Can Acupuncture Have An Impact In Postoperative Pain Management?
Acupuncture is one of the oldest forms of natural medicine. Practitioners have used acupuncture in the treatment and management of numerous disorders including acute pain, chronic pain and musculoskeletal disorders.1
In the surgical setting, researchers have demonstrated that acupuncture decreases preoperative anxiety, intraoperative anesthetic requirements and postoperative pain; reduces postoperative analgesic requirements; decreases postoperative nausea and vomiting; and supports chronic pain management.2 The exact mechanism by which acupuncture provides analgesia remains unclear but the pain-relieving effects of acupuncture theoretically include spinal mechanisms, hormonal effects, peripheral vasodilation and local tissue healing.3,4
Authors have shown acupuncture to be an effective adjunct for the management of postoperative pain. Chen and colleagues found that following total knee arthroplasty, acupuncture decreased the amount of fentanyl required from patient-controlled analgesia, delayed the time to first request for fentanyl, lowered pain intensity on a 100-mm visual analog scale (VAS) and decreased the incidence of analgesia-related adverse effects (including nausea and vomiting).5 Mikashiama and coworkers examined the use of acupuncture during post-acute (more than one week post-op) rehabilitation after total knee arthroplasty and found acupuncture treatment to reduce pain and swelling around the knee significantly in comparison to sham treatment.6
Erden and colleagues found acupuncture to reduce pain scores in patients undergoing laparoscopic cholecystectomy surgery.7 Huang and coworkers found that electrical acupoint stimulation decreased opioid usage, reduced pain scores, shortened extubation time and decreased post-anesthesia care unit stay following thoracic lobectomy.8
In addition to these individual studies, several systemic reviews have evaluated acupuncture as an adjunct to analgesics in postoperative pain management. Sun and colleagues reviewed 15 randomized control trials using acupuncture for postoperative pain management in comparison to sham treatment.9 The authors found acupuncture use significantly reduced opioid consumption, decreased pain on the visual analogue scale (VAS) at both eight and 72 hours postoperatively, and reduced opioid-related side effects including nausea, dizziness, pruritus and urinary retention.9 Cho and colleagues performed a systematic review examining the use of acupuncture for acute postoperative pain following back surgery. Their study showed acupuncture decreased pain after surgery as measured by the VAS score.10
Liu and colleagues performed a systematic review and meta-analysis of RCTs examining the use of acupuncture for postoperative pain control in various surgical procedures including cardiac surgery, Caesarean section and abdominal surgery. The authors found that acupuncture point stimulation significantly improved VAS scores and also reduced total morphine consumption.11
There is currently a lack of data regarding the use of acupuncture for the management of postoperative pain following foot and ankle surgery. However, given the benefits evident in other orthopedic and general surgical procedures, it is highly likely that similar benefits would occur with the use of acupuncture following foot and ankle surgery. Further research is needed to examine the postoperative use of acupuncture following foot and ankle surgery. Additionally, research is needed to develop ideal perioperative protocols to incorporate acupuncture into postoperative treatment regimens.
References
1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-1453.
2. Faircloth A. Acupuncture: history from the yellow emperor to modern anesthesia practice. AANA J. 2015;83(4):289-295.
3. Carlsson C. Acupuncture mechanisms for clinically relevant long-term effects--reconsideration and a hypothesis. Acupunct Med. 2002;20(2-3):82-99.
4. Napadow V, Ahn A, Longhurst J, et al. The status and future of acupuncture mechanism research. J Altern Complement Med. 2008;14(7):861-869.
5. Chen CC, Yang CC, Hu CC, Shih HN, Chang YH, Hsieh PH. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2015;40(1):31-36.
6. Mikashima Y, Takagi T, Tomatsu T, Horikoshi M, Ikari K, Momohara S. Efficacy of acupuncture during post-acute phase of rehabilitation after total knee arthroplasty. J Tradit Chin Med. 2012;32(4):545-548.
7. Erden V, Yildiz AS, Guler C, et al. [Postoperative analgesic effect of acupuncture in laparoscopic cholecystectomy surgery]. Agri. 2015;27(3):155-159.
8. Huang S, Peng W, Tian X, et al. Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage, recovery, complications, and prognosis in video-assisted thoracic surgical lobectomy: a randomized, double-blinded, placebo-controlled trial. J Anesth. 2015; epub Sept. 8.
9. Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth. 2008;101(2):151-160.
10. Cho YH, Kim CK, Heo KH, et al. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2015;15(3):279-291.
11. Aslangul E, M'Bemba J, Caillat-Vigneron N, et al. Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture. Diabetes Care. 2013;36(8):2203-2210.
