The patients were randomly allocated to receive true AA (lung, shenmen, thalamus and hip points) or sham procedure (4 non-acupuncture points on the auricular helix). Permanent press AA needles were retained in situ 3 days after surgery. Postoperative pain was treated with intravenous piritramide (opioid receptor agonist with analgesic potency of 0.7 compared with morphine) using a patient-controlled analgesia (PCA) pump.
Sample Count
54
Control
Sham
sham group(n=30)
Experiment
AA group(n=31)
Indicator
Postoperative piritramide requirementVisual analog scale(VAS)Time to first PCA requestTotal piritramide requirementTotal ibuprofen consumptionIntraoperative fentanyl requirementBody temperatureHeart rate(HR)Blood pressure(BP)White blood cell countErythrocyte sedimentation rateC-reactive protein(CRP)Side effectsPostoperative Nausea and Vomiting(PONV)SedationPruritus
Auxiliary Medication
Thirty minutes before surgery the patients were given oral midazolam 0.05 mg/kg. Anesthesia was induced intravenously with thiopental (4-5 mg/kg) and fentanyl (1-2 ug/kg). Cis-atracurium (0.1 mg/kg) was used to facilitate trachea intubation. Lung ventilation was mechanically controlled to keep endtidal carbon dioxide at 4.5–5.3kPa throughout the surgery. Anesthesia was maintained with isoflurane (0.8–1.0 vol% end-tidal concen- tration) in a 40% oxygen–air mixture. The fentanyl was titrated to prevent spontaneous movements during surgery and to ensure that the heart rate and mean arterial pressure were within 20% of baseline values. After surgery the patients were transferred to the anesthesia recovery room until they complained of pain. After the first request for pain medication the patients received the initial bolus of piritramide (opioid receptor agonist with analgesic potency of 0.7 compared with morphine) of 0.05mg/kg and the PCA pump with piritramide was connected to the patient. The ‘Vygon’ PCA-pumpw (Laboratories Pharmaceutiques Vygon, France) was set to deliver 2 mg piritramide with a 5-min lock-out period. If the patients still complained of pain on the first postoperative day with pain intensity >40 mm, additional doses of intravenous piritramide (3–5 mg) were administered by the orthopedic surgeon in-charge and registered at the study protocol. The PCA pump was left connected to the patient until the evening of the third postoperative day. PCA analgesia was discontinued on the second or third postoperative day if the patient reported pain intensity !40 mm (VAS-100) after a 3-h period without analgesic demand. If the patients complained of pain O40 mm (VAS-100) on the second postoperative day (36h after surgical procedure), oral analgesia was administered (ibuprofen 400–800 mg twice a day) and was also recorded.
Stimulation Method
MS
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
-
-
-
-
-
The needles were inserted the evening before surgery, fixed with the flesh-colored adhesive tape and retained in situ during the 3 days after surgery. The stimulation was manually performed for 5 min by massage of the AA needles before the trachea intubation, during the most painful phase of surgery and before the extubation.
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
0.22×1.5 mm
Helio Medical Supplies, USA
-
Description Disposable permanent press steel 'Carbo' AA needles from Helio Medical Supplies, USA, had the diameter of 0.22 mm and the length of 1.5 mm. The needles were inserted the evening before surgery, fixed with the flesh-colored adhesive tape and retained in situ during the 3 days after surgery. The stimulation was manually performed for 5 min by massage of the AA needles before the trachea intubation, during the most painful phase of surgery and before the extubation.
Anesthesia Method
AAA
Clinical Trial Type
randomly
Adverse Effects
Three patients (2 controls and 1 from AA group) complained of local pain at the AA needles insertion sites. One patient from the control group who refused to participate further in the study was excluded from the final assessment (Fig. 1). Minor auricular hemorrhages occurred at the insertion sites of AA needles in 2 patients. In both cases the acupuncture needles were withdrawn on the second postoperative day and the site of hemorrhage appropriately treated without further complications. One patient from the AA group reported a headache ipsilateral to acupuncture site the morning prior to surgery. After the surgical procedure the headache disap_x005fpeared and postoperative AA treatment was completed. Two patients from the AA group reported increased pain at the site of surgery after the withdrawal of acupuncture needles on the third postoperative day.
Contraindications
The patients were not included if they: (1) had a history of opioid medication, (2) were unable to understand the consent form or how to use a PCA device and a visual analogue scale (VAS) for pain measurement, (3) had a history of alcohol abuse and/or psychiatric disease, (4) revealed extreme obesity (body mass indexO40), (5) had local or systemic infection, (6) or if they had prosthetic or damaged cardiac valves. Patients were excluded from the study: (1) when surgery time exceeded 200 min or intraoperative compli_x005fcations (intraoperative bleeding requiring blood transfusion of more than 4 units of packed red blood cells or cardiovascular instability requiring catecholamines) occured, (2) when there was a necessity to change perioperative treatment scheme, (3) or in the cases of auricular perichondritis or severe intercurrent disease
Effector
Piritramide requirement during 36 h after surgery in AA group was lower than in control: 37±18 vs. 54±21 mg; mean±SD; P=0.004. Pain intensity on VAS-100 and incidence of analgesia-related side effects were similar in both groups. The differences between the groups as regard patients' opinions concerning success of blinding were not significant. Findings from our study demonstrate that AA could be used to reduce postoperative analgesic requirement.
Auricular acupuncture for pain relief after total hip arthroplasty - a randomized controlled study.
Abstract
Auricular acupuncture (AA) is known to be effective in treatment of various pain conditions, but still there have been no randomized controlled studies of AA for treatment of acute postoperative pain. Therefore we tested whether AA of specific points is superior to sham acupuncture for complementary analgesia after total hip arthroplasty in a patient-anesthesiologist-evaluator-analyst blinded study. The patients were randomly allocated to receive true AA (lung, shenmen, thalamus and hip points) or sham procedure (4 non-acupuncture points on the auricular helix). Permanent press AA needles were retained in situ 3 days after surgery. Postoperative pain was treated with intravenous piritramide (opioid receptor agonist with analgesic potency of 0.7 compared with morphine) using a patient-controlled analgesia (PCA) pump. The time to the first analgesic request, the amount of postoperative piritramide via PCA and pain intensity on a 100-mm visual analogue scale (VAS-100) were used to evaluate postoperative analgesia. Intraoperative anesthetic requirement, incidence of analgesia-related side effects, inflammation parameters and success of patients' blinding were also recorded. Fifty-four patients (29 AA and 25 controls) completed the study. Piritramide requirement during 36 h after surgery in AA group was lower than in control: 37+/-18 vs. 54+/-21 mg; mean+/-SD; P=0.004. Pain intensity on VAS-100 and incidence of analgesia-related side effects were similar in both groups. The differences between the groups as regard patients' opinions concerning success of blinding were not significant. Findings from our study demonstrate that AA could be used to reduce postoperative analgesic requirement."
