Acupuncture can be a simple and effective way to complete the treatment of pain following a cesarean section.
A team, led by Taras I. Usichenko, MD, PhD, Department of Anesthesiology, Greifswald University Medicine, evaluated the effectiveness and efficacy of acupuncture as an adjunct therapy for pain control after caesarean section compared with placebo intervention and standard care alone.
Pharmacological approaches to pain control after caesarean section are often insufficient without additional treatment such as acupuncture. There remains a need to better understand the pathophysiological and pharmacological components of nociception and the implementation of procedure-specific multimodal analgesic pathways leading to better quality treatment of acute postoperative pain after surgical procedures.
In the single-center, placebo-controlled, patient- and rater-blinded randomized clinical trial, researchers examined 180 patients from January 13, 2015 to June 27, 2018 at a tertiary teaching hospital. The average age of the patient population was 31 years.
Each participant had to undergo a planned Caesarean section under spinal anesthesia and randomized to the acupuncture group (n = 60) or the placebo group (n = 60). Sixty additional consecutive patients received standard postoperative analgesia to form a non-randomized standard care group.
The entire study population in the acupuncture group received ear and body acupuncture with indwelling intradermal needles, while the placebo group was treated with non-penetrating placebo needles.
Investigators looked for the primary outcomes of pain intensity during movement, measured using an 11-item verbal rating scale. They also looked at secondary outcomes of adverse events related to analgesia, analgesic consumption, time to mobilization and removal of the Foley catheter, quality of blinding of patients at randomisation, and patient satisfaction with pain treatment.
Reduce pain with acupuncture
The average intensity of pain on movement was lower in the acupuncture group on the first postoperative day than in the placebo group (4.7 [1.8] against 6.0 [2.0] points; Cohen D, 0.73; 95% CI, 0.31-1.01; P = 0.001) and standard care group (6.3 [1.3] points; Cohen D, 1.01; 95% CI, 0.63-1.40; P
Additionally, 98% (n=59) in the acupuncture group were fully mobilized on the first postoperative day, compared to 83% (n=49) in the placebo group (RR, 1.18; 95% CI, 1.06-1 .33; P = 0.01) and 58% (n = 35) in the standard care group (RR, 1.69; 95% CI, 1.36-2.09; P <.001>
The Foley catheter was removed in 93% (n=57) of the acupuncture group compared to 72% (n=43) of the placebo group (RR, 1.33; 95% CI, 1.12-1.57; P = 0.003) and 70% (n = 42) of the standard care group (RR, 1.37; 95% CI, 1.14-1.62; P = .002).
The other parameters were comparable in the 3 cohorts.
“The results of this trial showed that acupuncture was safe and effective in reducing pain and accelerating mobilization in patients after cesarean section,” the authors wrote. “Taking into account personnel and time expenditures, acupuncture may be recommended as a routine adjunctive therapy for pain control in patients after elective caesarean section.”
The study, “Effectiveness of acupuncture for pain control after caesarean sectionwas published online in Open JAMA Network.