15: A prospective randomized, controlled, blinded trial of pre-operative acupuncture in the management of pain in gynecologic surgery

Abstract

The goal of the study is to evaluate if acupuncture placed for pain control pre-operatively before ambulatory laparoscopic gynecologic surgery after the induction of anesthesia improves post-operative pain and decreases the use of intra-operative and post-operative opioids. This is a blinded, prospective, randomized controlled trial. Patients were recruited by two surgeons at a single institution and were included if they were >18 years of age undergoing ambulatory laparoscopic surgery for benign gynecologic indications. Exclusion criteria included history of substance abuse or chronic pain. Patients were randomized to receive either true or sham acupuncture placed after the induction of anesthesia and prior to the start of surgery. True acupuncture was performed by a trained acupuncturist at sites on the body associated with decreasing pain while the sham was performed by the surgeon at random sites on the hands and feet. Data was collected through chart review and included post-operative pain scores and the amount of intra-operative and post-operative morphine equivalents (MEs) the patient received. Patients were sent home with logs to record the daily number of opioid tablets they took and daily pain scores. The study was powered to demonstrate a 40% decrease in post-operative opioid use. There were 102 patients in the study; 54 patients received true acupuncture and 48 received sham. There were no statistically significant differences between the groups at baseline. Most of the surgeries performed were laparoscopic supracervical hysterectomies with the indication of abnormal uterine bleeding. While all measurements of opioid use and pain scores decreased in the treatment group as compared to the sham, none of these values reached statistical significance. Intraoperatively, the true acupuncture group used 7% less ME than the sham group (p = 0.54) and post-operatively the true acupuncture group used 14% less ME than the sham in the recovery room (p = 0.22). At home, the true acupuncture group used 26% fewer acetaminophen-oxycodone tablets in the first week post-operatively than the sham group (p = 0.19) and used opioids for fewer days than the sham group, 2.7 versus 2.9 days, respectively (p = 0.44). Although the differences between groups did not reach statistical significance, the acupuncture group on average demonstrated better pain control with less intra-operative and post-operative ME usage, lower average pain scores and fewer days at home taking less opioids than the sham group. This study was not powered to show these smaller than expected differences. Further studies will need to be conducted to explore the relationship between acupuncture and pain control with gynecologic surgeries, either with larger study populations or surgeries that traditionally cause more pain such as laparotomies.