Having acupuncture before surgery can mean significantly less pain and need for opioid pain medication after surgery, according to results of a randomized controlled study of veterans. "Six percent of patients given opioids after surgery become dependent on them, and veterans are twice as likely to die from accidental overdoses than civilians," lead author Dr. Brinda Krish, anesthesiology resident at Detroit Medical Center, in Michigan, said in a statement. "Clearly it is crucial to have multiple options for treating pain, and acupuncture is an excellent alternative. It is safe, cost effective and it works." Dr. Krish presented the study Oct. 5 during Anesthesiology 2020, the virtual annual meeting of the American Society of Anesthesiologists. The study included two groups of largely male veterans in their mid-60s undergoing surgery at Detroit's John D. Dingell VA Medical Center. The first group included 42 patients undergoing total hip arthroplasty; half received traditional acupuncture (TA) 30 minutes before surgery and half received sham acupuncture (control group). TA involves the insertion of very thin needles at specific trigger points around the body to relieve pain. Those who received TA needed significantly less opioid medication in the first 24 hours after surgery than those who received sham acupuncture (average morphine milligram equivalent 20.4 mg vs. 56.0 MME; P<0.0001), Dr. Krish reported. Pain scores on a visual analog scale (VAS) were also significantly reduced in the TA group (P<0.001) at six, 12, 18, and 24 hours, and TA patients were more satisfied with their postoperative pain management. No patient in the TA group had postoperative anxiety compared to five patients (14%) in the sham group, a difference that was not statistically significant. There were also no significant differences between the two groups in the incidence of postoperative nausea and vomiting or time spent in the hospital. The second group included 64 veterans undergoing a variety of surgeries including gallbladder removal, hernia repair, hysterectomy, and prostate surgery; 28 were randomly allocated to receive battlefield acupuncture (BFA) and 36 to sham BFA 30 minutes before surgery. Developed by a US Air Force physician to ease pain without opioids on the frontlines, BFA uses tiny needles that are inserted at various trigger points in the ear. Similar to what was seen with TA, BFA was associated with significantly less opioid use in the first 24 hours after surgery (17.4 vs 35.0 MME), significantly lower pain scores and higher patient satisfaction, compared with the sham group. Postoperative nausea and vomiting was also less likely in the BFA group, which makes sense, the study team says, as some of the acupuncture points in the ear are located near trigger points for the stomach, gall bladder, and small intestines. "From the battlefield-acupuncture standpoint, there are a few studies mainly done by the military showing successful treatment of acute pain in headache and traumatic-brain-injury patients," Dr. Krish told Reuters Health by phone. "But in terms of preoperative use of battlefield acupuncture in the surgical pain relief arena, there really has been no study of this, so this is really a quite novel study in the sense that we are using pre-op administration of battlefield acupuncture and the benefits shown for post-op pain control are quite novel." The acupuncture was provided by the study's principal investigator, anesthesiologist Dr. Padmavathi Patel of John D. Dingell VA Medical Center, who plans to use BFA as an additional therapy for pain management for all patients receiving general anesthesia. "Based on these good study results, I'm offering it to everybody for your pain control and to decrease narcotic use and nausea and vomiting after surgery. In the VA system, I don't need to take even a written consent, I can take just a verbal consent if the patient is willing to have it and I can just do it," she told Reuters Health by phone. The study had no commercial funding and the authors have disclosed on conflicts of interest. —Megan Brooks Source
