Philip A.M. Rogers MRCVS

AP Analgesia


Chen_W; Wang Y; Wu H; Gu Z (1991) [Analysing the effects of tooth extraction under APA in 825 cases of old patients]. Chen Tzu Yen Chiu 16(1):1-3, 14. Dept of Stomatol of Tong Ji Hospital, Tong Ji Med Univ, PRC. The effects of tooth extraction under APA for old patients generally are said to be good. To verify this, from >4000 cases whose records of APA were available from 1973-1988, we statistically analyzed 825 cases >60 yr (Group A) and a similar number aged 18-40 yr (Group B). 1. There was no significant difference under APA for different sexes. 2. The differences of the excellent rate of APA between Group A and Group B were extremely evident either in the positions of the tooth or the reason of tooth extraction. The former was 89% and the latter 76% (p <.005). 3. Although a low rate in excellence of tooth extraction under simple APA (only 76%), not so good as the effect by EAP-analgesia (circa 88%), simple APA was more common and more easily accepted by patients. 4. Tooth extraction under APA was safe, effective and without any complications. 5. The reasons for the extractions in old people were mainly for broken crowns, or for roots, or for prosthetic restoration. Old people usually have higher pain thresholds and this is important in the good effect and good rate of tooth extraction under APA. Hospitals which can use the APA for tooth extraction use it as the analgesic method of first choice in old patients who agree to it.

Ekblom_A; Hansson P; Thomsson M; Thomas M (1991) Increased postoperative pain and consumption of analgesics after AP. Pain Mar 44(3):241-247. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. AP was given to patients before (preoperative-AP group, PRE-ACU, n=25) or after (postoperative-AP group, POST-ACU, n=25) operative removal of impacted mandibular third molars. 60 patients did not receive AP and participated as a control group (CG). All patients completed a questionnaire in order to characterize state tension and stress, degrees of neuroticism, extroversion, depression and psychosomatic disorders. We also recorded intraoperative discomfort and pain intensity, postoperative pain intensity and consumption of analgesics for 72 h. The PRE-ACU was significantly more tense after surgery and found the operative procedure more unpleasant than the other 2 groups. The PRE-ACU further rated intraoperative pain intensity higher than the CG and experienced higher pain intensity immediately postoperatively compared with POST-ACU and CG. Of the PRE-ACU patients15/24 needed additional local anaesthesia intraoperatively while none in the POST-ACU or CG requested extra lidocaine. Postoperatively patients in both PRE- and POST-ACU reported a higher total sum of pain scores (pain intensity) and the PRE-ACU consumed more analgesics compared with the CG. A significantly larger number of patients suffering from "dry socket" (a complication during wound healing) was found in both PRE- and POST-ACU compared with the CG. No correlation was found between assessed personality characteristics and reported postoperative pain/consumption of analgesics in any group. Differences observed between the groups could not be explained. The reason for our unexpected "negative" findings is unclear but some hypothetical explanations are discussed.

headNauta_J; Zhang T (1990) Some introductory remarks on AP in dentistry. EDS Mag May 1:33-36. In general 2 different types of AP are used in dentistry, Traditional Chinese AP and AP according to Dr Voll. Both use imaginary lines, called Channels, according to theories of TCM. However fundamental differences between the 2 types of AP exist.

Huang_H (1995) Application of APA combined with drugs during neolarynx reconstruction. Chen Tzu Yen Chiu 20(2):3-6. Ear Nose and Throat Inst, Shanghai Med Univ, PRC. 50 Cases of neolarynx reconstruction under APA combining with drugs were performed from 1992-1995. We used Ear-points "Lung", "Shenmen", "Sympathetic" and body points LI04, TH06, LI18. The patients were given pethidine, rotundine, metoclopramide im 15-25 min before operation. The excellent rate was 98%.

