Acupuncture analgesia for craniomaxillofacial surgery

Acupuncture analgesia for craniomaxillofacial surgery

iety had objective signs of trance and no problems during the surgery, but reported no subjective relief of their anxiety. In 94.3% of cases, the pati...

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iety had objective signs of trance and no problems during the surgery, but reported no subjective relief of their anxiety. In 94.3% of cases, the patient and surgeon rated the experience as successful. Patients noted especially significant relaxation, inhibited motor skills, and increased tolerance toward physically invasive surgery. Patients who exhibited severe treatment anxiety preoperatively particularly had an improved surgical experience. The ability to elicit active cooperation as needed and the option of complete reorientation at any point in the process were noted as very helpful. Patients reported a general feeling of mental distance from the surgical situation. Some experienced temporary pain, but this distancing led to few patients needing additional doses of local anesthesia. Most patients vastly underestimated the duration of the surgery, and several remembered only parts of it, with 5 having no memory of the surgery at all. All patients who had a positive experience said they would submit to another operation performed under medical hypnosis; 26 of these patients had multiple procedures under the combined local anesthesia/medical hypnosis. Surgeons reported the specific effects of hypnosis improved treatment modalities significantly. However, the special requirements for hypnotic treatment required significant restructuring of treatment sequences. Among the requirements were a consistent reduction of noise and movement within the operating room. A limitation to the use of hypnotic therapy routinely was the need for timeand cost-intensive training. In addition, various irritating intraoperative stimuli (movement during tooth extraction or

noise and vibration during drilling) were not adequately managed by the local anesthesia/hypnosis combination, which led to short-lived reorientation, then remission of the hypnotic trance. However, most patients did not recall this reaction after surgery. Discussion.—This 1-year trial period documented the usefulness of hypnosis as a supplement to anxiolytic pharmacologic agents. The number and type of procedures performed under this combination expanded over the time of the study, with largely positive responses from both patients and surgeons. Controlled clinical trials are needed to provide objective data on the effectiveness of this approach.

Clinical Significance.—Often viewed as a party trick, this clinical study of medical hypnosis shows promise for controlling patient discomfort while reducing the odds of pharmacological mishaps. Controlled studies are needed.

Hermes D, Truebger D, George S, et al: Tape recorded hypnosis in oral and maxillofacial surgery—Basics and first clinical experience. J Craniomaxillofac Surg 33:123-129, 2005 Reprints available from D Hermes, Dept of Maxillofacial Surgery, Univ Hosp Schleswig-Holstein/Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; fax: +49 451 500 4188; e-mail: [email protected]

Acupuncture analgesia for craniomaxillofacial surgery Background.—Conventional anesthetic procedures carry side effects that make them unacceptable for some patients. Acupuncture analgesia is directed toward relieving pain and regulating the physiologic status of the body using needling. Certain specific points are stimulated to abolish pain during surgery. Advantages offered by acupuncture analgesia include its simplicity, low cost, safe application for high-risk patients, excellent postoperative

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pain relief, and low rate of complications after surgery. The ability of acupuncture analgesia to manage pain at the operative site was studied for patients undergoing craniomaxillofacial procedures. Methods.—One hundred twenty patients were evaluated. Twenty had general anesthesia combined with acupuncture analgesia, and 100 had acupuncture plus traditional

Fig 1.—Distribution of channels and related acupuncture points (anterior view). (Reprinted from Pohodenko-Chudakova IO: Acupuncture analgesia and its application in cranio-maxillofacial surgical procedures. J Craniomaxillofac Surg 33:118-122, 2005. Copyright 2005, with permission of the publisher, Churchill Livingstone.)

Fig 2.—Distribution of channels and related acupuncture points (posterior view). (Reprinted from Pohodenko-Chudakova IO: Acupuncture analgesia and its application in cranio-maxillofacial surgical procedures. J Craniomaxillofac Surg 33:118-122, 2005. Copyright 2005, with permission of the publisher, Churchill Livingstone.)

postoperative analgesia. For patients whose postoperative pain was not effectively managed, additional sessions of acupuncture stimulation were used. The channels of the human body related to the craniomaxillofacial region and those passing directly through the operative site were determined (Figs 1-3). Evaluations were conducted before surgery, after the incision, during surgery, and immediately after surgery, measuring patients’ pulse, blood pressure, electrocardiographic status, and cortisol levels.

acupuncture. Cortisol levels were minimally increased. Sixty-two percent of patients had complete alleviation of postoperative pain and 38% had partial relief. One patient had pain relief lasting 6 to 10 hours after discontinuing the acupuncture stimulation, indicating that the effect can be prolonged. Only 10% of the patients required additional analgesic drugs. Three patients requiring additional acupuncture had complete pain relief near the end of the fifth session of acupuncture treatment. Four patients had partial analgesia with acupuncture.

Results.—Pulse rates fluctuated between 10% and 20%, and arterial pressure varied between 0.3% and 5% throughout the procedure for those having general anesthesia plus

Discussion.—Acupuncture analgesia is a simple, cheap, and safe method for obtaining pain relief during

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and after surgery. Combined with sedation or general anesthesia, it proved extremely effective in these patients having craniomaxillofacial procedures. Patients maintained stable pulse rates and blood pressure during surgery, and plasma cortisol levels were minimally elevated.

Clinical Significance.—Often considered esoteric, acupuncture is shown in this study to be an effective adjunct to conventional techniques for anesthesia and analgesia.

Pohodenko-Chudakova IO: Acupuncture analgesia and its application in cranio-maxillofacial surgical procedures. J Craniomaxillofac Surg 33:118-122, 2005 Reprints available from IO Pohodenko-Chudakova, Pushkina av, 33-239, 220092 Minsk, Belarus; fax: +375 17 272 44 97; e-mail: ip-c @yandex.ru, [email protected]

Fig 3.—Distribution of channels and related acupuncture points (lateral). (Reprinted from Pohodenko-Chudakova IO: Acupuncture analgesia and its application in cranio-maxillofacial surgical procedures. J Craniomaxillofac Surg 33:118-122, 2005. Copyright 2005, with permission of the publisher, Churchill Livingstone.)

Pediatric Dentistry Mineral trioxide aggregate versus formocresol Background.—In pulpotomy the entire coronal pulp is removed to eradicate the site of inflammation. Formocresol (FC) has been used for pulp therapy of the primary dentition for many years, but its toxicity and potential carcino-

54 Dental Abstracts

genicity have led to the search for alternatives. A root-end filling material, mineral trioxide aggregate (MTA), has proved able to stimulate cytokine release from bone cells, which actively promotes hard tissue formation, and has