Acupuncture Anesthesia: History, Dilemma and Future

This study presents a comprehensive analysis of acupuncture anesthesia (AA), a technique that integrates traditional Chinese medicine with modern anesthetic practice. The research traces the historical evolution of AA from its origins in 1950s China, when Dr. Yin Hui-Zhu performed the first surgery using acupuncture exclusively for anesthesia in 1958, to its contemporary applications in the perioperative period. The development of AA followed distinct trajectories in China and Western countries.

In China, the technique experienced rapid growth during the 1960s and 1970s, driven by limitations in narcotic production and political support. The peak occurred in 1966, when the Ministry of Health officially adopted the practice nationally. Internationally, interest arose after reports in JAMA in 1971 and President Nixon's visit to China in 1972, which demonstrated the technique to the Western world. The mechanisms underlying AA involve multiple physiological systems.

Acupuncture analgesia operates through endogenous opioid mechanisms, activating delta and mu receptors, modulating neurotransmitters such as GABA and serotonin, and influencing the hypothalamic-pituitary-adrenal axis. Neuroimaging studies reveal that acupuncture activates specific brain regions, including the sensory cortex, prefrontal cortex, and insula, which are fundamental in pain perception and emotional regulation. AA is currently applied as adjuvant therapy in various surgical procedures, including thyroid, abdominal, and pulmonary surgeries. The most frequently used acupuncture points are LI-4 (Hegu) and PC-6 (Neiguan), known for their potent analgesic properties.

The combination of acupuncture with pharmacologic anesthesia shows significant advantages: a 70% reduction in anesthetic consumption, an 18.3% decrease in pain scores on the visual analog scale, and a 32.3% reduction in postoperative complications. The combined approach also preserves cervical muscle tone, maintains airway patency, stabilizes hemodynamic parameters, and provides effective organ protection. Despite these benefits, AA faces significant challenges that limit its widespread adoption. The lack of standardization represents a major obstacle, with few studies establishing clear criteria for acupuncture point selection and stimulation parameters.

Individual variability in response to AA increases clinical risks, and infectious complications, although rare, have been documented. The standalone application of AA remains challenging, especially in major surgery, limiting its efficacy to small-scale case series. The scarcity of professionals specialized in AA represents another obstacle, compounded by the absence of systematized training programs and standardized curricula. Future prospects for AA are promising, especially in the context of Enhanced Recovery After Surgery (ERAS) protocols.

Future development should focus on industry standardization through efficient acupuncture point selection, optimization of needling techniques, refinement of electroacupuncture use, establishment of efficacy assessment methods, and implementation of standardized training and education. Emerging technologies, including artificial intelligence and acupuncture robots, offer opportunities for more consistent and standardized treatment protocols. Global recognition of AA is growing, evidenced by the consistent increase in international publications from 2005 to 2022. Countries such as the United States, South Korea, and Germany are leading research, suggesting increased acceptance of acupuncture as a complementary therapy.

The integration of AA into public hospitals in countries such as Malaysia since 2006 demonstrates its potential for global dissemination. Modern AA differs significantly from its historical application, functioning primarily as a perioperative adjuvant modality rather than as an independent anesthetic technique. Its role centers on holistic regulation to reduce perioperative complications such as nausea, vomiting, postoperative pain, and cognitive impairment. This approach offers particular benefits for vulnerable populations, including the elderly, pregnant patients, and patients with severe adverse reactions to traditional anesthetics.

In conclusion, AA represents a promising perioperative adjuvant modality with significant therapeutic potential. Its role in improving postoperative recovery is gaining growing recognition, providing a solid basis for integration into various medical disciplines. Growing acceptance highlights AA's potential to complement traditional methods, offering a valuable tool to improve patient outcomes and broaden the scope of modern anesthetic practice.