The influence of sitting position during shoulder arthroscopy on regional brain saturation with oxygen: comparasion of interscalene block and inhalation anaesthesia with sevoflurane

Cilj istraživanja: Cilj je ovoga istraživanja ispitati povezanost postavljanja bolesnika u sjedeći položaj (engl. beach chair position - BCP) s posljedičnim promjenama arterijskoga tlaka i srčanih otkucaja, kao i njihova utjecaja na regionalnu moždanu saturaciju tijekom artroskopije ramena u dvjema skupinama bolesnika; inhalacijska anestezija sevofluranom i regionalna anestezijska tehnika (interskalenski blok). Nacrt studije: Prospektivna klinička studija Ispitanici i metode: Ispitanici su bolesnici predviđeni za elektivnu artroskopiju ramena, a tijekom operacijskoga zahvata postavljaju se u sjedeći položaj. U studiju je bilo uključeno 60 bolesnika koji su podijeljeni u 2 skupine: prvu skupinu (OA) čine bolesnici kod kojih je operacijski zahvat izveden u inhalacijskoj anesteziji sevofluranom, dakle strojno ventilirani, a drugu skupinu (ISB) čine bolesnici kod kojih je operacijski zahvat izveden u interskalenskom bloku sa ili bez primjene sedacije. Vrijednosti neinvazivnoga mjerenja arterijskoga tlaka, srčanih otkucaja, periferne saturacije krvi kisikom i regionalne moždane saturacije kisikom mjerile su se i bilježile u dvanaest predefiniranih točaka tijekom perioperacijskoga razdoblja. Rezultati: Značajno veći broj bolesnika u OA skupini imalo je pad srednjeg arterijskoga tlaka od 20% i više u odnosu na početne (bazalne) vrijednosti, u usporedbi s bolesnicima ISB skupine (p<0.001). Značajna razlika u regionalnoj moždanoj saturaciji kisikom između promatranih skupina postoji samo u točkama koje označavaju uvod i buđenje iz anestezije u OA skupini kada su primali 100% kisik (p<0.001). Analizom korelacija ΔMAP i ΔscO2 za obje moždane hemisfere uočava se korelacija samo u 10. minuti nakon postavljanja bolesnika u sjedeći položaj kod bolesnika u OA skupini, a za lijevu moždanu hemisferu i u 20. minuti (p=0.004, desna; p=0.003, lijeva). Korelacija ne postoji kod bolesnika u ISB skupini u bilo kojoj od mjerenih točaka. Zaključak: Bolesnici u OA skupini imali su značajno niže vrijednosti arterijskoga tlaka i srčanih otkucaja nakon uvoda u anesteziju i posjedanja u BCP tijekom artroskopije ramena, u odnosu na bolesnike u ISB skupini, bez značajnoga utjecaja na sniženje regionalne moždane saturacije kisikom.Objectives: The aim of this study was to investigate the correlation between the patients positioning at the BCP with consequential arterial pressure and heart rate changes and their influence on regional cerebral oxygen saturation in two types of anesthesia techniques - general and regional (interscalene block). Study design: Prospective clinical study Participants and Methods: Subjects were patients for elective arthroscopy of the shoulder, placed in a sitting position. Sixty patients were included in this case control study and divided into two groups: the first group of 30 patients in whom shoulder arthroscopy was performed under general anesthesia and therefore mechanically ventilated, and the second group of 30 patients whom shoulder arthroscopy was performed using interscalene block technique with or without sedation. Non-invasive blood pressure, heart rate, peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. Results: A significantly higher number of patients in the GA group had a decrease of 20% and more of MAP compared to the baseline value in the ISB group (p<0.001). There is a significant difference in regional cerebral saturation between groups measured only in points of induction and emergence from anesthesia in favor of the GA group when received 100% oxygen (p<0.001). ΔMAP and ΔscO2 for both brain hemispheres correlate only at the 10th minute after setting up the BCP in GA patients, and for the left hemisphere 20 minutes after setting up the BCP in GA group (p=0.004, right; p=0.003, left). This correlation does not exist for the patients in ISB group at any of the points measured. Conclusion: The reduction of arterial blood pressure and heart rate after the positioning of the patients in the BCP for elective shoulder arthroscopy in inhalational anesthesia with sevoflurane is significant in comparison to the patients anesthetized using the interscalene block technique, but this does not have a significant impact on reduction of regional cerebral oxygenation

Utječe li anestezijska tehnika na arterijski tlak i regionalnu moždanu perfuziju tijekom artroskopije ramena u sjedećem položaju?

