• 沒有找到結果。

本研究目的在探討電針穴位對膝關節鏡手術術後先機止痛之療 效評估,結果發現對照組、偽假電針組、術前電針組及術後電針組在 手術後第一次要求止痛藥的時間間隔彼此間皆有 s計學上的意義(對 照組 9.90±0.59 <偽假電針組 22.10±2.26 <術前電針組 47.25±2.47 <術 後電針組 57.30±1.75 ),表示電針穴位的確可延長術後疼痛的發生時 間,尤其是當在手術後馬上施以電針治療效果最好。

其次,術前電針組、術後電針組及偽假電針組在 PCA 嗎啡的總 需求量均明顯低於對照組,而前兩者又比偽電針組在術後嗎啡之需求 量為低,且均有 s計學上的顯著意義。由此可知電針穴位確有降低術 後疼痛的作用,而且電針亦存在著安慰劑的效果。

再者,術後電針組比術前電針組在手術後第一次要求 PCA 的時 間間隔有延長的情形,且在 計學上明顯的差異。而術前電針組及術s 後電針組在術後二十四小時內 PCA 的嗎啡總需求量的使用上,前者 嗎啡的使用量多於後者,但在 s計學上並無明顯的差異。此結果顯示 電針在術後馬上給予疼痛治療與術前電針治療之鎮痛效果相近,且此 兩組皆比對照組有更好的術後鎮痛作用,可見電針的止痛作用具有預 防由手術時所產生的中樞神經致敏化及術後發炎性傷害所造成的疼 痛,亦即具有先機止痛的作用。根據本研究結果,關於術後止痛給予 電針穴位的時機上,術前或術後電針之效果並無明顯的差異。

在鴉片類相關副作用的研究中,結果顯示術前及術後電針組在噁 心、眩暈的發生率上明顯低於對照組,因此可推論此可能是因前者的 鎮痛作用而使嗎啡的使用量減少,或是透過針刺穴位的療效,而使鴉 片類相關副作用的發生率降低。

參考文獻:

1. Naito Y, Tarnai S, Shingn K Shindo K, Matu T, Segawa H, Nakai Y, Mori K: Response of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery.

Anesthesiology 1992; 77: 426-431.

2. Loeser JD, Melzack R: Pain: An overview. Lancet 53: 1607-1609, 1999.

3. Woolf CJ, Chong MS: Preemptive analgesia -treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 77:362-379,1993.

4. Kissin I: Preemptive analgesia: why its effect is not always obvious?

Anesthesiology 84; 1015-1019, 1996.

5. Richmond CE, Bromley LM, Woolf CJ: Preoperative morphine preempts postoperative pain. Lancet 342:73-75,1993.

6. McQuay HJ.Pre-emptive analgesia.Br J of Anaesth 69:1-3,1992.

7. Woolf CJ, Chong MS: Preemptive analgesia – treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-379.

8. White PF.Mishaps with patient-controlled analgesia (PCA).

Anesthesiology 6:81-83,1987.

9. Tamsen A, Hartvig P, Dahlstrom B, Lindstrom B, Holmdahl MH:

Patient controlled analgesic therapy in the early postoperative period.

Acta Anaesth Scandinavica. 23(5):462-470,1979.

10. Wang HH, Chang YH, Liu DM, Ho YJA: Clinical study on physiological response in electroacupuncture analgesia and meperidine analgesia for colonoscopy. Am J Chin Med 1997;

25:13-20.

11. 林 昭 庚 , 新 針 灸 大 成 。 中 國 醫 藥 學 院 針 灸 研 究 中 心 , 台 中 1993 P991-994。

12. Pomeranz BH, Chiu D. Naloxone blocks acupuncture analgesia and causes hyperalgesia: Endorphin is implicated. Life Sci 19:1757-1862,1976.

13. Christensen PA, Noreng M, Anderson PE, Nielsen JW.

Electroacupuncture and postoperative pain. British Fournal of Anaesthesia 62:258-262,1989.

14. Christensen PA, Rotne M, Vedelsdal R, Jensen RH, Jacobsen K, Husted C. Electroacupuncture in anaesthesia for hysterectomy.Br J Anesth 71:835-838,1993.

15. Han JS, Xie GX: Dynorphin, Important mediator for electroacupuncture analgesia in spinal cord of the rabbit. Pain 18:

367-376, 1983.

