the patient to alleviate mental tension and good cooperation during the surgery are also important factors for the success of acupuncture anesthesia. The duration of the surgery significantly affects the effectiveness of acupuncture anesthesia, with shorter surgeries yielding better results.

II. Individual Differences and Acupoint Specificity

Clinical practice has shown that there are significant individual differences in the effectiveness of acupuncture anesthesia. That is, the same disease, the same surgical procedure, and the same acupoints can produce completely different effects in the same patient. The patient's mental state, understanding of acupuncture anesthesia, and type of nervous system all significantly affect the effectiveness of acupuncture anesthesia. Some have observed 11 cases of failed ophthalmic surgeries under acupuncture anesthesia, where local anesthesia with drugs was used instead. The results showed that only 1 case was completely pain-free, 3 cases had reduced pain, and 7 cases had no change in pain, indicating that both acupuncture anesthesia and local anesthesia with drugs have individual differences. The question of whether acupoints have specificity remains unresolved. The Beijing Ophthalmic Acupuncture Anesthesia Collaboration Group explored acupoint specificity through 100 cases of glaucoma surgery, and statistical analysis showed no significant specificity. However, most regions believe that the selection of acupoints affects the effectiveness of acupuncture anesthesia. For example, a hospital in Xi'an initially used 5-6 pairs of acupoints including scalp acupuncture, body acupuncture, ear acupuncture, and foot acupuncture for anesthesia, but the clinical results were unsatisfactory. Later, they used Yangbai (GB14) through Yuyao (EX-HN4) and successfully completed various eye surgeries. Another example is that some hospitals, through extensive clinical practice, have proven that for glaucoma surgery, acupoints Yangbai (GB14) through Yuyao (EX-HN4) and Sibai (ST2) through Chengqi (ST1) are more effective than another group of acupoints Hegu (LI4) and Zhigou (TE6). Some believe that adding ear acupuncture Shenmen (HT7) through sympathetic or Xinming on the basis of Yangbai (GB14) through Yuyao (EX-HN4) can further improve the effectiveness of acupuncture anesthesia. They believe that the selection of acupoints should have a certain theoretical basis, and acupoints have relative specificity.

Principles of Acupoint Selection and Acupoint Choice in Ophthalmic Acupuncture Anesthesia

Ophthalmic surgeries often use three types of acupoints: periocular acupoints, body acupoints, and ear acupoints. Commonly used periocular acupoints include Zanzhu (BL2), Sibai (ST2), Jingming (BL1), Yuyao (EX-HN4), Qiuhou (EX-HN7), Yangbai (GB14), Chengqi (ST1), and Taiyang. These are mostly selected based on meridian theory and nerve distribution areas. For example, Zanzhu (BL2) belongs to the Hand Taiyang Bladder Meridian near the supraorbital nerve; Sibai (ST2) belongs to the Foot Yangming Stomach Meridian (ST) near the infraorbital nerve; Qiuhou (EX-HN7) is related to the ciliary ganglion and branches of the oculomotor nerve. Body acupoints are far from the surgical field, making the surgery more convenient. Commonly used body acupoints include Neiguan (PC6), Hegu (LI4), Zhigou (TE6), Zhongzhu (TE3), and Lieque (LU7), especially Neiguan (PC6) and Hegu (LI4), which have strong needling sensations and good analgesic effects. Ear acupuncture is convenient, and the acupoints have strong responses. Commonly used ear acupoints include Shenmen (HT7), Lung, Liver, Eye, and Eye. The combination of acupoints can be freely grouped, or the through-acupoint method can be used, such as Sibai (ST2) through Chengqi (ST1), Yangbai (GB14) through Yuyao (EX-HN4); Zanzhu (BL2) through Yuyao (EX-HN4), and Eye acupoint through Muliao. The effectiveness of acupuncture anesthesia on the same side versus the opposite side is compared. For ophthalmic surgeries using periocular acupoints, generally, single-eye same-side or double-eye bilateral acupoints are used. Observation results show that local acupoint selection on the same side as the surgical eye has better acupuncture anesthesia effects than on the opposite side, because same-side acupoint selection not only causes the same response but also has a local skin sensory weakening area superior to the opposite side. Therefore, ophthalmic acupuncture anesthesia should preferably use periocular acupoints on the same side.

