Acupuncture techniques have been in existence for centuries, with roots tied to Eastern Asian medicine. Ease of application, low cost, and minimal side effects make traditional acupuncture a perioperative modality that has been linked to decreased morbidity and mortality in patients undergoing surgical procedures and anesthesia (1). In the United States, in light of the opioid epidemic, there is a strong need to decrease perioperative opioid use.
Opioid use due to postoperative pain along with perioperative anxiety has been linked to increased length of hospital stay, increased morbidity and mortality, and ultimately higher healthcare costs. This study investigated the use of two different acupuncture techniques: the auricular acupuncture technique of Battlefield Acupuncture (BFA) and the Traditional acupuncture (TA) technique.
The objectives/hypothesis of this study is that BFA and TA used for general and neuraxial anesthesia procedures will decrease opioid requirements, postoperative pain, the incidence of post-operative nausea and vomiting (PONV), and the incidence of perioperative anxiety in comparison to control patients given sham acupuncture.Methods: This study was IRB and VA approved. Upon consent patients in the TA arm of the study undergoing total hip arthroplasty were randomly assigned to receive TA (n=21) at hip points Spleen 11, Liver 10, Liver 11, Gallbladder 30, Gallbladder 32 or controls given sham acupuncture (n=21). The BFA study arm had all patients undergoing general surgery procedures and were randomly assigned to receive BFA (n=28) needles placed according to 5 VA approved BFA auricular acupuncture points associated with PONV, pain, and anxiety respectively. BFA controls were given auricular sham acupuncture (n=36). I
nclusion criteria for patients were ages 18-100, ASA 1 to 4. Measured variables included opioid requirements, postoperative pain, the incidence of PONV, and patient satisfaction scores. Statistical analyses included Student’s t-test (unpaired), repeated measures ANOVA and Chi-Squared tests for categorical variables. Statistical significance was defined as p<0.05.Results: TA patients consumed a significantly lower 24-hr PO (oral) Milligram Morphine equivalent (MME) of 20.4 mg compared to that of control patients (56.0 mg; p<0.0001). VAS scores in the 24-hr post-operative period were significantly reduced in the TA group (p<0.001) across all of the measured post-operative time periods (6,12,18, 24 hours) compared to controls. Patient post-operative patient satisfaction scores were significantly improved in TA patients.
Although there was no significant difference between TA and controls, a 15% reduction in the incidence of anxiety was observed in TA patients. No statistically significant difference between the two groups was observed in the incidence of PONV or hospital length of stay.BFA patients consumed a significantly lower 24-hr PO (oral) Milligram Morphine equivalent (MME) of 17.4 mg compared to that of control patients (35.0 mg; p<0.05). VAS scores in the 24-hr post-operative period were significantly reduced in the BFA group (p<0.001) across all of the measured post-operative time periods (6,12,18, 24 hours) compared to controls. A statistically significant reduction in the incidence of PONV was observed in BFA patients (3%) compared to controls (38%; p<0.001).
Conclusions: In this pilot study, there was a significant reduction in post-operative opioid use and post-operative pain levels in patients who underwent TA and BFA compared to control patients undergoing standard of care perioperative treatment. Administration of BFA and TA techniques performed by trained personnel for patients undergoing surgical procedures may be an effective perioperative treatment method for a low cost, low risk method to reduce post-operative opioid use and post-operative pain