CLINICAL STUDY Analgesic effect of acupuncture at Hegu LI 4 on transvaginal oo-cyte retrieval with ultrasonography Jianwei Zhang, Xiaohua Wang, Ruisha Lü aa Jianwei Zhang, Reproduction a
Trang 1© 2013 JTCM All rights reserved.
CLINICAL STUDY Analgesic effect of acupuncture at Hegu (LI 4) on transvaginal oo-cyte retrieval with ultrasonography
Jianwei Zhang, Xiaohua Wang, Ruisha Lü
aa
Jianwei Zhang, Reproduction and Heredity Center
Combin-ing Traditional Chinese Medicine with Western Medicine in
Hospital Affiliated to Shandong University of Traditional
Chi-nese Medicine, Jinan 250011, China
Xiaohua Wang, Shandong University of Traditional Chinese
Medicine, Jinan 250011, China
Ruisha Lü, Master Degree Candidate of 2006 Grade in
Shan-dong University of Traditional Chinese Medicine, Jinan
250011, China
Correspondence to: Prof Jianwei Zhang, Integrative
Med-icine Reproductive and Genetic Center, Affiliated Hospital of
Shandong University of Traditional Chinese Medicine, Jinan
250011, China zhangjianwei1970@sina.com
Telephone: +86-13075323626
Accepted: January 31, 2013
Abstract
OBJECTIVE: To observe the analgesic effect of
acu-puncture at Hegu (LI 4) in vitro fertilization-embryo
transfer (IVF-ET) transvaginal oocyte retrieval using
ultrasonography and explore its mechanism
METHODS: Ninety patients undergoing IVF-EF
oo-cyte retrieval were randomly divided into three
groups: an acupuncture group with needles
insert-ed into bilateral Hegu (LI 4) points, a placebo group
given placebo needles, and a control group with
routine oocyte retrieval Each group had an
indo-metacin enema 30 min before the operation We
compared the pain-rated index (PRI), visual analogy
scale (VAS), and present pain intensity (PPI)
immedi-ately after operation and 1 h after operation We
al-so determined the neuropeptide Y (NPY) level of
the follicular fluid
RESULTS: PRI, VAS, and PPI after operation and 1 h
after operation in the acupuncture group were sig-nificantly lower than those in the control group (P< 0.01) No obvious difference (P>0.05) was observed
in PRI, VAS, and PPI after operation and 1 h after op-eration between the placebo group and the con-trol group The NPY level of the follicular fluid in the acupuncture group was significantly higher than that in the control group (P<0.01) No obvious dif-ference (P>0.05) was observed in the NPY level of the follicular fluid between the placebo group and the control group
CONCLUSION: The analgesic effect of acupuncture
at Hegu in transvaginal oocyte retrieval using ultra-sonography may be related to the increase in the NPY level of the follicular fluid
© 2013 JTCM All rights reserved
Key words: Acupuncture; Hegu (LI 4); Analgesics,
non-narcotic; Oocyte retrieval; Neuropeptide Y
INTRODUCTION
Oocyte retrieval is an important step in vitro
fertiliza-tion and embryo transfer (IVF-ET) With the vigorous development of assisted reproductive technology (ART), ultrasonographic transvaginal oocyte retrieval has become a routine operation in reproduction cen-ters In recent years, Traditional Chinese Medicine has been used in assisted reproduction, and the analgesic ef-fect of acupuncture has been clinically reported in transvaginal oocyte retrieval.1 In this study, we ob-served the analgesic effect of acupuncture at Hegu (LI 4) in IVF-EF transvaginal oocyte retrieval using ultraso-nography and explored its mechanism
Trang 2MATERIALS AND METHODS
Clinical data
Ninety patients underwent transvaginal IVF-ET
oo-cyte retrieval using ultrasonography at the Center of
Reproduction and Heredity, Affiliated Hospital of
Shandong University of Traditional Chinese Medicine
from April to October 2010 Patients were 25-40 years
old, had no severe disease, and had no prior
acupunc-ture treatment Patients were excluded if they had
aller-gies or were uncooperative The 90 patients were
ran-domly divided with a single-blind method into an
acu-puncture group, a placebo group, and a control group
(n=30) Average age was (31±5) years in the
acupunc-ture group, (32±3) years in the placebo group, and (32±
5) years in the control group The infertility illness
course was (5±3) years in the acupuncture group, (5±3)
years in the placebo group, and (4±3) years in the
con-trol group Body weight was (59±9) kg in the
acupunc-ture group, (58±8) kg in the placebo group, and (60±
10) kg in the control group There were 15 cases of
pri-mary infertility and 15 cases of secondary infertility in
the acupuncture group, 17 cases of primary infertility
