Acupuncture Before THA May Reduce Postoperative Opioid Use, Improve Pain Control

    In a study from the John D. Dingell VA Medical Center in Detroit, veterans who received acupuncture treatment before undergoing total hip arthroplasty (THA) reported less postoperative pain and need far fewer opioids than veterans in the control group who did not receive acupuncture. Veterans in the acupuncture group also reported that they were more satisfied with their pain control.

    The randomized, controlled study was presented at the ANESTHESIOLOGY 2020 annual meeting.

    “Six percent of patients given opioids after surgery become dependent on them, and veterans are twice as likely to die from accidental overdoses than civilians,” said Brinda Krish, DO, lead author of the study and an anesthesiology resident at Detroit Medical Center, “Clearly it is crucial to have multiple options for treating pain, and acupuncture is an excellent alternative. It is safe, cost effective and it works.”

    In the THA study, 21 patients were randomized to receive traditional acupuncture, which involves the insertion of very thin needles at specific trigger points around the body to relieve pain, and 21 patients were randomized to the control group. Those who had traditional acupuncture consumed an average of 20.4 of morphine milligram equivalent (MME) in the first 24 hours after surgery, while patients in the control group consumed 56 MME, nearly 3 times as much.

    Traditional acupuncture patients reported significantly higher satisfaction scores regarding their postoperative pain management 24 hours after surgery (median 8 vs 5). Patient satisfaction was estimated using a scale (0-10), with 10 being completely satisfied. Acupuncture patients reported less pain and 14% reported less anxiety.

    The researchers conducted a second study with patients undergoing a variety of surgeries, including gallbladder removal, hernia repair, hysterectomy or prostate surgery, who were randomly assigned to receive battlefield acupuncture or to a control group before surgery. Battlefield acupuncture, developed by a US Air Force physician to reduce pain without the use of opioids on the front lines, uses tiny needles that are inserted at various trigger points in the ear.

    The results were similar to those of the THA study, with patients receiving battlefield acupuncture consuming half as many opioids in the first 24 hours after surgery as patients in the control group: 17.4 MME vs. 35 MME.

    Dr. Krish noted that, “[s]ome patients were open to trying acupuncture right away, and others became more interested when they learned more about the risks of opioid use. It’s easy, patients love it, it’s not just another medicine, and it’s very safe. Because battlefield acupuncture was developed by an armed services doctor, veterans also were more willing to participate.”

    The acupuncture was provided by the study’s principal investigator, physician anesthesiologist Padmavathi Patel, MD, who plans to use battlefield acupuncture as an additional therapy for pain management for all patients receiving general anesthesia, Dr. Krish said.


    Krish B, Patel V, Baldawi M, Patel P, McKelvey GM, Batarse B, Boctor B, Wesner M, Anderson P, Mostafa G. Traditional Acupuncture and Battlefield Acupuncture Use in Mutimodal Perioperative Anesthesia Care for Our Veteran Patients. Abstract A3091. Presented during the virtual ANESTHESIOLOGY 2020 annual meeting, October 2-5, 2020.