On 20th. Nov’11, an 11-month child presented with huge Abscess on the left post auricular area occupying the complete length of neck. In fact, the whole neck got buried in the abscess. Immediate Incision and drainage were needed under general anesthesia.But the main issue was that:The child was suffering from a runny nose, the common cold making him unfit for general anesthesia. The position of Abscess was such that it had to be operated in the prone position which made general anesthesia more difficult.Leech application in various surgico medical diseases has been reported from time to time from various researchers from all corners of the world. Leech Application to host for approximately 30 to 45 minutes and it’s almost painless. There must be something which makes leech bite site anaesthetise. This fact can be used for small and superficial surgical procedures so we decided to check this fact on Abscess.IntroductionLeech application in various surgico medical diseases has been reported from time to time from various researchers from all corners of the world. Leech Application to host for approximately 30 to 45 minutes and it’s almost painless. There must be something which makes leech bite site anaesthetise. This fact can be used for small and superficial surgical procedures so we decided to check this fact on Abscess.Aims To demonstrate Anaesthetic activity of Leech applicationObjectiveTo demonstrate management of Bahya Vidradhi ( Abscess) by Ayurvedicprocedure Bhedan karma.Methods And materialsLeech Application was carried out on Abscess which was Located on postero lateral aspect of Neck of 6 month yr old child who was Unfit for general anaesthesia. Bhedan Karma At the site of leech application subsequentVrankarma Hiruda Manillensis Aka Buffalo Leech was used For leech application.विद्रधी त्िग्रक्तम ांसमेद ांवस प्रदुष्य स्थी सम वित ाः दोषाः।। दोषाः शोफां शनै घोरां जनयत्युच्र्छीताःभृशां ।। मह मुलां रूज िांतां िृत्तां च प्यांथि आयतम् तम हू विद्रधीं वधर ।।
Classical textbook of Surgery love and belly quotes……
Wherever there is pus…. Let it out first i.e. Incision And drainage
Ayurveda Says the same thing Bhedan karma .
यतो यतो गवतम् विद्य त उत्सांगो यत्र यत्र च। तत्र तत्र व्रणां कुय ात यथ दोषो न वतष्ठवत।। सुिुत सांवहत विद्रधी सिामेि म्शोफित समुप चरेत प्रततां च हरेत् रक्तां पक्वे तु शोफित क्रिय ां।।
Previous studies and experience in treating painful conditions like Herpes Zoster, Thrombosed Piles gave us insight to use leech as an anaesthetist Searching Modern literature it was Found that Leech Saliva contains Some anaesthetic substance similar to lidocaine. So it was decided to use leech as Anaesthetist for Bhedan Karma on Vidradhi (Abscess). During the whole procedure the child remained calm in the mother’s womb and was receiving feed (the most secure feeling position for a child). After leech application artery forceps was introduced through wound of leech bite which was anaesthetised by leech, removing all the pus by breaking all the pus pockets, and after procedure pt was sent home with oral antibiotics and analgesics with advice follow up daily for dressing. In the next 8 days i.e. on 28 the Nov 2018 abscess and the bhedan karma wound was completely healed. If Child would have been given modern General Anaesthesia in this case the expenditure of that poor family would be many fold hospital stay would have been a minimum 2 to 3 days.
Child would Have been receiving so many injectable drugs and Risk factor Risk of endangering the life of a kid would have been many fold.
Please see the case in the subsequent photographs.
Discussion:
In Ayurveda it has been stated that leech Sucks vitiated Blood and that’s why
the patient gets relief . But According to Modern Science this is partly true only. In fact while biting leech secrets its saliva into the host and this Saliva contains different enzymes. Due to the effect of these enzymes results are seen.
Hirudin- Inhibits blood Coagulation by binding to Thrombin
Caline – Inhibits blood coagulation Von Willebrand factor to collagen inhibites collagen mediated platelet aggregation.
Destabilise: Dissolves Fibrine Thrombolytic effects
Hirustasin: Inhibits Kallikren, Trypsin, Chymotrypsin, Neutropholic cathepsin G
Bleddines: Anti inflammatory inhibits Trypsin, Plasmin and Acrocin 6
Hyaluronidase Spreding Factor: Increases interstitial Viscosity ,
Antibiotic.
Leech Derived Tryptase inhibitor – Tryptase inhibitor Inhibits
photolytic enzymes of host mast cells
Eglins: Anti inflammatory, inhibits the activity of alpha chymotrypsin
Factor Xa Inhibitor: Inhibits the activity of Coagulation Factyor Xa
Carboxypeptidase: Increases the inflow of blood at the bite site suspected Saliva Components
Histamine Like Substances: Vasodilators; Increases the inflow of blood at the bite site
Acetylcholine: Vasodilator Anesthetic Substance: Anesthesia
From the above table it is very clear that leech saliva is very beneficial in treating abscess in many ways.
Antibiotic effect
Anti inflammatory, analgesic effect
Vasodilator increases blood flow towards Abscess
Hyaluronidase reduces edema surrounding the Abscess
Anesthesia at the bite site
The mouth of the medicinal leech is located in anterior Sucker just within the oral cavity there are three jaws in the shape of Mercedes Benz Symbol. Each Jaw contains around 60 to 100 teeth in between these teeths. There are interdental pores in which discrete scattered salivary glandular cells pour their secretion.
The leech secretes Saliva into the wound through the interdental pores while sawing its teeths deeper and deeper into the skin this sawing-like action of teeth has its advantage, it requires less force and secondly patient perceives less discomfort and less likely to notice the bite.
There may also contain a substance with anesthetic properties that enhance this painless bite (Incision). Mechanically speaking, the anatomical structure works extremely efficiently. Micropipettes that injects pharmaceutically active substances into the wound. No other microsurgical tool can perform such complex functions with such high precision.
Conclusion:
Leech can be very well used for anesthesia purpose for small superficial conditions like Incision and drainage of abscess.
It is simple affordable and easy way of giving anesthesia It can be used where other forms of anesthesia are contraindicated
With this leech anesthesia Hospital stay is less patients can be treated on Opd basis and can be discharged after a few hours after procedure. Leech therapy is very effective in managing Vidradhi (Abscess) Principles of management of Abscess and Vidradhi are both Allopathic and Ayurved System are similar and effective
References:
1 Baskova IP et al. Zavalova LL Protinase inhibitors from the
medicinal leech, hirudo Medicinalis Biochemistry 2001:66: 703- 714
2. Harsfalvi J et al. calin from Hirudo Medicinalis an inhibitor of Von villerband factor binding to collagen under static and collagen conditions Blood 1995; 85 :705–7113
3. Baskova IP et al.Protine profiling of medicinal leech Salivary gland secretion by Proteomic Analytical methods. Biochemistry (Moscow) 2004;
4. Elliot EJ. Morphology Of Chemosensory organs Journal of Morphology 1987;192; 181- 187
5. Keim A. Sudy on the host speciality of the medicinal blood leech Hirudo medicinalis L. Parasitol.Res.1993; 79:225 – 232.
6. Shastri Ambikadatta, Sushrutsamhita, sutrasthan,Chaukhamba Surbharati
Prakashan, Varanasi , reprint 2017 , chapter 13; 43-46
7. Shastri Ambikadatta, Sushrutsamhita, sutrasthan, Chaukhamba Surbharati
Prakashan, Varanasi, reprint 2017 , chapter 25;104 – 105
8. Shastri Ambikadatta, Sushrutsamhita, Chikitsasthan, Chaukhamba Surbharati Prakashan, Varanasi.
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