Strabismus patient opts for acupuncture as anesthetic

By Karen Zabel
Reviewed by H. Jay Wisnicki, MD

Published in Ophthalmology Times

NEW YORK -- For what appears to be the first time in U.S. medical history, ophthalmic surgery was performed using acupuncture as the primary means of anesthesia.

The procedure, an adjustable suture strabismus, was performed by H. Jay Wisnicki, MD, on a 49 year old woman patient at Beth Israel Medical Center here.

Dr. Wisnicki is head of the ophthalmology department at the center.

"Of course, I've only had one experience, but for that experience, using acupuncture in no way changed the success rate or the complication rate of the basic procedure," Dr. Wisnicki said. "I don't see that using acupuncture would have any change over the traditional techniques."

Dr. Wisnicki's brush with acupuncture happened purely by chance.

"A few months ago, I had a patient come to see me, Jennifer Choi, MD, who specializes in pain management and is herself an acupuncturist. When we were setting the date for the operation, she asked if we could do the procedure under acupuncture, to which I said, 'Why not?" We will still be in the OR, and if it doesn't work, we will have the option of using another form of anesthesia," he said.

Prior to her surgery, Dr. Choi taught the basic acupuncture procedure to an anesthetist on the hospital staff.

On the day of the surgery, both the anesthetist and Dr. Choi placed the needles in their appropriate locations. Single needles were placed between each thumb and forefinger, in each car, and near each brow. The needles were attached to low-voltage electrodes, which provided stimulation as their effect began to wear off.

"This stimulation can be provided simply by wiggling or rotating the needle in a certain manner, but since the anesthetist was new at this, we decided to use the electrodes," Dr. Wisnicki said. "The patient let us know when to turn the current up or down."

Interest spreads

Word of the procedure drew a crowd of observers.

"We must have had 20 people watching, from technicians to ophthalmologists to anesthetists," he said." It was absolutely amazing that she was able to hold still while I performed the procedure. Most people have their doubts about these kinds of things, but it's really amazing to see how well it worked."

Dr. Wisnicki was surprised at the size of the acupuncture needles.

"They're so small that if you put one in your hand, you wouldn't feel it," he said. "They're much smaller than any medical needle we use because there is no hollow lumen in the middle. It's kind of like being bitten by a mosquito the stinger is so small, you don't know you're being bitten."

Smooth procedure

The procedure itself went "very smoothly," with only one drawback.

"As always, whenever you do something different, it takes a little more time than the usual routine," he said. "But that's all a matter of getting used to it. Our ability to do procedures swiftly and efficiently is not based on how fast we do the actual surgery, because we don't want to rush in any way during a patient's surgery. It's more a matter of preparation.

"This procedure represented a change in that routine. If someone said I had to use acupuncture all the time, it would probably take me a few months to fine-tune my routine fully, and then the issue of time would no longer be a factor."

Acupuncture itself takes about 15 minutes to become fully effective. In future procedures, Dr. Wisnicki said he would probably begin administering the needles about 10 to 15 minutes before entering the OR.

The benefits are startling, he said.

"What was most impressive was that when the procedure was over, the patient walked to the recovery room," he said. "She was not on a stretcher at all, and she was discharged only a few minutes after being in the recovery room. It was almost like an office procedure."

Because the patient was fully awake and her eye muscles were not paralyzed, Dr. Wisnicki was also able to adjust her sutures immediately following the procedure, rather than having to wait for the anesthesia to wear off.

"With acupuncture, I can do the adjustment in the OR right after the procedure. So if the alignment is not perfect, the patient will not have to wait 5 or 6 hours to be adjusted," he noted.

The biggest drawback to the procedure, Wisnicki says, is in finding the right patient.

"There's no doubt that when you choose a patient, even for general or local anesthesia, you must choose your technique based on the patient's willingness to cooperate," he said. "The decision to use acupuncture is based on a patient's tolerance, and obviously, this was a biased patient. She knows more about it than the average patient and is certainly suited for it. Certainly, this is not for everybody."

Based on his experience, Dr. Wisnicki said acupuncture might also find application as an anesthetic in patients whose medical condition make local or general anesthesia difficult to perform. And it might even have applications beyond the operating room.

Effective pain reliever

"One of the things I learned is that acupuncture is really an effective reliever of pain," he said. "For patients with chronic eye pain, I am convinced that this would be an appropriate medical technique to use. It's a technique that I had never considered before, but would offer an alternative to traditional anesthesia for select patients in the future."

"Obviously, I would want more comfort with the anesthetist having the proper training," he said. "But to the extent that the anesthetist would be willing and trained and that I would have the right type of patient to undergo the procedure, I would absolutely offer it in my practice."

Reprinted from OPHTHALMOLOGY TIMES, November 1, 1997 AN ADVANSTAR PUBLICATION Printed in USA