16. Susan MG: Pain Medicine: A Comprehensive Review. Mosby, Salem 1996; 2: 12-24.

17. Elizabeth AM: Clinical problem-solving in the post anesthesia care unit. Annual Refresher Course Lectures 1997;321:1-7.

18. Willis WD, Coggeshall RE. Sensory mechanisms of the spinal cord 2nd ed.New York: Plenum, 1991.

19. Treede RD, Meyer RA, Raja SN,Campbell JN. Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol 1992;38:397-421.

20. Woolf CJ: Recent advances in the pathophysiology of acute pain. Br J Anaesth 1989; 63: 139-146.

21. Rang HP, Bevan S, Dray A: Chemical activation of nociceptive peripheral neurons. Br Med Bull 1991; 47 (3): 534-538.

22. Woolf CJ: Evidence for a central component of postinjury pain hypersensitivity. Nature 1983; 308: 686-688.

23. Wall PD, Woolf CJ: Muscle but no cutaneous C-afferent input produces prolonged increase in the excitability of the flexion reflex in the rat. Jphysiol Lond 1984; 356: 443-458.

24. Cook AJ, Woolf CJ, Wall PD, McMahon SB: Dynamic receptive field plasticity in rat spinal cord dorsal horn following C-primary afferent inputs. Nature 1987; 325: 151-153.

25. Torebjork HE, Lundberg LER, La Motte RH: Central changes in processing of mechanoreceptive input in capsaicin-induced secondary hyperalgesia in humans. J Physiol 1992; 448: 765-780.

26. Woolf CJ, King AE: Dynamic alterations in the cutaneous mechanoreceptive fields of dorsal horn neurons in the rat spinal cord.

J Neuro sci 1990; 10(8): 2717-2726.

27. Simone DA, Sorkin LS, Oh U, Chung JM, Owens C, Lamotte RH, Willis WD: Neurogenic hyperalgesia central neural correlates in responses of spinothalamic tract neurons. J Neurophysiol 1991; 66:

228-246.

28. Crile GW: The kinetic theory of shock and its prevention through anoci-association. Lancer 1913; 185:7-16.

29. Woolf CJ: Evidence for a central component of post injury pain hypersensitivity. Nature 1983; 308:686-688.

30. Grass JA: Preemptive analgesia, Problems in Anesthesia, Volume 10.

Edited Grass JA. Philadelphia, Liippincott-Raven, 1998; 107-121.

31. Pasqualucci A: Experimental and clinical studies on preemptive analgesia with local anesthetics. Minerva Anestesiol 1998, 64:

445-457.

32. Niv D, Lang DE, Devor M: The effect of preemptive analgesia on subacute postoperative pain. Minerva Anestesiol 1999; 65: 127-140.

33. Kehlet H: Controlling acute pain – role of preemptive analgesia, peripheral treatment, balanced analgesia, and effects on outcome, Pain 1999 – An Updated Review. Edited by Max M. Seattle, LASP Press, 1999, 459-462.

34. Schmid RL, Sandler AN, Katz J: Use and efficacy of low-dose ketamine in the management of acute postoperative pain: A review of current techniques and outcomes. Pain 1999; 82: 111-125.

35. Kissin I: Preemptive analgesia. Anesthesiology 2000; 93; 1138-1143.

36. Katz J: Preemptive analgesia: Evidence, current starus and future directions. Eur J Anaesth 1995; 12: 8-13.

37. Malmburg AB, Yaksh TL: Hyperalgesia mediated by spinal glutamate or substance P receptor block by spinal cyclooxygenase inhibition. Science 1992;257: 1276-1279

38. Gillies GWA, Kenny GNC, Bullingham RES, McArgle CS: The morphine sparing effect of ketorolac tromethamine, A study of a new, parenteral non-steroidal anti-inflammatory agent after abdominal surgery. Anaesthesia 1987;42: 727-731.

39. Souter AJ, Fredman B, White PF: Controversies in the perioperative use of nonsteroidal anti-inflammatory drugs. Anesth Analg 1994; 79:

1178-1190.

40. Cataldo PA, Sena gore AJ, Kilbride MJ: Ketorolac and patient controlled analgesia in the treatment of postoperative pain. Sur Gyn Obst 1993; 176: 435-438.

41. Sevarino FB, Sinatra RS, Paige D, Ning T, Brull SJ, Silverman DG:

The efficacy of intramuscular ketorolac in combination with intravenous PCA morphine for postoperative pain relief. J Clin Anesth 1992; 4: 285-288.