This study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.Cilj ovoga istraživanja je bio ispitati povezanost postavljanja bolesnika u sjedeći položaj (engl. beach chair position, BCP) i vrste anestezijske tehnike s posljedičnim promjenama arterijskog tlaka i srčanih otkucaja, kao i njihovog utjecaja na regionalnu moždanu perfuziju tijekom artroskopije ramena. U studiju je bilo uključeno 60 bolesnika: prvu skupinu činilo je 30 bolesnika kod kojih je operacijski zahvat izveden u općoj anesteziji (OA) koji su bili mehanički ventilirani, a drugu skupinu 30 bolesnika kod kojih je operacijski zahvat izveden uz interskalenski blok (ISB) i spontano disanje. U 12 prethodno definiranih točaka tijekom perioperacijskog razdoblja mjerio se neinvazivno arterijski tlak, srčani otkucaji, periferna zasićenost kisikom i regionalna moždana zasićenost kisikom. Bolesnici u skupini OA imali su značajno niže vrijednosti srednjeg arterijskog tlaka i srčanih otkucaja u odnosu na bolesnike u skupini ISB tijekom BCP (p<0,001). Promjene srednjeg arterijskog tlaka i regionalne moždane zasićenosti kisikom za obje moždane hemisfere korelirale su samo u 10. minuti nakon postavljanja bolesnika u BCP kod skupine OA (desna p=0,004, lijeva p=0,003). Ova korelacija nije zabilježena kod bolesnika skupine ISB ni u jednoj od mjerenih točaka. Moždani desaturacijski događaji su zabilježeni u objema skupinama, ali nisu bili statistički značajni. Rezultati ovoga istraživanja ukazuju na to da je OA očuvala regionalnu moždanu zasićenost kisikom unutar sigurnog raspona u usporedbi sa skupinom ISB tijekom BCP, unatoč značajnim promjenama arterijskog tlaka i srčanih otkucaja

WHY MONITORING CEREBRAL DESATURATION EVENTS DURING SURGERY IN THE BEACH CHAIR POSITION?