and 13 cases of secondary infertility in the placebo
group, and 14 cases of primary infertility and 16 cases
of secondary infertility in the control group There was
no statistical difference in age, infertility course, and
disease history among the three groups (P>0.05) This
study was approved by the ethics committee of the
hos-pital and all the patients signed a participation
agree-ment
Methods
Therapy: thirty minutes before the operation, a 0.1 g
indometacin enema (produced by Shanghai Modern
Pharmaceutical Limited Company with batch number
H31020401, Shanghai, China) was given to the
pa-tients in the three groups Fifteen minutes before the
operation, needles were inserted into bilateral Hegu
(LI 4) points of the patients in the acupuncture group
with the uniform reinforcing-reducing method and
re-mained there until the end of the operation Hegu (LI
4) points of the patients in the placebo group were
tapped with placebo needles (15 mm was cut off from
25 mm filiform needle, the section was ground round
and smooth and the needle was inserted into a slice of
rubber) without pricking the epidermis, making the
pa-tient think that the filiform needle had been inserted
into their skin The rubber slice was fixed with
adhe-sive plaster to fix the needle in place No acupuncture
was given to the patients in the control group
Evaluation of analgesic effect: after the oocyte retrieval
and 1 h after the operation, the patient was asked to
fill out the short-form of McGill pain questionnaire
(SF-MPQ) The pain-rated index (PRI) consists of 11
sensory pain-describing phrases and four affective
pain-describing phrases For all the pain-describing
phrases, 0 means no pain, 1 means mild pain, 2 means
moderate pain, and 3 means severe pain The visual analogy scale (VAS) is a straight line, 100 mm long, with one end showing no pain and the other end show-ing acute pain The length of a section of the line shows the extent of pain The present pain intensity (PPI) is divided into no pain, mild discomfort, discom-fort, pain, moderate pain, and extreme pain expressed
as 0, 1, 2, 3, 4, and 5 respectively
Collection of follicular fluid: at the beginning of the oocyte retrieval, the main follicle was punctured to ex-tract the follicular fluid and avoid the filtration of blood as much as possible The follicular fluid was cen-trifuged for 10 min The supernatant was put in a ster-ile test tube and stored at －20℃ until examination Detection of NPY: enzyme-linked immunosorbent as-say (ELISA) was used to determine neuropeptide Y (NPY) level in the follicular fluid according to the man-ufacturer's instructions (Shanghai Fuzhong Biological Sci-tech Development Limited Company, Shanghai, China)
Statistical analysis
Measurement data are expressed with mean ± standard
deviation ( xˉ ± s ) A t-test was used for differences
be-tween two groups, and the SPSS 16.0 software (Inter-national Business Machines Co., Ltd Beijing, China) package was used to carry out statistical processing
RESULTS
PRI, VAS, and PPI scores of patients in the three groups immediately after oocyte retrieval
As shown in Table 1, the PRI, VAS, and PPI scores of patients in the acupuncture group after operation were significantly lower than those in the control group and
placebo group (P<0.01) No obvious difference (P>
0.05) was observed in the PRI, VAS, and PPI scores af-ter operation between the placebo group and the con-trol group
PRI, VAS, and PPI scores 1 h after oocyte retrieval among the three groups
As shown in Table 2, the PRI, VAS, and PPI scores 1 h after oocyte retrieval in the acupuncture group were sig-nificantly lower than those in the control group and
the placebo group (P<0.01) No obvious difference (P>
0.05) was observed in the PRI, VAS, and PPI scores 1 h after operation between the placebo group and the con-trol group
NPY level in the follicular fluid among the three groups
As shown in Table 3, the NPY level in the follicular
flu-id of the acupuncture group was significantly higher than that in the control group and the placebo group
(P<0.01) No obvious difference (P>0.05) was
ob-served in the NPY level of the follicular fluid between the placebo group and control group
Trang 3Transvaginal oocyte retrieval is a microtraumatic
opera-tion under the guidance of ultrasonography with slight
pain and no anesthesia However, it is difficult to take
eggs from some IVF patients with severe adhesion of
the pelvic cavity and high ovary position, thus
