• Posted October 12, 2021

Acupuncture During a Knee Replacement Could Lessen Post-Surgical Pain

After knee replacement surgery, many patients experience a level of pain that has them reaching for prescription opioid painkillers. Now new research suggests that using acupuncture during the operation may help reduce that pain without raising the risk of addiction.

"The opioid epidemic has been in the news and on our minds for years and has created an urgency for us to seek alternatives to postoperative pain, and acupuncture can be an attractive option," said study author Dr. Stephanie Cheng. She is an assistant attending anesthesiologist at the Hospital for Special Surgery and an assistant professor of clinical anesthesiology at Weill Cornell Medicine, both in New York City.

Acupuncture may ease pain by stimulating the release of the body's endorphins or feel-good chemicals, Cheng explained.

For the study, 41 people underwent knee replacement surgery using standard anesthesia protocol plus electroacupuncture, which involves applying a small electric current to thin needles that are inserted at known acupuncture points in the ear during surgery.

In addition to reporting less pain, 65% of people who received acupuncture during their knee surgery took a low-dose opioid regimen of 15 pills or less or remained completely opioid-free for 30 days after their surgery. By contrast, just 9% of people who undergo knee replacement typically report such low usage.

Now, Cheng and her colleagues at looking at acupuncture during other types of joint replacement surgeries.

"Patients are all interested when asked if they want to try acupuncture to help with pain," Cheng said. "Ask your surgeon if he or she works with a trained medical acupuncturist."

The findings were presented Sunday at the annual meeting of the American Society of Anesthesiologists. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

The findings are welcome news, outside experts say.

It's time to think outside of the box when it comes to pain relief following surgery, said Dr. Nicolas Piuzzi, director of adult reconstructive surgery research in the Department of Orthopedic Surgery at the Cleveland Clinic. "We have major health problems with opioid abuse and misuse, so anything we can do to mitigate this problem is welcome," he said.

Still, more studies are needed before acupuncture during surgery becomes a standard of care, noted Piuzzi. "We would have to really assess the added value of acupuncture based on time, cost and resources, compared to other approaches that have decreased our use of opioids," he explained.

Today, most people receive two or more types of anesthesia during joint replacement surgery, such as a spinal block with local nerve blocks that target specific areas, Piuzzi said. "With current methods, most of the time people go home the first day after surgery, and pain is pretty tolerable," he said.

Others may not be so lucky and need pain relief after surgery. "Opioids are great pain relievers and have a role to play when taken for the appropriate amount of time and in the appropriate amount," Piuzzi said.

More and more medical and surgical centers have relationships with licensed acupuncturists, said Chris D'Adamo, director of research for the Center for Integrative Medicine at the University of Maryland School of Medicine.

"If we have something like this with no side effects, many would be open to it, especially since we have witnessed the problem of opioid addiction subsequent to surgical procedures," D'Adamo said.

More information

The U.S. National Center for Complementary and Integrative Health offers more on acupuncture and its potential benefits.

SOURCES: Stephanie Cheng, MD, assistant attending anesthesiologist, Hospital for Special Surgery, and assistant professor, clinical anesthesiology, Weill Cornell Medicine, New York City; Nicolas Piuzzi, MD, director, adult reconstructive surgery research, Department of Orthopedic Surgery, Cleveland Clinic, Ohio; Chris D'Adamo, PhD, director, research, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore; American Society of Anesthesiologists annual meeting, presentation, Oct. 10, 2021