Acupuncture Helps Reduce Pain Following Cesarean Delivery

Taras I. Usichenko, MD, PhD

Acupuncture can be an easy and effective way to supplement treatment for a pain following a cesarean delivery.

A team, led by Taras I. Usichenko, MD, PhD, Department of Anesthesiology, University Medicine of Greifswald, evaluated the efficacy and effectiveness of acupuncture as an adjunctive therapy for pain control following cesarean delivered compared to a placebo intervention and standard care alone.

Pain

Pharmacological approaches to pain control following cesarean deliveries are often insufficient without supplemental treatment such as acupuncture. There remains a need for a better understanding of the pathophysiological and pharmacological components of nociception and the implementation of procedure-specific, multimodal analgesic pathways leading to improved quality of treatment for acute postoperative pain after surgical procedures.

In the single-center, placebo-controlled, patient- and assessor-blinded randomized clinical trial, the investigators examined 180 patients from January 13, 2015 to June 27,2018 at a tertiary university hospital. The mean age of the patient population was 31 years.

Each participant was scheduled for elective cesarean delivery under spinal anesthesia and randomized to either the acupuncture group (n = 60) or placebo group (n = 60). An additional 60 consecutive patients received the standard postoperative analgesia to form a nonrandomized standard care group.

The entire study population in the acupuncture group received auricular and body acupuncture with indwelling intradermal needles, while the placebo group was treated with non-penetrating placebo needles.

The investigators sought primary outcomes of pain intensity on movement, measured using an 11-item verbal rating scale. They also looked at secondary outcomes of 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.

Lower Pain From Acupuncture

The mean pain intensity on movement was lower in the acupuncture group on the first postoperative day than 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).

In addition, 98% (n = 59) of the acupuncture group was 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 = .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 = .003) and 70% (n = 42) from the standard care group (RR, 1.37; 95% CI, 1.14-1.62; P = .002).

Other parameters were comparable across the 3 cohorts.

“Results of this trial showed that acupuncture was safe and effective in reducing pain and accelerating mobilization of patients after cesarean delivery,” the authors wrote. “With consideration for personnel and time expenditures, acupuncture can be recommended as routine, supplemental therapy for pain control in patients after elective cesarean delivery.”

The study, “Effectiveness of Acupuncture for Pain Control After Cesarean Delivery,” was published online in JAMA Network Open.