Moždani oksimetri se koriste u novije vrijeme za nadzor nad regionalnom moždanom oksigenacijom tijekom kirurških zahvata kod kojih se očekuje hemodinamska nestabilnost bolesnika. Jedan od takvih zahvata je operacija ramena u sjedećem položaju, koji se u inozemnoj literaturi naziva “the beach chair position” (engl. BCP). Hipotenzija koja se javlja nakon pozicioniranja bolesnika u sjedeći položaj dovodi do pada perfuzijskog tlaka u mozgu što bi moglo predisponirati potencijalni cerebrovaskularni incident. Cerebralni desaturacijski događaji (engl. cerebral desaturation events, CDE’s) predstavljaju pad vrijednosti zasićenosti kisika u mozgu za 20 % u odnosu na bazalnu vrijednost mjerenu s moždanim oksimetrom INVOS (engl. In Vivo Optical Spectroscopy, INVOS 5100; Somanetics Corp., Troy, Michigan, USA). Zbog tih potencijalnih desaturacijskih događaja koji bi mogli biti štetni za neurološku funkciju istraživači i kliničari stalno nastoje pronaći odgovarajuće metode za nadzor nad moždanom perfuzijom kao i vezu između hipotenzije, smanjene perfuzije mozga, smanjene zasićenosti mozga kisikom i neuroloških incidenata kod bolesnika tijekom artroskopije ramena u sjedećem položaju.Regional cerebral oximeters are used more recently to monitor regional cerebral oxygenation during surgical procedures in which patients are expected to be hemodynamically unstable. Such procedures are cardiac surgery, abdominal surgery that requires anti-Trendelenburg’s position, thoracic surgery with one-lung ventilation, posterior fossa neurosurgery, carotid endarterectomy, and shoulder surgery, performed in the beach chair position (BCP). Patient positioning for particular surgical procedures is extremely important for surgical fi eld visualization, but implies various physiological regulation mechanisms for adaptation to new positions. During patient positioning from supine to other positions, such as BCP, gravity infl uences distribution of the circulating blood volume to the abdomen and extremities. Anesthetized patients have an altered sympathetic response to position changes, which leads to hypotension, particularly during patient positioning from supine to sitting position. Systemic hypotension that occurs after positioning the patient to BCP is followed by decline in the cerebral perfusion pressure, which can lead to potential cerebrovascular incident. There are several case reports describing visual loss and ophthalmoplegia, postoperative cerebral ischemia with persistent vegetative state or brain death following these surgical procedures in BCP. Therefore, BCP is a major challenge for the anesthesiologist and for arterial pressure regulation during the surgery due to hypotension. Some investigators found that cerebral blood fl ow was lower with hypotension (measuring blood velocity in middle cerebral artery with transcranial Doppler) in patients during BCP for shoulder arthroscopy. Monitoring cerebral perfusion in patients during shoulder arthroscopy in BCP is suggested by many authors as a measure to improve patient safety due to potentially endangered brain perfusion. The noninvasive method of the brain oxygenation monitoring is based on the theory of light absorption within the infrared spectrum and uses the near-infrared spectroscopy (NIRS) technology. This monitoring method is user friendly, therefore is gaining much popularity as a method for monitoring cerebral oxygenation. Cerebral desaturation events (CDEs) represent a 20% decline in relation to basal cerebral oxygen saturation values measured with INVOS (In Vivo Optical Spectroscopy, INVOS 5100; Somanetics Corp., Troy, Michigan, USA) cerebral oximeter and are often recorded during this position. Meex et al. carried out a prospective observational study in volunteers and patients in the lateral decubitus position and BCP to describe changes in cerebral tissue oxygen saturation due to changes in body position. They found that more than 55% of patients in BCP had CDEs as compared with volunteers without anesthesia. As these potential CDEs could be detrimental for neurologic function, the clinicians are constantly trying to fi nd appropriate methods for monitoring cerebral perfusion and the link between hypotension, decreased brain perfusion, decreased brain oxygen saturation and neurological incidents during shoulder arthroscopy in BCP. They are also trying to correlate CDEs with possible neurocognitive changes in patients after these surgical procedures, which has not been confi rmed so far. Salazar et al. found that 18% of patients included in their study had the intraoperative incidence of CDEs during BCP but did not fi nd statistically signifi cant preoperative versus postoperative neurocognitive test scores. They concluded that the transient intraoperative CDEs were not associated with postoperative cognitive dysfunction. Patient safety is strongly ssociated with technical and clinical monitoring capabilities during any surgical procedure; therefore, using all available techniques for supervision of the patient’s vital functions is necessary to minimize the occurrence of potential adverse events

Traheobronhalna morfometrija korelira s demografskim obilježjima i infekcijama u kritično oboljelih pacijenata

Tracheal measurements in the intensive care unit (ICU) are important for the choice of endotracheal tube and may correlate with patient demographic characteristics and infections. The study included 42 surgical patients, age 60 [48-71] years, who underwent diagnostic chest computed tomography (CT) scans during treatment in the ICU, Osijek University Hospital, in 2019 and 2020. CT scans were analyzed using AW Server 3.2. Measurement analysis showed that the diameters of the tracheobronchial tree, the length of the trachea and left main bronchus were significantly larger in men compared to women (p<0.05 all). The smallest tracheal upper diameter was 15.25 [IQR 11.8-18.8] mm vs. 17.95 [13.55-20.05] mm in septic and nonseptic patients, respectively (p=0.028). A total of 26 patients who underwent CT scans developed nosocomial pneumonia. It was right-sided in 15, left-sided in 6 and bilateral in 5 patients, and correlated significantly with the left main bronchus length (ρ=0.515, p=0.007). No correlation was observed between tracheobronchial measurements and length of ICU treatment, number of hours spent on mechanical ventilation, or survival. A larger study could provide better data on the importance of tracheobronchial tree measurements in ICU patients.Izmjere traheje u jedinici intenzivnog liječenja (JIL) važne su zbog odabira veličine tubusa te mogu korelirati s demografskim obilježjima bolesnika i infekcijama. U ovoj studiji su analizirana 42 kirurška bolesnika u dobi od 60 [48-71] godina kojima je učinjena dijagnostička kompjutorizirana tomografija (CT) prsnog koša za vrijeme liječenja u JIL-u Kliničkog bolničkog centra Osijek tijekom 2019. i 2020. godine. Snimci CT-a su analizirani programom AW Server 3.2. Analiza izmjera pokazala je da su promjeri traheobronhalnog stabla, duljina dušnika i lijevog glavnog bronha značajno veći kod muškaraca nego kod žena (p<0,05 za sve). Najuži gornji promjer dušnika bio je 15,25 [IQR 11,8-18,8] naspram 17,95 [13,55-20,05] mm u septičkih i neseptičkih bolesnika (p=0,028). Kod ukupno 26 bolesnika koji su podvrgnuti CT-u tijekom liječenja u JIL-u dijagnosticirana je pneumonija. Bila je desnostrana u 15, lijevostrana u 6, a obostrana u 5 bolesnika i značajno je korelirala s duljinom lijevog glavnog bronha (ρ=0,515, p=0,007). Nije uočena korelacija između traheobronhalnih mjerenja i duljine liječenja u JIL-u, duljine mehaničke ventilacije ili preživljenja. Veća studija bi mogla pružiti bolje podatke o značenju dimenzija traheobronhalnog stabla kod kritično oboljelih pacijenata