42. Etches RC, Warriner CB, Badner N, Buckley DN, Beattie WS, Chan VWS, Parsons D, Girard M: continuous intravenous administration of ketorolac reduces pain and morphine consumption after total hip of knee arthroplasty. Anesth Analg 1995; 81: 1175-1180.

43. Parker RB, Holtman B, Smith I, White PF: Use of ketorolac after lower abdominal surgery. Effect on analgesic requirement and surgical. Outcome. Anesthesiology 1994; 80:6-12.

44. Reuben SS, Connelly NR, Steinberg R: Ketorolac as an adjunct to patient-controlled morphine in postoperative spine surgery patients.

Reg Anesth 1997; 22: 343-346.

45. Goldstein JL, Silverstein FE, Agrawal NM, Hubbard RC, Kaiser J, Maurat HCJ, Verburg KM, Steven Geis G: Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor. Am J Gastroenterol 2000; 95: 1681-1690.

46. Leese PT, Hubbard RC, Karim A, et al: Effects of celecoxib, a novel cyclooxygenase-2 inhibitor, on platelet function in healthy adults: a ransomized, controlled tried. J Clin Pharmacol 2000; 40:124-132.

47. Langman MJ, Jensen DM, Watson DJ, Harper SE, Zhao PL, Quan H, Bolognese JA, Simon TJ: Adverse upper gastrointestinal effects of rofecoxib compared with NSAIDs. JAMA 1999; 282: 1929-1933.

48. Cryer B, Gottesdiener K, Gertz B, et al: In vivo effects of rofecoxib, a new cyclooxygenase (COX)-2 inhibitor, on gastric mucosal prostaglandin (PG) and serum thromboxane B2 (TXB2) synthesis in healthy humans.[abstract] Gastroenterology 1999; 116: G0611.

49. Susan MG: Pain Medicine: A Comprehensive Review. Mosby, Salem 1996; 16: 162-175.

50. Kehlet H: The stress response to surgery: Release mechanisms and the modifying effect of pain relief. Acta Chir Scand 1988; 550:

22-28.

51. Susan MG: Pain Medicine: A Comprehensive Review. Mosby, Salem 1996; 13: 126-140.

52. Stein C: Review. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993; 76: 182-191.

53. Schulte-Steinberg H, Weninger E, Jokisch D, Hofstetter B, Misera A, Lange V: Intraperitoneal versus intrapleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology 1995;

82: 634-640.

54. Pasternack GW: Review. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol 1993; 16: 1-18.

55. Niv D, Nemirovsky A, Rudick V, Geller E, Urca : Antinociception induced by simultaneous intrathecal and intraperitoneal

administration of low doses of morphine. Anesth Analg 1995; 80:

886-889.

56. Hylden JLK, Thomas DA, Ladarola MJ, Nahin RL, Dubner RS:

Spinal opioid analgesic effects are enhanced in a model of unilateral inflammation/hyperalgesia: possible involvement of noradrenergic mechanisms. Eur J Pharmacol. 1991; 194: 135-143.

57. Stein C, Millan JJ, Shippenberg TS, Peter K, Herz A: Peripheral opioid receptors mediating antinociception in inflammation.

Evidence for involvement of Mu, Delta and Kappa receptors. J Pharmacol Exp Ther 1988;248: 1269-1275.

58. Akil H, Meng F, Mansour A, Thompson R, Xie GX, Watson S:

Cloning and characterization of multiple opioid receptors. NIDA Res Monogr 1996; 161: 127-140.

59. Mollereau C, Parrnentier M, Mailleux P, Butour JL, Moisand C, Chalon P, Caput D, Vassart G, Meunier JC: ORL1, a novel member of opioid receptor family: cloning, functional expression and localization. FEBS Lett 1994; 341:33-38.

60. Darland T, Grandy DK: The orphanin FQ system: an emerging target for the management of pain? Br J Anaesth 1998; 81: 29-37.

61. Tamsen A, Hartvig P, Dahlstrom B, Lindstrom B, Holmdahl MH:

Patient controlled analgesic therapy in the early postoperative period.

Acta Anaesth Scand 1979; 23: 462-470.

62. Burn JW, Hodsman NB, McLintock TT, Gillies GW, Kenny GN, Mcardle CS: The influence of patient characteristics on the requirements for postoperative analgesia. A reassessment using patient-controlled analgesia. Anaesthesia 1989; 44: 2-6.

