Intraoperative Acupuncture as Part of a Multimodal Analgesic Regimen to Reduce Opioid Usage After Total Knee Arthroplasty: A Prospective Cohort Trial

Stephanie I Cheng, Deirdre C Kelleher, Danya DeMeo, Haoyan Zhong, George Birch, Michael P Ast, Stephanie I Cheng, Deirdre C Kelleher, Danya DeMeo, Haoyan Zhong, George Birch, Michael P Ast

Abstract

Objective: Given the U.S. opioid crisis, surgeons and anesthesiologists must collaborate to optimize nonopioid analgesics perioperatively. A common surgical procedure, total knee arthroplasty (TKA) is a critical target for opioid reduction and development of enhanced recovery protocols. Auricular therapy can help reduce pain and opioid analgesic use in the perioperative timeperiod, but intraoperative use for TKA has yet to be explored. The aim of the present study was to investigate the effect of integrating intraoperative auricular therapy as part of an opioid-sparing protocol for TKA. Materials and Methods: In this prospective cohort study, 41 patients undergoing primary unilateral TKA under neuraxial anesthesia received a standardized, opioid-free intraoperative protocol including electroauricular acupuncture. The primary outcome was the number of patients able to remain on a low-dose opioid regimen: ≤112.5 oral morphine equivalents. Additional outcomes included patient-reported pain scores, side-effects, and prior experience with acupuncture. Results: Of the 40 patients who completed the study, 26 (65%) maintained a low-dose opioid regimen, with 3 (7%) remaining opioid-free for 30 days. No subjects used opioids beyond 30 days. Mean pain scores were low at rest (Day 0: 3.4, standard deviation [SD] 2.4; Day 1: 2.4, SD 1.8) and moderate with movement (Day 0: 4.8, SD 2.6; Day 1: 5.1, SD 2.1). The most-common side-effects were dry mouth (43.2%), drowsiness (24.3%), and lightheadedness (24.3%). Conclusions: Incorporating intraoperative electroauricular acupuncture into an existing multimodal analgesia regimen is a feasible way to maintain a low-dose opioid regimen after TKA. This research was registered at clinicaltrials.gov as Clinical Trial Number: NCT#04084288.

Keywords: acupuncture; enhanced recovery; multimodal pain management; total knee arthroplasty.

Conflict of interest statement

No competing financial interests exist.

Copyright 2022, Mary Ann Liebert, Inc., publishers.

Figures

FIG. 1.
FIG. 1.
Model ear with Enhanced Electro-Auricular Trauma Protocol (ATP; ITO® PHYSIOTHERAPY&REHABILITATION) in situ.
FIG. 2.
FIG. 2.
STROBE [Strengthening The Reporting of Observational Studies in Epidemiology] flow diagram of enrollment and analysis.
FIG. 3.
FIG. 3.
Timeline of number of patients taking opioids by postoperative day (POD).
FIG. 4.
FIG. 4.
Total oxycodone consumption from induction to postoperative day (POD) 30. One 5-mg oxycodone pill is equivalent to 7.5 oral morphine equivalents.

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