The use of an ultrasound-guided supraclavicular brachial plexus block in a high risk patient with cardiomyopathy

With the rapid growth of the elderly population, along with increased comorbidities and greater life expectancy, geriatric surgery has become more frequent and requires careful tailoring of anesthesia technique. Preanesthetic evaluation should concentrate on the identification of age-related diseases and an estimation of physiological reserve. Age-related cardiovascular changes are leading factors impacting perioperative outcomes among elderly patients. The management of a patient with dilated cardiomyopathy, who undergoes a non-cardiac surgery is always a challenge for an anesthesiologist, as this situation is associated with a high mortality rate. We report a use of the ultrasound guided supraclavicular brachial plexus block in 87-year old woman for revision of wound of left wrist and reposition and immobilization of left forearm and elbow. Her previous medical records revealed that she arterial hypertension, chronic atrial fibrillation with dilated cardiomyopathy and chronic kidney disease, stage II. Postoperatively, she developed respiratory insufficiency. This case report exemplifies how despite all the measures and precaution we had taken, with choosing anesthesia having only minimal hemodynamic fluctuations and carefully planned and balanced hydration of patient we still had unwanted outcome

Percutaneous Laser Disc Decompression in the Treatment of Lumbar Radicular Pain

Lumbar radicular pain is defined as pain in the lumbar spine with propagation to the lower extremities. It is a major public health, social and economic problem in the modern society, and is one of the most common reasons for visits to the doctor. Lumbar radicular pain is often the reason for absenteeism and occupational disabilities. It is estimated that about 70-85% of the world’s population have experienced lumbar spine pain once in their lifetime. There are numerous modalities for the treatment of lumbar radicular pain, ranging from pharmacotherapy to surgery. In order to avoid systemic side effects of analgesics, anaesthesia and long-term and extensive surgery, minimally invasive procedures are increasingly used for treating lumbar radicular pain. Percutaneous laser disc decompression (PLDD) is one such procedure, first performed by Dr Choy and Dr Ascher in 1986. PLDD is an outpatient surgery performed under local anaesthesia, its success rate is high and the complication rate is low. This method therefore certainly attracts the attention of clinicians dealing with this issue. (Budrovac D, Radoš I, Tot OK, Haršanji Drenjančević I, Omrčen I. Percutaneous Laser Disc Decompression in the Treatment of Lumbar Radicular Pain. SEEMEDJ 2020; 4(2); 62-68

Arterial pressure and heart rate changes in patients during “beach chair position” for shoulder surgery: comparison of the regional and general anesthesia techniques

Background and Purpose: Patients scheduled to shoulder surgery are placed in a sitting position called “the beach chair position” during the operation. This type of surgery can be performed with two anesthetic techniques: general anesthesia or regional anesthesia (interscalene block). This patient positioning is characterized by changes in heart rate and systemic blood pressure. The aim of this study is to show whether the type of anesthetic technique influence the changes in systemic pressure and heart rate in this particular patient position. Materials and methods: Retrospective clinical study with reviewed anesthetic charts and medical documentation of the patients scheduled for elective shoulder surgery. Point measurements of systolic and diastolic blood pressure and heart rate were: before surgery, after the positioning of the anesthetized patient, at the end of the operation (lodging of the patient) and then the lowest recorded pressure and heart rate during surgery. Results: The study included 66 patients in the sitting position for shoulder surgery. Positioning the patients in the beach chair position for shoulder surgery in a population of patients undergoing general anesthesia in relation to the population of patients treated under regional anesthesia, had a significant effect on the decline in systolic blood pressure (p<0.001) and dyastolic blood pressure (p=0.008). Conclusion: Regional anesthesia has proven again to be the superior technique over general anesthesia, including cardiovascular stability in patients subjected to shoulder surgery in the beach chair position