63. Notcutt WG, Morgan RJ: Introducing patient-controlled analgesia for postoperative pain control into a district general hospital.

Anaesthesia 1990; 45:401-406.

64. Ma QP, Han JS: Neurochemical studies on the mesolimbic circuitry of antinociceptive. Brain Res 1991; 566:95-102.

65. Ying CB, Ping PX: Correlation of pain threshold and level of β

-endorphin-like immunoreactive substance in human CSF during electroacupuncture analgesia. Acta Physiol Sin 1984; 36: 183-187.

66. Zhu JM, He XP, Cao XD: Changes of releases of

β

-endorphin-like immunoreactive substance and noradrenaline in rabbit’s preoptic area during acupuncture analgesia. Acta Physiol Sin 1990; 42:

188-193.

67. Yuan H, Han JS: Electroacupuncture accelerates the biogenesis of central enkephalins in the rat. Acta Physiol Sin 1985; 37: 265-273.

68. Han JS, Fei H, Zhou ZF: Met-Enkephalin-Arg-Phe-like immunoreactive substances mediate electroacupuncture analgesia in the periaqueductal gray of the rabbit. Brain Res 1984; 322: 289-296.

69. Jin WQ, Zhou ZF, Han JS: Inhibition of enlephalins degradation in nucleus accumbens leads to potentiatio n of acupuncture and morphine analgesia. Acta Physiol Sin 1985; 37: 377-382.

70. Xie CW, Zhang WG, Hong XJ, Han JS: Relation between the cintent of central met-enkephalin and the analgesic effect of electroacupuncture in rats. Acta Physiol Sin 1984; 36: 192-197.

71. Xu SF, Zhou GZ, Lu WX, Jiang YF, Dong WQ: Changes in noradrenaline, serotonin and enkephalin contents in certain brain structure of rabbit related to descending inhibition during acupuncture analgesia. Acta Physiol Sin 1984;36: 220-229.

72. Han JS, Xie GX: Dynorphin: Important mediator for electroacupuncture analgesia in the spinal cord of the rabbit. Pain 1984; 18: 367-376.

73. Cheng RSS, Promeranz B: Electroacupuncture analgesia could be mediated by at least two pain-relieving mechanisms; endorphin and nonendorphin system. Life Sci 1979; 25: 1957-1962.

74. Bing Z, Villanueva, Bars DL: Acupuncture and diffuse noxious inhibitory control: Naloxone-reversible depression of activities of trigeminal convergent neurons. Neuroscience 1990; 37: 809-818.

75. He L, Dong WQ, Wang M: Effects of iontrophoretic etorphin and naloxone and electroacupuncture on nociceptive response from thalamic neurons in rabbits. Pain 1991; 44:89-95.

76. Chen XH, Han JS: Analgesia induced by electroacupuncture of different frequencies if mediated by different types of opioid receptors: another crosstoloerance study. Behav Brain Res 1992; 47:

143-149.

77. Sun SL, Han JS: High and low frequency electroacupuncture analgesia are mediated by different types of opioid receptors at spinal level: A cross tolerance study. Acta Physiol Sin 1989; 41:

416-420.

78. Chen XH, Han JS: all three types of opioid receptors in the spinal cord are important for 2/15 Hz electroacupuncture analgesia. Eur J Pharmacol 1992; 211: 203-210.

79. Han JS, Ding XZ, Fan SG: Cholecystokinin octapeptide (CCK-8) antagonism to electroacupuncture analgesia and a possible tole in electroacupuncture tolerance. Pain 1986; 27:101-115.

80. Zhou Y, Sun YH, Zhang ZW, Han JS: Increased release of immunoreactive cholecystokinin octapeptide by morphine and potentiation of

μ

-opioid analgesia by CCKB receptor antagonist L-365, 260 in rat spinal cord. Eur J Pharmacol 1993; 234: 147-154.

81. Wang XH, Wang XJ, Han JS: cholecystokinin octapeptide (CCK-8) antagonized-analgesia mediated by mu and kappa opioid receptors.

Acta Physiol Sin 1990; 42: 219-225.

82. Wang XJ, Wang XH, Han JS: cholecystokinin octapeptide antagonized opioid analgesia mediated by

μ

- and

κ

- but not

δ

- receptors in the spinal cord of the rat. Brain Res 1990; 523:5-10.