There is no significant difference in effect between retaining needle and non-retaining needle. The rates of Grade I and II for retaining needle are 85.89%; for non-retaining needle, 87.30%. Retaining needle is commonly used in ophthalmic surgery acupuncture anesthesia. Non-retaining needle involves stopping the electrical stimulation and removing the needle after the induction of acupuncture during surgery. After 30 minutes of electroacupuncture, the pain threshold significantly increases and can maintain a certain duration of aftereffect. Non-retaining needle utilizes the aftereffect of acupuncture for surgery, with the advantage that the absence of filiform needles in the eye area does not affect the surgical field, facilitating surgical operations; the surgeon can also perform the acupuncture themselves, eliminating the need for dedicated acupuncture anesthesia personnel, thus saving manpower; patients can reduce discomfort such as pain caused by the movement of filiform needles.

No Induction Period Electric Acupuncture Anesthesia. While producing the anesthetic effect at Zhongshu (GV7), the pulse stimulation can also significantly increase the pain threshold in the distal distribution area of sensory nerves, producing an analgesic effect. The pain threshold rises after acupuncture, and no induction time is required. No induction period anesthesia is established on this basis. Some have reported performing 113 cases of surgeries such as internal visual obstruction, glaucoma, and strabismus with a success rate of 85.8%. The induction period of acupuncture anesthesia occupies a lot of time for medical staff, thus limiting the application of acupuncture anesthesia in surgeries. The no induction period electric acupuncture anesthesia method saves time, is beneficial for the promotion of acupuncture anesthesia, and is suitable for various ophthalmic surgeries.

Regarding the selection of frequency. Different acupoints should adopt corresponding frequencies. Some ophthalmologists, through personal experience and observation, believe that distal acupoints such as Hegu (LI4) and Zhigou (TE6) are better with 3～5Hz. For example, Yangbai (GB14) through Yuyao (EX-HN4) and Sibai (ST2) through Chengqi (ST1) using low frequency can cause obvious eyelid twitching, even aggravating the tension of the orbicularis oculi muscle, bringing difficulties to the surgery, while at high frequency, the eyelid twitching is subtle and not obvious, and the patient feels comfortable.

Advantages, Existing Problems, and Countermeasures of Ophthalmic Acupuncture Anesthesia

I. Advantages of Ophthalmic Acupuncture Anesthesia Surgery

(1) The method is simple, easy to operate, and safe. When there is no electric anesthesia machine, manual needle twisting can be used.

(2) It solves some surgical problems where patients are allergic to anesthetics or where drug anesthesia is indeed difficult, avoiding possible complications during drug anesthesia.

(3) The tissue anatomy is clear, with distinct layers, which is beneficial for intraoperative observation and surgical operation. Strabismus surgery facilitates intraoperative observation of eye position, allowing for more accurate determination of the surgical amount, with unique characteristics.

(4) The intraoperative reaction is small, and postoperative recovery is fast. It has the effect of regulating physiological functions.

II. Existing Problems and Countermeasures

(1) The requirements for anesthesia in ophthalmic surgery are mainly analgesia and muscle relaxation. Acupuncture anesthesia has incomplete analgesia, and intraoperative muscle contraction due to protective reflexes brings certain difficulties to some patients' intraocular surgeries. Incomplete analgesia is the current main problem, and the solutions include the following aspects:

1. Adding a small amount of surface anesthetic.

2. Improving acupoint prescriptions, using external canthus through Yuyao (EX-HN4) and external canthus through Chengqi (ST1), which has a certain effect in reducing the tension of the orbicularis oculi muscle.

3. Improving surgical operations to adapt to the characteristics of acupuncture anesthesia. Ophthalmic acupuncture anesthesia surgery needs further exploration and continuous improvement and enhancement in clinical practice.

(2) Pay attention to the selection of indications.

(3) The close relationship between the effect of acupuncture anesthesia and psychological factors. Preoperative psychological preparation, eliminating nervousness, and good cooperation from patients can significantly improve the effect of acupuncture anesthesia.

(4) The induction period of acupuncture anesthesia prolongs the surgery time, consumes manpower and time, and also affects its widespread application. Some have already paid attention to research and solutions, such as using Qiuhou (EX-HN7) acupoint with one needle and no induction period acupuncture anesthesia, which has shown initial effects.

(5) Intraoperative bleeding is sometimes slightly more than drug anesthesia (local anesthesia), and 0.1% adrenaline can be appropriately added to stop bleeding.

(6) Acupuncture anesthesia requires the operator to be steady, accurate, gentle, and fast. Try to shorten the surgery time and improve surgical methods.