CONNECTION BETWEEN ACUPUNCTURE ANALGESIA IN CHRONIC PAIN WITH PAIN INTENSITY, BLOOD PRESSURE AND HEART RATE

Cilj rada: Utvrditi vezu između akupunkturnog liječenja i vrijednosti arterijskog krvnog tlaka, srčane frekvencije i intenziteta boli. Metode: Prospektivnim istraživanjem su obuhvaćena 64 pacijenta sa kroničnom boli, liječena farmakološkom terapijom i akupunkturom u Zavodu za liječenje boli KBC Osijek. Intenzitet boli, krvni tlak i srčana frekvencija mjereni su prije postavljanja i nakon uklanjanja akupunkturnih igala. Rezultati: Intenzitet boli iskazan na vizualno analognoj ljestvici značajno je viši kod prvih mjerenja prije insercije akupunkturnih igala, te neposredno nakon skidanja akupunkturnih igala (poslije akupunkture) (Friedmanov test, p<0,001). Prije akupunkture značajno su niže vrijednosti sistoličkog (Friedmanov test, p<0,001) i dijastoličkog (Friedmanov test, p=0,036) tlaka u zadnjim mjerenjima. Vrijednosti tlaka poslije akupunkture ne mijenjaju se značajno tijekom mjerenja. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja. Zaključak: tijekom primjene prvih pet akupunkturnih terapija značajno je smanjen intenzitet boli i vrijednosti krvnoga tlaka nakon provedenoga tretmana, te su u zadnjih pet tretmana navedene niže vrijednosti održane. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja.The aim of this study was to prove or disprove connection between acupuncture analgesia with the level of blood pressure and heart rate during implementation of acupuncture analgesia in patients with chronic pain. The secondary aim was to measure pain intensity during implementation of acupuncture analgesia. Patients with chronic pain receiving 10 acupuncture sessions with pharmacological analgesic therapy were included. The inclusion criteria were pain intensity due to chronic pain of at least 5 on the 0-10 visual analog scale (VAS) and patient age 18 to 65. Excluding criteria were age under 18 and over 65, unregulated arterial hypertension, heart rhythm disorders, signifi cant psychiatric comorbidity, pregnancy, allergy to acupuncture needles, anticoagulant therapy, and patients who refused to participate in monitoring and therefore did not sign the informed consent form. Pain intensity, blood pressure and heart rate were evaluated before and after acupuncture. The study included 64 patients, 11 (17%) male and 53 (83%) female. Wilcoxon test proved a signifi cantly lower pain intensity after acupuncture on the second (p=0.009), third (p=0.006), fourth (p=0.005) and seventh (p=0.013) measurement. Pain intensity on the VAS was signifi cantly higher on the initial measurement before acupuncture and after acupuncture (Friedman test, p<0.001). Systolic pressure was signifi cantly decreased on the fi rst two measurements (Wilcoxon test, p=0.003 and p=0.014), and on the fourth (Wilcoxon test, p=0.036) and fi fth (Wilcoxon test, p=0.002) measurements after acupuncture. Diastolic blood pressure was signifi cantly lower on the fi fth (Wilcoxon test, p=0.030) and the last two measurements (Wilcoxon test, p=0.041 and p=0.003). The 6-10 measurements showed signifi cantly lower systolic (Friedman test, p<0.001) and diastolic (Friedman test, p=0.036) pressure before acupuncture in relation to systolic and diastolic blood pressure on the fi rst fi ve measurements before acupuncture. The pressure values after acupuncture did not change signifi cantly during measurements. Heart rate before and after acupuncture did not change the measurements signifi cantly, but was signifi cantly lower after acupuncture on the fi rst eight measurements. This study demonstrated that the fi rst fi ve acupuncture sessions signifi cantly reduced pain intensity and blood pressure, thereafter aintaining the levels of pain intensity and blood pressure achieved (acupuncture sessions 6-10), which were lower compared to the fi rst five measurements (acupuncture sessions 1-5)