83. Watkins LR, Kinscheck IB, Mayer DJ: Potentiation of morphine analgesia by the cholecystokinin antagonist proglumide. Brain Res 1985;327: 169-180

84. Watkins LR, Kinscheck IB, Kaufaman EFS, Miller J, Frenk H, Mayer DJ: cholecyctolinin antagonist Selectively potentiate analgesia induced by endogenous opiates. Brain Res 1985; 327:

181-190.

85. Kellstein DE, Mayer DJ: Chronic administration of cholecyctolinin antagonist reverses the enhancement of spinal morphine analgesia induced by acute pretreatment. Brain Res: 1990; 516: 263-270.

86. Ding XZ, Fan SG, Zhou JP, Han JS: Reversal of tolerance to morphine but no potentiation of morphine-induced analgesia by antiserum against cholecyctolinin octapeptide. Neuropharmacology 1986; 25: 175-178.

87. Poggopli R, Vergoni AV, Sandrini M, Barbafiera L, Marrama D, Bertolini A: influence of the selective cholecyctolinin antagonist L-364, 718 on pain threshold and morphine analgesia. Pharmacology 1991; 42: 197-201.

88. Faris PL, Komisaruk BR, Watkins LR, Mayer DJ: Evidence for the neuropeptide cholecyctolinin as an antagonist of opiate analgesia.

Science 1983; 29:310-312.

89. Wiertelak EP, Maier SF, Watkins LR: cholecyctolinin antianalgesia:

Safety cues abolish morphine analgesia. Science 1992; 256:830-833.

90. Qian ZN, Gu ZL, Pan JX: Effects of acupuncture analgesia on the monoamine transmitters levels in the striata and spinal cord in rats.

Chen Tzu Yen Chiu 1985;(3): 199-201.

91. Liu X, Zhang SX, Zhu B, Chen ZR: Effects of noxious stimulation and electroacupuncture on raphe-spinal neurons in nucleus raphe magnus of rats. Acta physiol Sin 1984; 36: 349-357.

92. Dong XW, Ye WL, Feng XC, Shen E: Effects on acupuncture analgesia by injection of 5,6-DHT into the rat’s locus coeruleus. Acta Physiol Sin 1984; 36: 214-219.

93. Tsai HY, Chen YF, Lin JG: Eddect of eletroacupuncture on the serotonergic neurons in rat central nervous system. Chin Pharm J.

1988; 41: 123-126.

94. Segal M, Sandberg D: Analgesia produced by electrical stimulation of catecholamine nuclei in the rat brain. Brain Res 1977; 123:

369-372.

95. Yaksh TL: Direct evidence that spinal serotonin and noradrenaline terminals mediate the spinal antinociceptive effects of morphine in the periaqueductal gray. Brain Res 1979; 160: 180-185.

96. Wang JK: Antinociceptive effect of intrathecally administered serotonin. Anesthesiology 1977; 47: 269-271.

97. Hylden JLK, Wilcox GL: Intrathecal serotonin in mice: Analgesia and inhibition of a spinal action of substance P. Life Sci1983; 33:

789-795.

98. Alhaider AA, Wilcox GL: Differential roles of 5-hydroxytryptamine1A and 5-hydroxytryptamine1B receptor subtypes in modulating spinal nociceptive transmission in mice. J Pharmacol Exp Ther 1993; 265: 378-385.

99. Kuraishi Y, Hirota N, Satoh M, Takagi H: Antinociceptive effects of intrathecal opioids, noradrenaline and serotonin in rats: Mechanical and thermal analgesic tests. Brain Res 1985; 326: 168-171.

100. Kuraishi Y, Harada Y, Takagi H: Noradrenaline regulation of pain-transmission in the spinal cord mediated by

α-

adrenoceptors.

Brain Res 1979;174: 333-336.

101. Howe JR, Wang JY, yaksh TL: Selective antagonism of the antinociceptive effects of intrathecally applied alpha adrenergic agonists by intrathecal prazosin and intrathecal yohimbine. J Pharmacol Exp Ther 1983; 224: 552-558.

102. Kanui TI, Tjolsen A Lund A, Mjellem-Joly N, Hole K:

antinociceptive effects of intrathecal administration of

α -

adrenoceptor antagonists and clonidine in the formalin test in the mouse. Neuropharmacology 1993; 32: 367-371.

