Electro-Acupuncture for Pain Relief and Relaxation During an Oocyte Retrieval
Submitted by Webdoktor
from Chinese Medicine Tools.com, December 2009
TCM Patterns & Identification
PATIENT HISTORY: The patient had been trying to conceive for 3 years, this was her
first IVF cycle. Because of her high BMI, it was not advisable for the patient to
receive the intravenously administered atropine & fentanyl anesthetic which is usually
used during the oocyte retrieval procedure. She would, however, receive a local vaginal
mucosa anesthetic of 1% lidocaine with epinephrine. The patient requested that acupuncture
be used during the ooctye retrieval to assist with pain management and relaxation.
She also received 1 mg of ativan, and an intravenous drip of saline & glucose.
Treatment Protocols and Duration
ACUPUNCTURE PROCEDURE: The patient had received acupuncture treatments at our clinic
in previous months for fertility reasons. On the oocyte retrieval procedure day,
she received one long acupuncture treatment at the ART clinic, which included 3 separate
acupuncture needle insertions. Before the acupuncture treatment began, the patient
was hooked up to an intravenous drip of saline and glucose, in a vein near the acupuncture
point ZhongZhu / TE3 of her left hand. The first part of her acupuncture treatment
was done in a lounging chair outside of the surgical suite. Acupuncture point Baihui
/ GV20 was connected to Yintang with 1 htz of continuous electro-stimulation. Bilaterally
Hegu / LI4 was connected to Zusanli / ST36, Sanyinjiao / SP6 was connected to Taichong
/ LV3, and Siman / KI14 was connected to both Guilai / ST29 and Zigong, all with
200 htz of continuous electro-stimulation. Part one of her acupuncture treatment
lasted 30 minutes. All needles except GV20 & Yintang were removed, and the patient
was allowed to empty her bladder before moving to the surgical suite. The second
part of her acupuncture treatment began directly before her egg retrieval procedure,
in the surgery suite. GV20 and YinTang were again continuously electo-stimulated
with 1 htz, and bilaterally LI4 & ST36, and SP6 & LV3 were continuously electro-stimulated
with 200 htz throughout the procedure. No abdominal acupuncture points were stimulated
used during the ooctye retrieval procedure itself. The egg retrieval procedure lasted
approximately 15 minutes. At the completion of the egg retrieval procedure, all electro-stimulation
was discontinued, and all acupuncture needles except GV20 & YinTang were removed,
and the patient was wheel-chaired back to her lounging chair for the third part of
her acupuncture treatment. YinTang and GV20 were again electro-stimulated, and LI4
& ST3, and SP6 & LV were also electro-stimulated as in part one of her acupuncture
treatment. Abdominal points KI14 & ST29 were again needled, but without electro-stimulation
in the interests of minimizing any post-procedure ovarian bleeding.
Conclusions
RESULTS: Before the first part of her acupuncture treatment began, the patient was
awake and alert, and was displaying what I would consider to be "nervous energy".
She mentioned she had not slept well the night before. Within 30 seconds of beginning
electro-stimulation, the patient was asleep and snoring in her lounging chair. During
this part of her treatment she woke a few times, but remained asleep for most of
the time. During the oocyte retrieval the patient remained calm, while awake and
alert. At one point she requested the intensity of the stimulation of her right foot
(SP6 & LV3) be increased so that she could feel it more, as it seemed to be helping
her pain tolerance. At the end of her oocyte retrieval procedure, the patient reported
that the most painful part of her day so far had been the IV needle inserted into
the back of her hand. Just before the third part of her acupuncture treatment, the
patient reported that her post-procedure pain was minimal, and she seemed strong
and in good spirits. Two days later, when her embryos were transferred into her uterus,
the patient reported that since the oocyte retrieval she had experienced some mild
cramping pain, which Tylenol was helping to relieve.
REMARKS: The choice of acupuncture points and electro-stimulation intensities used
in this case study were decided upon after consulting with colleagues who had used
the protocol to assist an anesthetic-free caesarian section, with good results. I
would consider this to have been a "strong" acupuncture treatment, with the intensity
of the electro-stimulation adjusted to the maximum level of her pain threshold. The
fact that this patient had already received acupuncture treatments with myself and
my colleagues at Acubalance, and was familiar and comfortable with acupuncture's
effects and sensations, in my opinion contributed my ability to give her the necessarily
strong treatment. I believe it is therefore important that future patients who request
acupuncture assisted oocyte retrieval first experience electro-acupuncture in a series
of treatments before the oocyte retrieval itself, to assess their particular responses
to the effects of acupuncture. In future treatments I would be curious to see if
certain protocol steps could be streamlined or improved - perhaps adding manual stimulation
of auricular points ShenMen during the egg retrieval procedure, or adding electro-stimulation
of abdominal points during the egg retrieval procedure, or replacing the electro-stimulation
of the foot points SP6 & LV3 with strong manual stimulation using thick gauge needles
before the egg retrieval procedure, to minimize the number if cords used in the surgical
suite, and therefore reduce time. In my opinion, electro-acupuncture for pain relief
during minimally invasive surgical procedures such as oocyte retrieval is an area
well worthy of more research.
Dr. Erin Flynn, Acubalance Wellness Centre Vancouver
