The Chinese look upon acupuncture anaesthesia as a useful working method for local or regional anaesthesia. They do not consider their methods of acupuncture anaesthesia to be perfect, but they look upon it as a subject that is being evaluated and developed all the time. The majority of operative procedures in Chinese hospitals are done with local or regional anaesthetics, and acupuncture anaesthesia is probably the commonest form of regional anaesthetic in use. Most hospitals that we visited seemed to be using acupuncture anaesthesia for between 40 % and 60 % of their surgical procedures.

The use of acupuncture anaesthesia is not confined to minor operations but includes major abdominal and cardio-thoracic surgery. During our visit to China we saw more than forty operations with acupuncture as the anaesthetic. There is no doubt that it was effective in a wide variety of operations. The Chinese often give figures of about 90% success rate, but our impression was that it was an acceptable form of anaesthesia for nearly all the operations we saw.

The clinical advantages of acupuncture anaesthesia are obvious. It is a safe and considerably less dangerous procedure than general anaesthesia, it is safer for the old and disabled, postoperative recovery is far swifter, it is a very cheap and simple form of anaesthesia, and the physiological functions of the body, such as the pulse rate and blood pressure, remain consistently stable during anaesthesia. The main disadvantage is that very occasionally the anaesthetic does not work and an alternative form of anaesthesia may be required fairly swiftly.

The possibility that a small number of patients might experience some pain is probably unacceptable in the context of a Western medical system. Furthermore, there is no muscle relaxation in acupuncture anaesthesia so it can be quite hard work to retract the abdominal muscles. Also, the Chinese have not found a solution to the discomfort that is occasionally caused by traction on the visceral contents.

Before acupuncture anaesthesia the Chinese explain to the patients what is going to happen. Most people, including the Chinese, are very frightened before going into an operating theatre, especially if they are going to be awake. It is therefore important to have the confidence of the patient before embarking on any type of surgery involving local anaesthesia. A premedication of barbiturates is usually given and the patient is wheeled to theatre. Body and ear points are selected on the same basis as for therapy and these are then stimulated electrically. In general low frequencies are used on the ear points and on distal body points (5-300Hz), and high frequencies are used on local points (3,000-l0,000Hz). When using the body points deqi is obtained first. When using ear points the Chinese insert the needle obliquely to be sure of hitting the point, and tape the needle in. Ear points will not be painful because there is not usually any local pain pre-operatively.

A period of induction is required whether ear or body points are used, and this is usually about twenty minutes. After inserting the needles the electrical stimulator is connected, set at the required frequency and maximum tolerable intensity, and left on throughout the operation. After the induction period anaesthesia should be adequate for the operation. For particularly painful operative procedures, such as separating the periosteum from the bone, small amounts of local anaesthetic are sometimes used. Very occasionally intravenous narcotics may be given if the operation is prolonged or the procedure is painful.