103. Sagen J, Proudfit HK: Evidence for pain modulation by pre- and postsynaptic noradrenergic receptors in the medulla oblongata. Brain Res 1985; 331: 285-293.

104. Tjolsen K, Lund A, Hole K: The role of descending noradrenergic systems in regulation of nociception: The effects of intrathecally administered

α-

adrenoceptor antagonists and clonidine. Pain 1990;

43: 113-120.

105. Su S, Zheng S, Su C: Effects of four adrenergic drugs on electroacupuncture analgesia. Chen Tzu Yen Chiu 1992; 17:

175-178.

106. Yu GD, Cui CD, Zhang HQ, Yin WP, Yin QZ: Effect of locus coeruleus stimulation and electroacupuncture on nociceptive response of spinal dorsal horn neurons in rats. Acta Physiol Sin 1990;

42:76-81.

107. Rochford J, Dube B, Dawes P: Spinal cord alpha-2 noradrenergic receptors mediate conditioned analgesia. Psychopharmacology 1992;

106: 135-138.

108. Melzack R, Wall P: Pain mechanism: a new theory. Science 1965;

150: 971-977.

114. Downie WW, Leatham PA, Rind VM, Wright V, Branco JA, Anderson JA: Studies with pain rating scales. Annala of Rheumatic Diseases 1978; 37: 378-381.

115. Szyfelbein SK, Osgood PE, Carr DB: The assessment of pain and beta-endorphin immunoactivity in burned children. Pain 1987; 26:

173-182.

116. Jensen MP, Karoly P, Braver S: The measure of clinical pain density:

A comparison of six methods. Pain 1986; 27: 117-126.

117. Kelle KD: The pain chart. Lancet 1948; 2: 6-8.

118. Kremer E, Atkinson JH, Igeneliz RJ: Measurement of pain: patient preference does not confound pain measurement. Pain 1981; 10:

241-248.

119. Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G: Studies with different types of visual analogue scales for measurement of pain. Clin Pharmacol Ther 1983; 34: 234-239.

120. Melzack R, Torerson WS: On the language of pain. Anesthesiology 1971; 34:50-59.

121. Melzack R: The McGill Pain Questionnaire major properties and scoring methods. Pain 1975; 1: 277-299.

122. McGuire DB, Measuring pain. In: Frank – Stromborg M, ed.

Instructs for Clinical Nursing research. Norwalk, Connecticut:

Appleton & age 1988; 333-334.

123. Lighgenboten CL, Jackson AW, Meske NB: Arthroscopy of the knee:

ten day pain profiles and corticosteroids. Am J Sport Med 1993; 21:

503-506

124. Scott FD, Geoffrey LV, Christopher CD: Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sport Med 1998; 26: 773-777.

125.黃 維 三 , 針 灸 科 學 。 國 立 編 譯 館 , 台 北 1993 P 218-219.

126. Wu JN: A short history of acupuncture. J Altern Complement Med 1996;2: 19-21.

127. Ekblom A, Hansson P, Thomsson M, Thomas M: Increased postoperative pain and consumption of analgesics following acupuncture. Pain 1991; 44: 241-247.

128. Ernst E, Pittler MH: The effectiveness of acupuncture in treating acute dental pain: a systemic review. Br Dent J 1998; 184: 443-447.

129. Stener-Victorin E, Wa ldenstrom U, Nilsson L, Wikland M, Janson PO: A prospective randomized study of electroacupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999; 14: 2480-2484.

130. Lin JG, Lo MW, Wen YR, Hsieh CL, Tsai SK, Sun WZ: The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery. Pain 2002; 99: 509-514.

131. Mayer DJ: Biological mechanisms of acupuncture. Prog Brain Res 2000; 122: 457-477.

132. Pomeranz B, Chiu D: Naloxone blockade of acupuncture analgesia:

endorphin implicated. Life Sci 1976; 19: 1757-1762.

133. Sjolund B, Terenius L, Eriksson M: Increased cerebrospinal fluid levels of endorphin after electroacupuncture. Acta physiol Scand 1977; 100: 382-384.

134. He LF: Involvement of endogenous opioid peptides in acupuncture analgesia. Pain 1987; 31: 99-121.

135. Wang Q, Mao L, Han J: The arcuate nucleus of hypothalamus

135. Wang Q, Mao L, Han J: The arcuate nucleus of hypothalamus

相關文件