As the opioid crisis rages on, surgeons have been looking for ways to lessen reliance on highly addictive drugs for pain relief during routine surgeries.
A new study suggests that giving patients acupuncture during total joint replacement procedures reduces their pain, resulting in the need for fewer opioids for postoperative pain.
The researchers found that 65% of the patients in the study who received acupuncture during total knee replacement surgery only needed a low dose of opioids – 15 oxycodone tablets or less – for postoperative pain or not at all. In comparison, this was true for only 9% of the knee replacement patients outside the study.
The use of opioids for pain management during and after surgery is a known contributor to opioid dependence and fatal overdoses. The United States Centers for Disease Control and Prevention reported a record 93,000 overdose deaths last year, a 29% increase from the record number of deaths in 2019. Opioid overdose deaths are increased from 50,963 in 2019 to 69,710 in 2020.
Philadelphia recorded 1,214 overdose deaths in 2020, according to the Department of Public Health. That total, the second highest in city history, was a 6% increase from 2019. Of the deaths, 86% involved an opioid such as heroin, oxycodone or fentanyl.
âTotal knee replacements are one of the most common surgical procedures in the United States and are often very painful. Hospital for Special Surgery and Professor of Clinical Anesthesiology at Weill Cornell Medicine.
“Acupuncture is extremely safe and can help reduce pain with few unwanted side effects, but it has not been well studied in surgical anesthesia.”
Acupuncture is a type of traditional Chinese medicine used for pain management and treatment of various chronic health conditions in the United States. However, whether it also has a role to play in the operating room, has not been well defined.
Acupuncture involves the insertion of fine needles into the skin as specific points on the body. It is believed to relieve pain and enhance the healing process by releasing endorphins, the body’s natural pain reliever, and affecting serotonin levels in the brain.
It is most often used to treat musculoskeletal pain such as neck and back pain, as well as nausea, migraines, anxiety, depression, high blood pressure, allergies, female infertility , fibromyalgia and osteoarthritis. Studies have shown that serious side effects from acupuncture are very rare.
Only a few studies have explored its potential ability to reduce opioid use during and after surgery.
A 2016 study found that surgical patients treated with acupuncture had less pain and used less opioids on the first day after surgery. A 2020 study of veterans undergoing hip replacement surgeries found similar results. Veterans who received traditional acupuncture during their procedures reported less pain and less anxiety.
This latest study included 41 patients who underwent total knee replacement surgery at the New York Special Surgery Hospital. All received the standard hospital opioid-sparing analgesic protocol plus electroacupuncture. The patients were given small electrical currents through thin needles inserted at known acupuncture points on the body.
Cheng, who is board certified in medical acupuncture, applied the needles to eight specific points in the ear to relieve targeted pain in the knee.
Reducing opioid use during surgeries is key to reducing the risk of long-term opioid use in patients, she explained.
âOur study shows that if a qualified medical acupuncturist is available to perform acupuncture in the operating room, it can help patients recover from postoperative pain,â Cheng said. “Most studies fail to incorporate non-traditional techniques, such as acupuncture, to help reduce reliance on opioid drugs for postoperative pain control.”
The study was presented at the ANESTHESIOLOGY 2021 annual meeting.
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