Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy-A Pilot Study

Taras I Usichenko, Maria Hermsen, Torsten Witstruck, Andre Hofer, Dragan Pavlovic, Christian Lehmann, Frank Feyerherd, Taras I Usichenko, Maria Hermsen, Torsten Witstruck, Andre Hofer, Dragan Pavlovic, Christian Lehmann, Frank Feyerherd

Abstract

Auricular acupuncture (AA) is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points) or sham procedure (three non-acupuncture points on the auricular helix) before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

Figures

Figure 1
Figure 1
Flow diagram showing specific and sham auricular acupuncture points (non-acupuncture points of the helix) used in the study.
Figure 2
Figure 2
Post-operative ibuprofen requirement between surgery and the follow-up examination the next morning, as a box plot. The thick horizontal lines are median values. The outlier represents the patient from the control group who required only 400 mg ibuprofen. *P = 0.043.
Figure 3
Figure 3
Pain intensity on a visual analogue scale (VAS-100) measured before and after surgery, on discharge from the anesthesia recovery room and during the follow-up examination the next morning. Hatched bars: patients who received true auricular acupuncture; empty bars: control group with sham acupuncture as mean ± standard deviation. The differences are not significant.

References

    1. McHugh GA, Thoms GM. The management of pain following day-case surgery. Anaesthesia. 2002;57:270–5.
    1. Shang AB, Gan TJ. Optimising postoperative pain management in the ambulatory patient. Drugs. 2003;63:855–67.
    1. Simmons M, Oleson T. Auricular electrical stimulation and dental pain threshold. Anesth Prog. 1993;40:14–9.
    1. Vorobiev VV, Dymnikov AA. The effectiveness of auricular microneedle acupuncture at the early postoperative period under conditions of the day surgical department. Vestn Khir im II Grek. 2000;159:48–50.
    1. Usichenko TI, Dinse M, Hermsen M, Witstruck T, Pavlovic D, Lehmann C. Auricular acupuncture for pain relief after total hip arthroplasty—a randomized controlled study. Pain. 2005;114:320–7.
    1. Csongradi JJ, Goodman SB, Mihm FG. Surgery of the lower extremities. In: Jaffe RA, Samuels SI, editors. Anesthesiologist's Manual of Surgical Procedures. Philadelphia, PA: Lippincott Williams & Wilkins; 1999. pp. 757–758.
    1. Usichenko TI, Lysenjuk VP, Groth M, Pavlovic D. Detection of ear acupuncture points by measuring the electrical skin resistance in patients before, during and after orthopedic surgery performed under general anesthesia. Acupunct Electrother Res. 2003;28:167–73.
    1. Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth. 1995;7:500–6.
    1. McQuay HJ, Moore RA. Methods of therapeutic trials. In: Wall PD, Melzack R, editors. Textbook of Pain. Edinburgh: Churchill Livingstone; 1999. pp. 1125–38.
    1. Walker JS, Carmody JJ. Experimental pain in healthy human subjects: gender differences in nociception and in response to ibuprofen. Anesth Analg. 1998;86:1257–62.
    1. Taenzer AH, Clark C, Curry CS. Gender affects report of pain and function after arthroscopic anterior cruciate ligament reconstruction. Anesthesiology. 2000;93:670–5.
    1. Peuker ET, Filler TJ. The nerve supply of the human auricle. Clin Anat. 2002;15:35–7.
    1. MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R. Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. Complement Ther Med. 2001;9:246–9.
    1. Moher D, Schulz KF, Altman DG CONSORT GROUP (Consolidated Standards of Reporting Trials) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med. 2001;134:657–62.
    1. Patel M, Gutzwiller F, Paccaud F, Marazzi A. A meta-analysis of acupuncture for chronic pain. Int J Epidemiol. 1989;18:900–6.
    1. Le Bars D, Dickenson AH, Besson JM. Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain. 1979;6:283–304.
    1. Lewith GT, Machin D. On the evaluation of the clinical effects of acupuncture. Pain. 1983;16:111–27.
    1. Sebel PS, Lang E, Rampil IJ, White PF, Cork R, Jopling M, et al. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg. 1997;84:891–9.
    1. Doufas AG. Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2003;17:535–49.
    1. Ma SX. Neurobiology of acupuncture: toward CAM. Evid Based Complement Alternat Med. 2004;1:41–7.
    1. Usichenko TI, Ma SX. Basic science meets clinical research: 10th North American Symposium on Acupuncture. Evid Based Complement Alternat Med. 2004;1:343–4.

Source: PubMed

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