Journal name: JAMA Network Open
Manuscript title: Effectiveness of Acupuncture for Pain Control After Cesarean Delivery: A Randomized Clinical Trial
Question Is adding preoperative acupuncture to standard pharmacological therapy effective for pain control in patients after cesarean delivery?
Findings In this randomized clinical trial with 180 female patients, acupuncture reduced pain on movement and accelerated patient mobilization after cesarean delivery compared with placebo acupuncture and standard pharmacological therapy alone.
Meaning Findings from this trial suggest that use of preoperative acupuncture as an additional pain therapy is safe and effective in patients after elective cesarean birth.
Importance A pharmacological approach to pain control after cesarean delivery is often insufficient on its own. Acupuncture is a promising method for mitigating postoperative pain and reducing postoperative opioid requirements.
Objective To evaluate the efficacy and effectiveness of acupuncture as an adjunctive therapy for pain control after cesarean delivery, compared with a placebo intervention and standard care alone.
Design, Setting, and Participants This single-center, placebo-controlled, patient- and assessor-blinded randomized clinical trial was conducted from January 13, 2015, to June 27, 2018, at a tertiary university hospital in Greifswald, Germany. Participants were women who were scheduled for elective cesarean delivery under spinal anesthesia and were randomized to either the acupuncture group (n = 60) or placebo group (n = 60). Another 60 consecutive patients who met the eligibility criteria and received the standard postoperative analgesia were selected to form a nonrandomized standard care group. The intention-to-treat analysis was performed from August 19, 2019, to September 13, 2019.
Interventions In addition to standard pain treatment, each patient in the acupuncture group received auricular and body acupuncture with indwelling intradermal needles, whereas patients in the placebo group were treated with nonpenetrating placebo needles.
Figure 1 Auricular acupuncture points used for additional treatment of postoperative pain in patients after Caesarean section. All points were needled bilaterally. MA-SC, Kidney; MA-TF1, Ear Shenmen; MA-IC1, Lung; MA-AT1, Subcortex.
Main Outcomes and Measures The primary outcome was pain intensity on movement, which was measured using an 11-item verbal rating scale. Secondary outcomes were analgesia-related adverse effects, analgesics consumption, time to mobilization and Foley catheter removal, quality of patient blinding to randomization, and patient satisfaction with treatment of pain.
Results A total of 180 female patients (mean [SD] age, 31  years) were included in the intention-to-treat analysis. The mean pain intensity on movement in the acupuncture group on the first postoperative day was lower than in the placebo group (4.7 [1.8] vs 6.0 [2.0] points; Cohen d, 0.73; 95% CI, 0.31-1.01; P = .001) and the standard care group (6.3 [1.3] points; Cohen d, 1.01; 95% CI, 0.63-1.40; P < .001). On the first postoperative day, 59 patients (98%) in the acupuncture group were fully mobilized vs 49 patients (83%) in the placebo group (relative risk [RR], 1.18; 95% CI, 1.06-1.33; P = .01) and 35 patients (58%) in the standard care group (RR, 1.69; 95% CI, 1.36-2.09; P < .001). The Foley catheter was removed in a total of 57 patients (93%) from the acupuncture group vs 43 patients (72%) from the placebo group (RR, 1.33; 95% CI, 1.12-1.57; P = .003) and 42 patients (70%) from the standard care group (RR, 1.37; 95% CI, 1.14-1.62; P = .002). Other parameters were comparable across the 3 study groups.
Conclusions and Relevance Results of this trial showed that acupuncture was safe and effective in reducing pain and accelerating mobilization of patients after cesarean delivery. With consideration for personnel and time expenditures, acupuncture can be recommended as routine, supplemental therapy for pain control in patients after elective cesarean delivery.
My comments :
This article showed that acupuncture is helpful for reducing acute surgery pain.
Effectiveness of Acupuncture for Pain Control After Cesarean Delivery: A Randomized Clinical Trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886541/