Acupuncture Continuing Education

Acupuncture Ups Epidural Anesthesia For Labor And Delivery

Researchers find acupuncture an effective complementary therapy to epidural analgesia during labor and delivery. In a a clinical study from the First Affiliated Hospital of Guangzhou Medical University, researchers conclude that acupuncture enhances the effects of epidural analgesia and reduces complications during childbirth. The researchers (Lu, Mai) discovered that patients receiving acupuncture had less emergency caesarean sections, required less epidural analgesics to achieve appropriate pain management levels, and required less assisted deliveries. The results indicate that patient outcomes significantly improve when acupuncture is added to the epidural analgesia protocol.

 

Hand Acupoints 

 

During labor, mothers experience labor pain, which stresses the body and may lead to pathological responses affecting the delivery process. Among the painkilling methods available at present, epidural analgesia is currently acknowledged as the one of the most effective and safest painkilling methods during labor, with few adverse effects. However, epidural analgesia may cause weaker uterine contractions, prolong the expulsion stage, and increase the need for assisted birth (Wu, Re, Wang). The research team cites modern studies demonstrating that acupuncture successfully induces labor, reduces delivery time, and strengthens cervical contractions. Based upon the data, the research team initiated the combined protocol investigation of epidural anesthesia with acupuncture. They hypothesized that acupuncture would mitigate anesthesia’s adverse effects and potentially enhance efficaciousness. The results tabulated, the research team discovered that pain relief was achieved more easily, total delivery time reduced significantly, and the rate of vaginal delivery increased. The combined protocol resulted in a significant reduction in the need for caesarean sections. 

We’ll take a close look at the clinical procedures that produced positive patient outcomes. First, a brief history of Traditional Chinese Medicine (TCM) obstetrics is appropriate. For over 1,000 years, TCM physicians utilized acupuncture to induce labor. Hegu (LI4) and Sanyinjiao (SP6) remain two of the most common labor induction acupoints. According to TCM principles, Sanyinjiao is located at the intersection of the spleen, liver, and kidney meridians. Hegu is a Yuan-source acupoint, located on the large intestine meridian, that is a Gao Wu Command point and a Heavenly Star point. TCM principles note that since the large intestine meridian is connected to the Du (Governing) meridian, which has a branch originating from the uterus, acupuncture at Hegu can strengthen cervical contractions, improve qi and blood circulation, and induce labor. The ancient principles are supported by modern research. Liu et al. and Jin & Ma tested the clinical efficacy of Hegu and Sanyinjiao. The acupoints successfully increased the strength of cervical contractions, decreased delivery time, and reduced pain. In addition, the work of Li reveals that acupuncture significantly increases endorphin concentrations and reduces the transmission labor pain.

The study compared expectant mothers receiving only epidural analgesia or a combination of epidural anesthesia with acupuncture therapy. The caesarian section rate dropped 6% when acupuncture was combined with epidural anesthesia. Mothers receiving only epidural anesthesia had a 12.1% caesarean rate. Mothers receiving a combination of epidural analgesia with acupuncture had a 6.1% caesarean section rate. The need for assisted vaginal deliveries also improved with the addition of acupuncture therapy. Using only epidural anesthesia, the rate was 15.2%. Using acupuncture combined with epidural anesthesia, the rate dropped to 9.1%. The amount of epidural analgesic medication required to achieve adequate pain relief decreased with the addition of acupuncture. Using only epidural analgesia, the requirement was 20.18 ± 5.34 ml. When acupuncture was added to the treatment protocol, the requirement dropped to 17.45 ± 4.83 ml.

A total of 66 healthy, full-term pregnant females aged between 19 – 34 years old were involved in the study at the First Affiliated Hospital of Guangzhou Medical University. They were randomly divided into two equal groups of 33, the treatment group and the control group. Both groups received epidural analgesia during labor and the treatment group received acupuncture therapy in addition to epidural anesthesia.

For the treatment group, acupuncture therapy was conducted according to the following protocol. When cervical dilation was 2 – 3 cm, bilateral Sanyinjiao acupoints were needled with a 45° orientation, between the trailing edge of tibia and the skin. Ti, Cha, and Xie needling techniques were used. Next, bilateral Hegu acupoints were needled. Ti, Cha, and Bu needling techniques were used for Hegu. Upon arrival of a deqi sensation, all needles were connected to a Han electroacupuncture device set to a frequency of 2 Hz / 100 Hz (disperse-dense electrical wave stimulation). The needles were retained for a total of 30 minutes. During the needle retention period, the electrical intensity was adjusted to patient tolerance levels. During the expulsion stage, Hegu acupoints were manually manipulated for 1 minute.

For both groups, epidural analgesia was administered according to the following protocol. When cervical dilation was 3 cm, an epidural was injected at the L3 and L4 levels. A 3 ml solution of 1% lidocaine was used to test the level of anesthesia in order to ensure that the epidural catheter did not penetrate the subarachnoid cavity or blood capillaries. Initially, 5 ml of a 0.1% ropivacaine and sufentanil mixture was injected. Thereafter, injections were at a rate of 4 ml per hour. The patient was allowed to control additional dosage with a digital microinfusion pump set to a continuous background injection mode. The maximum allowed patient-controlled additional dosage was 3 ml. The duration of epidural analgesia was 30 minutes. The clinical results of this study demonstrate that acupuncture is a valuable complementary therapy to epidural analgesia during labor and delivery. Acupuncture enhances epidural analgesia by reducing the amount of analgesics needed, decreases the chance of an emergency caesarean section, and reduces the need for vaginal assisted delivery.

 

References:
Lu LY & Mai GL. (2014). Feasibility and reliability of acupuncture combined with epidural analgesia for labor and delivery. Shandong Medical Journal. 54(7).

Jin ZH & Ma SX. (2010). Effects of Sanyinjiao acupoint acupuncture-moxibustion on first stage of labor. Journal of Chinese General Practice. 13(28): 3229-3230.

Li P & Liu XW. (2006). Effect of Acupuncture on labor pain. Journal of Tianjin University of TCM. 25(2): 74-76.

Liu JY, Han Y, Zhang N, et al. (2006). Electroacupuncture on Hegu acupoint in relieving labor pain.
International Journal of Traditional Chinese Medicine. 28(4): 244-246.

Wu CY, Ren LY, Wang ZH. (2005). Effect of ropivacaine on delivery process and methods, as well as relieving labor pain. Chinese Journal of Obstetrics and Gynecology. 40(6): 369-371.

 


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