Perioperative Acupuncture: Why Are We Not Using It?

Abstract

Acupuncture is mostly known to the general readership for its analgesic effects. 1 Focusing on the treatment of acute postoperative pain, a meta-analysis of 15 randomised controlled trials (RCTs) comparing acupuncture with sham control in the management of postoperative pain showed that acupuncture decreased both pain intensity and opioid consumption up to 72 h after surgery. 2 This opioid reduction effect was associated with a decreased incidence of opioid-related side effects such as nausea, dizziness, sedation, pruritus and urinary retention. More evidence is provided by two trials 3 4 which suggest that the perioperative administration of acupuncture may be a useful adjunct for postoperative analgesia.The study by Ntritsou et al 3 confirms the conclusions of this meta-analysis and again demonstrates the benefits of postoperative acupuncture listed above. Besides the importance of confirming the evidence from previous studies, there are several interesting aspects in this investigation which are worthy of comment.Ntritsou et al used a pragmatic approach, where acupuncture for postoperative pain relief was performed immediately at the end of surgery in the operating room. This postoperative approach means that acupuncture interferes much less with the running of the operation. The results confirm the previously described effect of acupuncture point stimulation on postoperative pain 5 and suggest the same effectiveness as when the stimulation is started before surgery. 6 Moreover, the choice of acupuncture points was more practical than in other investigations in which acupuncture point stimulation was superior to a variety of control conditions. 2 Points LI4 and ST36 are easier to access for stimulation during the surgery than segmental paravertebral points, although both locations produce the same clinical effect in the treatment of postoperative pain after abdominal surgery. 5

Acupuncture and PC6 stimulation for the prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic resection of colorectal cancer: a study protocol for a three-arm randomised pilot trial

“…Our systematic review found that trials in which acupuncture was administered postoperatively showed inconsistent results in the prevention of PONV in patients with colorectal cancer 5. Although it is plausible that sensory stimulation triggering favourable physiological responses to prevent PONV would not be obtained under general anaesthesia,9 10 favourable effects of the perioperative administration of acupuncture, including intraoperative stimulation, were observed in some trials 1112 While specific recommendations cannot be made due to a paucity of evidence, the perioperative administration (ie, preoperative, intraoperative and postoperative) of acupuncture stimulation was chosen for the maximum possible benefit in our trial.…”

A randomised controlled trial: can acupuncture reduce drug requirement during analgosedation with propofol and alfentanil for colonoscopy? A study protocol

“…So the question whether acupuncture can reduce the dosage of sedative, and be implemented into the clinical routine as a complementary sedative method has still to be answered [ 21 ].…”

Health professionals’ attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: a survey and implications for implementation

“…1 Despite the evidence, acupuncture in the peri-operative setting has largely remained at the research stage. Although used by individual, interested anaesthetists, 6 to date it has not been implemented systematically. Clinicians involved in peri-operative care from Norway, Germany and the United States have questioned why this safe, simple and effective therapy has not been routinely implemented.…”

“…Clinicians involved in peri-operative care from Norway, Germany and the United States have questioned why this safe, simple and effective therapy has not been routinely implemented. 5,6 According to the Diffusion of Innovation Theory, 7 positive attitudes towards an innovation, perceived need for change and openness to new ideas are features of early adopters of innovations and facilitate uptake and implementation. 8 A recent survey studied the knowledge and attitudes of 292 anaesthesia providers from the United States towards the use of A/A for PONV 9 and found an overall positive attitude and receptivity to A/A.…”

“…Clinicians involved in peri-operative care from Norway, Germany and the United States have questioned why this safe, simple and effective therapy has not been routinely implemented. 5,6…”