CONNECTION BETWEEN ACUPUNCTURE ANALGESIA IN CHRONIC PAIN WITH PAIN INTENSITY, BLOOD PRESSURE AND HEART RATE

Cilj rada: Utvrditi vezu između akupunkturnog liječenja i vrijednosti arterijskog krvnog tlaka, srčane frekvencije i intenziteta boli. Metode: Prospektivnim istraživanjem su obuhvaćena 64 pacijenta sa kroničnom boli, liječena farmakološkom terapijom i akupunkturom u Zavodu za liječenje boli KBC Osijek. Intenzitet boli, krvni tlak i srčana frekvencija mjereni su prije postavljanja i nakon uklanjanja akupunkturnih igala. Rezultati: Intenzitet boli iskazan na vizualno analognoj ljestvici značajno je viši kod prvih mjerenja prije insercije akupunkturnih igala, te neposredno nakon skidanja akupunkturnih igala (poslije akupunkture) (Friedmanov test, p<0,001). Prije akupunkture značajno su niže vrijednosti sistoličkog (Friedmanov test, p<0,001) i dijastoličkog (Friedmanov test, p=0,036) tlaka u zadnjim mjerenjima. Vrijednosti tlaka poslije akupunkture ne mijenjaju se značajno tijekom mjerenja. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja. Zaključak: tijekom primjene prvih pet akupunkturnih terapija značajno je smanjen intenzitet boli i vrijednosti krvnoga tlaka nakon provedenoga tretmana, te su u zadnjih pet tretmana navedene niže vrijednosti održane. Srčana frekvencija prije i poslije akupunkture ne mijenja se značajno po mjerenjima, ali značajno je niža nakon akupunkture u prvih osam mjerenja.The aim of this study was to prove or disprove connection between acupuncture analgesia with the level of blood pressure and heart rate during implementation of acupuncture analgesia in patients with chronic pain. The secondary aim was to measure pain intensity during implementation of acupuncture analgesia. Patients with chronic pain receiving 10 acupuncture sessions with pharmacological analgesic therapy were included. The inclusion criteria were pain intensity due to chronic pain of at least 5 on the 0-10 visual analog scale (VAS) and patient age 18 to 65. Excluding criteria were age under 18 and over 65, unregulated arterial hypertension, heart rhythm disorders, signifi cant psychiatric comorbidity, pregnancy, allergy to acupuncture needles, anticoagulant therapy, and patients who refused to participate in monitoring and therefore did not sign the informed consent form. Pain intensity, blood pressure and heart rate were evaluated before and after acupuncture. The study included 64 patients, 11 (17%) male and 53 (83%) female. Wilcoxon test proved a signifi cantly lower pain intensity after acupuncture on the second (p=0.009), third (p=0.006), fourth (p=0.005) and seventh (p=0.013) measurement. Pain intensity on the VAS was signifi cantly higher on the initial measurement before acupuncture and after acupuncture (Friedman test, p<0.001). Systolic pressure was signifi cantly decreased on the fi rst two measurements (Wilcoxon test, p=0.003 and p=0.014), and on the fourth (Wilcoxon test, p=0.036) and fi fth (Wilcoxon test, p=0.002) measurements after acupuncture. Diastolic blood pressure was signifi cantly lower on the fi fth (Wilcoxon test, p=0.030) and the last two measurements (Wilcoxon test, p=0.041 and p=0.003). The 6-10 measurements showed signifi cantly lower systolic (Friedman test, p<0.001) and diastolic (Friedman test, p=0.036) pressure before acupuncture in relation to systolic and diastolic blood pressure on the fi rst fi ve measurements before acupuncture. The pressure values after acupuncture did not change signifi cantly during measurements. Heart rate before and after acupuncture did not change the measurements signifi cantly, but was signifi cantly lower after acupuncture on the fi rst eight measurements. This study demonstrated that the fi rst fi ve acupuncture sessions signifi cantly reduced pain intensity and blood pressure, thereafter aintaining the levels of pain intensity and blood pressure achieved (acupuncture sessions 6-10), which were lower compared to the fi rst five measurements (acupuncture sessions 1-5)