increas-ing pain in these patients With improvement in the
various parts of IVF, oocyte retrieval has become
in-creasingly popular Therefore, the search for a safe and
effective analgesic method is necessary in clinical
re-search.2,3
Hegu (LI 4), a source point of the Large Intestine
Channel of Hand-Yangming, promotes the circulation
of Qi, removes stagnancy, clears channels and activates
collaterals It is an important point for regulating Qi
and blood There are many reports on acupuncture at
Hegu (LI 4) enhancing the pain threshold and having
an analgesic and anesthetic effect in clinical opera-tions.4 In oocyte retrieval, the lower limbs of the pa-tient are fixed, the operational area is covered with a sterile sheet, and the upper limbs are exposed to easily choose a point The hypothesis that analgesia with acu-puncture is attributed to the transfer of attention was addressed by setting up a placebo group In reference
to Streitberger5 for placebo needles, a section of a fili-form needle is ground round and smooth and tapped
on the skin surface to make the patient think that the filiform needle has been inserted into skin The real acupuncture procedure is mimicked and patients who have had prior acupuncture are excluded.6The result of this study showed that the PRI, VAS, and PPI scores af-ter operation and 1 h afaf-ter operation in the acupunc-ture group were significantly lower than those in the
control group and the placebo group with (P<0.01) Moreover, no obvious difference (P>0.05) was
ob-served in the PRI, VAS, and PPI scores after operation and 1 h after operation between the placebo group and the control group, indicating that acupuncture at Hegu has a better analgesic effect in transvaginal IVF-ET oo-cyte retrieval
NPY is widely distributed in the central peripheral nerves.7,8 NPY regulates the pain threshold of the cen-tral nervous system on the spinal cord level and above the spinal cord.9-12This study showed the NPY level of the follicular fluid in the acupuncture group was signif-icantly higher than that in the control group and the
placebo group (P<0.01) This indicates that analgesic
Table 1 PRI, VAS and PPI scores after the ovum retrieval (xˉ ± s )
Group
Treatment group
Placebo-contro1 group
Control group
F value
P value
n
30 30 30
-PRI 3.0±1.5 ab 6.8±2.1 c 6.7±2.6 7.898 0.001
VAS 2.3±1.3 ab 3.9±1.1 c 4.0±1.5 15.332 0.000
PPI 1.6±0.7 ab 2.2±0.8 c 2.3±0.9 32.345 0.000 Notes: treatment group was given needles inserted into bilateral Hegu (LI 4) points; placebo group was given placebo needles; control group was given routine oocyte retrieval PRI: pain rating index; VAS: visual analogue scale; PPI: present pain intensity aP<0.01,cP>0.05,
compared with control group; bP<0.01, compared with placebo-contro1 group.
Table 2 PRI, VAS and PPI scores 1 h after the oocyte retrieval (xˉ ± s )
Group
Treatment group
Placebo-contro1 group
Control group
F value
P value
n
30 30 30
-PRI 0.4±0.7 ab 1.3±0.9 c 1.4±0.9 9.194 0.000
VAS 0.2±0.6 ab 1.0±1.0 c 1.1±1.2 6.418 0.003
PPI 0.1±0.3 ab 0.6±0.6 c 0.5±0.5 12.811 0.000 Notes: treatment group was given needles inserted into bilateral Hegu (LI 4) points; placebo group was given placebo needles; control group was given routine oocyte retrieval PRI: pain rating index; VAS: visual analogue scale; PPI: present pain intensity Compared with control group, aP<0.01,cP>0.05; compared with placebo-contro1 group,bP<0.01.
Group
Treatment group
Placebo-contro1 group
Control group
F value
P value
n
30 30 30
-NPY (pmol/L) 9±11 ab 2±5 c 2±3 10.494 0.000 Table 3 NPY concentrations in FF (xˉ ± s )
Notes: treatment group was given needles inserted into bilateral
Hegu (LI 4) points; placebo group was given placebo needles;
control group was given routine oocyte retrieval NPY:
neurop-eptide Y; FF: follicular fluid Compared with control group, aP<
0.01, cP>0.05; compared with placebo-contro1 group,bP<0.01.
Trang 4acupuncture at Hegu (LI 4) in oocyte retrieval may be
related to an increase in NPY of the follicular fluid
The formation of the follicular fluid is closely related
to the circulation of body fluid However, detecting
NPY in the follicular fluid is only a preliminary trial to
probe the mechanism of analgesic acupuncture at
Hegu (LI 4) It is still necessary to explore the
mecha-nism of regulating pain threshold with acupuncture at
Hegu (LI 4) through the neuroendocrine network in
oocyte retrieval
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