Cut recovery time, amount of drugs by up to half with acupuncture

Same-day surgery programs report excellent results with select patients

If you knew that adding one service to your same-day surgery program could reduce the amount of general anesthesia by up to 50% - with a corresponding drop in postoperative complications such as nausea, urinary retention, and paralytic ileus - would you interested? What if you knew the same service could have your patients going back to their normal routines in half the time?

This service is here, and it is beginning to be used on a selective basis by same-day surgery programs around the country. It's even gotten a stamp of approval for treating nausea from an expert panel convened for the Consensus Development Conference on Acupuncture by the National Institutes of Health (NIH) in Kensington, MD. In its draft consensus statement, the panel listed nausea as one of the conditions most successfully treatable with acupuncture, based on research evidence presented. (For details on ordering the consensus statement, see source box, p. 89.)

The Office of Alternative Medicine (OAM) at the NIH reports there are 10,000 acupuncturists in the United States, including nonphysicians. That number is expected to double by the year 2000, the OAM reports.

Currently, nonphysician acupuncturists (including dentists, podiatrists, and chiro practors) are licensed, registered, or certified in 34 states plus the District of Columbia. Physicians licensed in acupuncture are allowed to practice acupuncture in all 50 states, according to the OAM.

The U.S. Food and Drug Administration (FDA) has received few reports of adverse effects resulting from acupuncture, according to C. David Lytle, PhD, FDA research biophysicist. The FDA approved acupuncture needles for use by licensed practitioners in 1996. It requires sterile, nontoxic needles labeled for single-use only, and the FDA requires patients to sign informed consent forms before being treated. (For additional information, see informed consent form, p. 87.)

Yue-Pang Mok, MD, FACPM, PAAPM, anesthesiologist in Barberton and Medina, OH, has been able to reduce the amount of general anesthetics his patients need by up to 50% with acupuncture-assisted anesthesia. Mock has been published in Medical Acupuncture and by the American Academy of Medical Acupuncture in Los Angeles, and he has made a presentation to the academy. Reducing the amount of anesthesia has led to a reduction in post-op complications, including nausea, urinary retention, and paralytic ileus, Mok says.

Here's how it works: Once patients are anesthetized with a nerve block or general anesthesia, Mok applies acupuncture at the same time that the surgeon starts working. Thus, there's no down time. He places four to six needles on the wrist and below the knee and three to four needles in both ear lobes.

"Once the acupuncture is taking effect, we can cut down the general anesthetic to 30% to 50% of the usual dose," he says. "This allows the patient to wake up almost immediately after surgery." Patients require much less postoperative medication, and some don't need any at all, he says.

Why not acupuncture alone?

In the more than 100 cases Mok has performed, patients have been pleased. "They come out comfortably." If acupuncture-assisted anesthesia works so well, why not use acupuncture alone? It takes too long to prepare patients, he says. "Most surgery schedules don't allow that." In addition, acupuncture alone doesn't work to relax muscles 100%, Mok says; the pain is blocked only about 90%. Research is well-documented concerning the effect of acupuncture on postoperative pain and nausea, he says. (See selected references, p. 88.)

At St. Agnes Health Care in Baltimore, Hiroshi Nakazawa, MD, general surgeon, is using acu puncture preoperatively to invigorate patients and boost their energy levels. His theory is that by bringing patients up to their optimal energy level, they respond better to surgery. Three or four days before surgery, patients come to Nakazawa's office for one or two sessions that last a half-hour each. He places 10 needles in the patient, mainly in the spleen and kidney.

The effect is twofold, he says. Acupuncture stimulates the skin and muscle, and that impulse stimulates the pituitary gland, which produces beta-endorphins. The beta-endorphins act like morphine in that the patients become euphoric and feel less pain, Nakazawa says.

Cortisone works as antibody

Secondly, the pituitary gland produces adreno cortico tropic hormone, which produces cortisone in the adrenal gland. The cortisone acts as an anti-inflammatory and antibody and provides resistance against the stress of surgery, Nakazawa says. "Your body is like your own pharmacy."

Patients are able to carry on their normal activities between the time of the acupuncture treatment and the surgery, Nakazawa says.

In the year he's been using acupuncture on some outpatient surgery patients, including those having hernia surgery and breast biopsies, he's finding that patients recover at home up to twice as quickly as without acupuncture. For example, hernia patients are returning to a full routine in four to six weeks instead of eight weeks.

Anesthesiologist uses it for nausea

At The Emory Clinic's ambulatory surgery center in Atlanta, Yung-Fong Sung, MD, chief of anesthesiology, uses acupuncture to treat postoperative nausea when patients are allergic to anti-nausea medications. The acupuncture and medications are equally effective, she says, but neither works for 100% of patients. An advantage of acupuncture over anti-nausea medication: Most anti-nausea medications make patients sleepy, but acupuncture doesn't, Sung points out.

She administers acupuncture postoperatively in the recovery room. Sung uses two needles in the forearm, and the process takes one or two minutes. There is no additional charge for acupuncture, which is included as part of the professional anesthesia charge.

Reimbursement appears to be one of the few downsides of using acupuncture with same-day surgery patients, sources say. But reimbursement is looking more hopeful, according to the executive administrator of the American Academy of Medical Acupuncture in Los Angeles.

"Five years ago, no one was reimbursing," explains James Dowden. "Today, a lot of carriers and national carriers are prepared to reimburse." For example, Oxnard-based Blue Cross of California reimburses acupuncture, he says.

However, even when payers reimburse, they typically don't reimburse at a level appropriate for a physician, Dowden maintains. "My Blue Cross, for example, will pay $25 for a visit. Typically, physician services are $70 to $125, depending on the length and complexity of the treatment."

Most members who have been offering acupuncture for a long time operate on a cash-only basis, he says. "They'll assist the patient in getting reimbursed, but the patient pays for the acupuncture."

[Editor's note: Is your same-day surgery program using any alternative treatments? If so, we'd like to share what you're doing. Please contact: Joy Daughtery Dickinson, P.O. Box 740056, Atlanta, GA 30374. Telephone: (912) 377-8044. Fax: (912) 377-9144. E-mail: joy_daughtery@medec.com.]