Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses

Background: In a controlled and double-blind study, the authors tested the hypothesis that preoperative insertion of intradermal needles at acupoints 2.5 cm. from the spinal vertebrae (bladder meridian) provide satisfactory p ostoperative analgesia. Methods: The authors enrolled patients scheduled for elective upper and low er abdominal surgery. Before anesthesia, patients undergoing each type of s urgery were randomly assigned to one of two groups: acupuncture (n = 50 and n = 39 for upper and lower abdominal surgery, respectively) or control (n = 48 and n = 38 for upper and lower abdominal surgery, respectively). in th e acupuncture group, intradermal. needles were inserted to the left and rig ht of bladder meridian 18-24 and 20-26 in upper and lower abdominal surgery before induction of anesthesia, respectively. Postoperative analgesia was maintained with epidural morphine and bolus doses of intravenous morphine. Consumption of intravenous morphine was recorded. Incisional pain at rest a nd during coughing and deep visceral pain were recorded during recovery and for 4 days thereafter on a four-point verbal rating scale. We also evaluat ed time-dependent changes in plasma concentrations of cortisol and catechol amines. Results: Starting from the recovery room, intradermal acupuncture increased the fraction of patients with good pain relief as compared with the contro l (P < 0.05). Consumption of supplemental intravenous morphine was reduced 50%, and the incidence of postoperative nausea was reduced 20-30% in the ac upuncture patients who had undergone either upper or lower abdominal surger y (P < 0.01). Plasma cortisol and epinephrine concentrations were reduced 3 0-50% in the acupuncture group during recovery and on the first postoperati ve day (P < 0.01). Conclusion: Preoperative insertion of intradermal needles reduces postopera tive pain, the analgesic requirement, and opioid-related side effects after both upper and lower abdominal surgery. Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies sur gery.