The effect of pre‐emptive acupuncture treatment on analgesic requirements after day‐case knee arthroscopy

Abstract

SummaryThe role of acupuncture analgesia in the management of postoperative pain is yet to be clearly evaluated. We conducted a prospective, double-blind, randomised controlled study to evaluate the effect of acupuncture pretreatment on the analgesic requirement after knee arthroscopy. Forty-two patients presenting for unilateral knee arthroscopy were randomly allocated to receive a standard anaesthetic with or without acupuncture (given after the induction of anaesthesia). Visual analogue pain scores, time to first postoperative analgesia and total analgesia requirement in the first 24 h were recorded. There was no significant difference between the two groups in any of the outcome measures. We conclude that acupuncture analgesia has no additional effect when given under anaesthesia to patients undergoing knee arthroscopy. There has been much interest in acupuncture as a method of analgesia in the West over recent years [1]. Various explanations have been forthcoming regarding the mechanisms by which it may work. The activation of central inhibitory mechanisms has been emphasised [2, 3]. Brief periods of activity in nociceptive afferents from deep tissues, produced for example by surgery, induce excitability changes in central neurones [4]. In an editorial based on these and other results, Wall [5] stressed the importance of pre-and intra-operative measures in trying to reduce or inhibit the development of this hyperexcitablity (e.g. pre-emptive analgesia) which might result in reduced postoperative pain.If acupuncture acts by reducing central hyperexcitability (possibly by the central release of endorphins) then it could be an effective method of pre-emptive analgesia. This project was a prospective, double-blind, randomised controlled study to determine whether acupuncture given after induction of anaesthesia, but before surgical stimulus, has any additional effect over standard analgesia. Methods

Postoperative Analgesia after Low-Frequency Electroacupuncture as Adjunctive Treatment in Inguinal Hernia Surgery with Abdominal Wall Mesh Reconstruction

“…There were no significant differences between the acupuncture and control groups. 30 The lack of significant difference between groups I and II (the two timings of EA) suggests that the use of intraoperative EA adds nothing to the perioperative stimulation, confirming the findings of others that acupuncture is ineffective if given during anaesthesia.…”

Acupuncture fails to reduce but increases anaesthetic gas required to prevent movement in response to surgical incision

“…To our knowledge five prospective, controlled studies on acupuncture for postoperative pain relief are reported in such detail that reproduction would be possible (1)(2)(3)(4)(5). An analgesic effect of acupuncture was found in three of these studies (1, 2, 5) but not in the other two (3,4).…”

“…To our knowledge five prospective, controlled studies on acupuncture for postoperative pain relief are reported in such detail that reproduction would be possible (1)(2)(3)(4)(5). An analgesic effect of acupuncture was found in three of these studies (1,2,5) but not in the other two (3,4). However, the design of one study (1) reporting reduced use of analgesics in acupuncture patients during only the first two postoperative hours is dubious, since the control patients seem to have had an approximately half-hour shorter period of anaesthesia than the acupuncture patients.…”

“…# Acta Anaesthesiologica Scandinavica 47 (2003) R EPORTS have differed as to the clinical value of acupuncture, since the method was introduced as an anaesthetic technique in China in 1958 (1)(2)(3)(4)(5). One factor contributing to difficulties associated with clinical studies on acupuncture is the technical problem regarding blinding (6).…”

Acupuncture in Stroke Rehabilitation

“…10;11 In knee arthroscopy acupuncture could not reduce postoperative pain. 12 In contrast recent studies showed decrease of postoperative opioid consumption by TENS or intradermal needles. 13;14 Postoperative Nausea and Vomiting (PONV) Most randomised controlled trials (RCT) of acupuncture for the prevention of PONV exist for stimulation of PC6.…”