Jiang_C (1992) [Normalization of APA used in neurosurgery]. Chen Tzu Yen Chiu 17(1):1-6. Dept of Neurosurgery, Huashan Hospital, Shanghai Med Univ, PRC. From Mar 1975 to Feb 1982 and from Apr 1987 to Oct 1990, the national cooperative neurosurgical AP research group had already accumulated the clinic data of 5244 cases totally, consisting of 2107 cases in frontal fossa, 1951 cases in the temporo-parieto-occipital region and 1186 in posterior fossa. By the same manipulative procedures and scaling criteria, the indications, choices of AP points, stimulus parameters, adjuvants, preoperative measurements, and physiological and biochemical changes during operations were studied. Practically, the result was not only reliable, but highly repeatable. 95% of the cases in frontal fossa belonged to grade I (success), 91% of the cases in temporo-parieto-occipital region was grade I and 89% of the cases in posterior fossa was grade I. APA should be widely used as one of the usual methods of anaesthesia. The relative specificity of AP points, the mechanism of adjuvants, personal differences and preoperative measurements were discussed. In the meantime, the advantages and the remaining problems of APA in craniocerebral operations were also mentioned.

Kho_HG; van Egmond J; Zhuang CF; Lin GF; Zhang GL (1990) APA: Observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital. Anaesthesia Jun 45(6):480-485. Inst for Anaesthesiol, Univ of Nijmegen, The Netherlands. APA, supplemented by small doses of pethidine, was evaluated in 20 patients who had surgery for removal of a thyroid adenoma. There were significant increases in mean arterial pressure and respiratory rate during surgery, but no significant change in heart rate. The mean dose of pethidine given during surgery was 45 mg (SD 8.9). Postoperative recovery was rapid and complication free. APA did not provide complete analgesia, but was safe and preferable to general anaesthesia where there was a shortage of facilities.

Wang_BG2; Wang EZ; Chen XZ (1994) A study on combined AP and enflurane anaesthesia for craniotomy. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Jan 14(1):10-13, 3. Beijing Tiantan Hospital, PRC. Synergism between enflurane anaesthesia and transcutaneous AP point electric stimulation (TAES) was studied during craniotomy. 110 neurosurgical patients were assigned at random to 3 groups: A=Enflurane anaesthesia (n=40); B=Enflurane anaesthesia + TAES ipsilateral at LI04, Z 06 and GB20 (n=40); C=Enflurane anaesthesia + TAES + scalp infiltration with 0.5% procaine (n=30). Compared with Group A, Groups B and C decreased their minimum alveolar concentration (MAC) of enflurane 38-47% and 42-66% respectively, had more stable haemodynamics during operation, and had faster postoperative recovery. TAES significantly potentiated the anaesthetic effect and decreased the side effects of enflurane during craniotomy. The triple combination of TAES, enflurane and scalp infiltration with procaine was the best method of anaesthesia for craniotomy.

Yan_H1; Jiang C (1990) [Application of APA during craniocerebral operation in temporo-fronto-occipital region]. Chen Tzu Yen Chiu 15(2):92-96. Huashan Hospital, Shanghai Med Univ, PRC. The paper reports 174 cases of brain operations in temporo-fronto-occipital region by using the regime of combined AP and medication. The patients comprised of 122 males and 52 females. The AP points consisted of ear needling and body needling. Adjuvant drugs used were half-dosage Innovar and 0.1% lidocaine for scalp infiltration. According to the documented 2-grade scaling criteria, 97.1% patients belonged to grade I. No obvious discrepancy existed between ear needling group and body needling one. 3 controlled groups were compared: 1) 0.1% lidocaine alone; 2) AP plus normal saline; 3) AP plus 0.1% lidocaine. The differences were highly significant (p <.005); 0.1% lidocaine per se did not give satisfactory analgesia, whereas the efficacy of AP was enhanced greatly by the combination of 0.1% lidocaine and AP. This was an effective way to offset the incomplete analgesia of AP, especially for those who need to use intraoperative surgical method to avoid impairment to functional areas of cerebral cortex; the combination of Ear- and body- point AP, with lidocaine infiltration of the scalp, is undoubtedly superior to general anaesthesia for such purposes.