SAN FRANCISCO, California—Acupuncture should be considered an option for postop pain control, Duke University researchers reported at the annual scientific conference of the American Society for Anesthesiology in San Francisco.¹

"Acupuncture and related techniques are an effective adjunct for postoperative pain management as demonstrated by a significant reduction in postoperative pain scores and opioid consumption," said lead study author Tong Joo Gan, MD, professor and vice chairman of clinical research in the department of anesthesiology at Duke University Medical Center in Durham, North Carolina.

The researchers reviewed 15 randomized controlled trials that looked at the effects of acupuncture on postop pain in several different types of surgeries including orthopaedic surgeries, abdominal surgeries, and hysterectomies.

More needles, fewer drugs

Patients who received acupuncture needed fewer opioids than their counterparts who did not receive acupuncture at 8, 24, and 72 hours after surgery. Specifically, the weighted mean difference (WMD) of postop opioid analgesic consumption in morphine equivalent for acupuncture versus control was -2.37 mg at 8 hours, -8.16 mg at 24 hours, and -7.74 mg at 72 hours. The WMD visual analog pain score was also significantly decreased in the acupuncture treatment group at 8 hours (-14.57 mm) and 72 hours (-9.75 mm) compared with the control group.

Patients who received acupuncture had a lower incidence of opioid-related side effects than their counterparts who did not receive acupuncture. Patients who received acupuncture had lower rates of nausea (RR: 0.68), severe itching (RR: 0.75), dizziness (RR: 0.62), and urinary retention (RR: 0.29) than did patients who did not undergo acupuncture before or during surgery.

"Acupuncture can potentially reduce opioid use and side effects and a lot of our patients want to avoid opioids," Dr. Gan told CIAOMed.

Coming soon to an OR near you?

"People get the false notion that you need to be fully trained with acupuncture to use acupuncture points, but it's easy to learn and you only need to know a handful of points to prevent postop nausea and pain," Dr. Gan commented. He recently completed a 2-year class in traditional Chinese medicine that included instruction in acupuncture.

"Acupuncture has a role to play in managing postop pain and reducing the amount of opioids that the patient needs," he continued. "Surgeons should talk to their anesthesiologists about simple acupuncture as some anesthesiologists may have knowledge or they may work in a facility where there are some acupuncturists on staff."

Tim Rhudy, an acupuncturist at the Cleveland Clinic in Ohio, agreed. "It might be a good idea for operating room/recovery room personnel to receive minimal ‘ear acupuncture' training; they can perform it on the patients in the recovery room as part of their normal duties without having to have a fully trained acupuncturist there," he said.

Another idea? "One might have an acupuncturist [on call] in the recovery rooms to attend to patients as they are coming out of surgery and out of anesthesia," Rhudy suggested. "If this practice were to catch on at Duke with favorable results and without raising too many eyebrows, then I expect it could catch on at many more hospitals."

Acupuncture benefits arthroplasty patients awaiting surgery

Related research showed that acupuncture can offer relief to acute knee pain patients awaiting arthroplasty. These findings appeared in the September issue of Rheumatology.²

In the study of 181 patients awaiting knee arthroplasty for severe knee osteoarthritis (OA) pain, those patients who underwent 6 weeks of acupuncture experienced a 10% drop in pain on the Oxford Knee Scores after 7 weeks compared with controls. These benefits disappeared after 3 months.

"We have demonstrated that patients with severe knee osteoarthritis can achieve a short-term reduction in Oxford Knee Scores when treated with acupuncture," the authors write.

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