Acupuncture in Anesthesia

Acupuncture, a key component of traditional Chinese medicine, involves the insertion of very thin needles through the skin at strategic points of the body.¹ Though it is most commonly used to treat pain, it has been increasingly used for overall wellness, including stress management.¹ In the Chinese tradition, acupuncture is a technique to re-balance the body’s flow of energy and life force.¹ With the globalization of acupuncture, many practitioners view it as a way of stimulating nerves, muscles and connective tissue to activate the body’s natural painkilling mechanisms.¹ Regardless of the underlying processes, practitioners use acupuncture to relieve discomfort associated with a variety of diseases and conditions, including chemotherapy-induced nausea and vomiting, headaches,³ low back pain,⁴ painful menstruation⁵ and more. Recent studies show that acupuncture can be useful in analgesia and alleviation of anesthesia-related side effects.⁶ Anesthesia providers can benefit from delivering acupuncture to their patients before, during and after surgery.⁶

Preoperative treatment with acupuncture can psychologically and physically prepare the patient for surgery by producing sedation and relaxation, reducing preoperative anxiety and triggering the release of endogenous opioids for analgesic purposes.⁶ For example, Wang et al. found that patients who received relaxation-focused ear acupuncture reported significantly lower levels of preoperative anxiety compared to controls.⁷ Another prospective study showed that electroacupuncture administered before a colonoscopy reduced anxiety, discomfort and demand for sedative medications throughout the procedure.⁶ A study by Kotani et al. showed that preoperative acupuncture reduced intraoperative pain and medication requirement, as well as postoperative nausea and vomiting.⁸ Furthermore, Streitberger et al. found that preoperative acupuncture administration reduced postoperative vomiting in patients undergoing gynecological or breast surgery.⁹ These data show that preoperative acupuncture can contribute to patient well-being throughout the entire perioperative period.

Anesthesia providers can also use acupuncture intraoperatively to reduce the need for addictive sedatives or pain medications. Taguchi et al.’s study found that anesthetic requirement—i.e., the amount of desflurane needed to prevent purposeful movement of the extremities in response to unpleasant electrical stimulation—was reduced by acupuncture applied during the procedure.¹⁰ Meanwhile, a meta-analysis by Asmussen et al. showed that acupuncture administered during craniotomy under general anesthesia had analgesic effects, reduced the needed amount of anesthetic drugs and prevented postoperative nausea and vomiting.¹¹ The authors posit that acupuncture in brain surgery may even have protective effects for brain tissue.¹¹ A study by Zhou et al. also found that patients undergoing open heart surgery with combined acupuncture–medicine anesthesia (CAMA) had better experiences than patients who had only general anesthesia.¹² Specifically, CAMA patients (compared to general anesthesia patients) used fewer narcotic drugs, had lower risk of postoperative pulmonary infection, stayed less time in the intensive care unit and had lower medical costs.¹² Finally, Gao et al. found that various types of intraoperative electrical acupuncture were effective in lowering patients’ pain, arterial pressure and heart rate throughout a thyroidectomy.¹³ Evidence suggests that intraoperative acupuncture administration may help reduce a patient’s pain and stress during and after a procedure.

After a procedure, acupuncture can be useful for pain control. A study by Lao et al. showed that patients who received Chinese acupuncture after third molar extractions reported longer pain-free periods and experienced less pain intensity than those who received placebo acupuncture.¹⁴ Another study by Mehling et al. found that postoperative massage and acupuncture in cancer patients resulted in decreased pain and depressive mood.¹⁵ Furthermore, Wong et al.’s data showed that electroacupuncture administered after thoracotomy delayed postoperative use of narcotic analgesic medications.¹⁶ Thus, acupuncture may even have benefits after a procedure has already been completed.

Acupuncture administration before, during or after surgery can provide benefits such as pain reduction, lowered anxiety, faster recovery and less need for medications. However, there are few randomized controlled trials on the effects of acupuncture throughout the perioperative period. Additionally, controversial or unexpected results, diverse study designs and different forms of acupuncture stimulation make it difficult to make conclusions about the efficacy of acupuncture.^6,17,18 Future researchers should aim to standardize the types of acupuncture used in surgery and develop high-powered studies for conclusive results.

1.         Mayo Clinic. Acupuncture. Tests & Procedures 2019; https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763.

2.         Ezzo J, Richardson MA, Vickers A, et al. Acupuncture‐point stimulation for chemotherapy‐induced nausea or vomiting. Cochrane Database of Systematic Reviews. 2014(11).

3.         Cruz R, Wojciechowski H, Sheets R. Does acupuncture decrease the frequency of tension headaches? Evidence-Based Practice. 2018;21(5):E11–E12.

4.         Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-Analysis: Acupuncture for Low Back Pain. Annals of Internal Medicine. 2005;142(8):651–663.

5.         Iorno V, Burani R, Bianchini B, Minelli E, Martinelli F, Ciatto S. Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment. Evidence-Based Complementary and Alternative Medicine. 2008;5(2).

6.         Chernyak Grigory V, M.D., Sessler Daniel I, M.D. Perioperative Acupuncture and Related Techniques. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2005;102(5):1031–1049.

7.         Wang S-M, Peloquin C, Kain ZN. The Use of Auricular Acupuncture to Reduce Preoperative Anxiety. Anesthesia & Analgesia. 2001;93(5):1178–1180.

8.         Kotani N, M.D., Hashimoto H, M.D., Sato Y, M.D., et al. Preoperative Intradermal Acupuncture Reduces Postoperative Pain, Nausea and Vomiting, Analgesic Requirement, and Sympathoadrenal Responses. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2001;95(2):349–356.

9.         Streitberger K, Diefenbacher M, Bauer A, et al. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo-controlled patient and observer blind trial. Anaesthesia. 2004;59(2):142–149.

10.       Taguchi A, Sharma N, Ali SZ, Dave B, Sessler DI, Kurz A. The effect of auricular acupuncture on anaesthesia with desflurane. Anaesthesia. 2002;57(12):1159–1163.

11.       Asmussen S, Maybauer DM, Chen JD, et al. Effects of Acupuncture in Anesthesia for Craniotomy: A Meta-Analysis. Journal of Neurosurgical Anesthesiology. 2017;29(3):219–227.

12.       Zhou J, Chi H, Cheng TO, et al. Acupuncture anesthesia for open heart surgery in contemporary China. International Journal of Cardiology. 2011;150(1):12–16.

13.       Gao Y-Q, Jia Q, Xie S, et al. Clinical Trials for Thyroidectomy Under Acupuncture-aided Anesthesia by Using Electroacupuncture or Transcutaneous Acupoint Electrical Stimulation of Different Acupoints. Zhen Ci Yan Jiu. 2017;42(4):332–337.

14.       Lao L, Bergman S, Langenberg P, Wong RH, Berman B. Efficacy of Chinese acupuncture on postoperative oral surgery pain. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 1995;79(4):423–428.

15.       Mehling WE, Jacobs B, Acree M, et al. Symptom Management with Massage and Acupuncture in Postoperative Cancer Patients: A Randomized Controlled Trial. Journal of Pain and Symptom Management. 2007;33(3):258–266.

16.       Wong RH, Lee TW, Sihoe AD, et al. Analgesic effect of electroacupuncture in postthoracotomy pain: a prospective randomized trial. Annals of Thoracic Surgery. 2006;81(6):2031–2036.

17.       Ekblom A, Hansson P, Thomsson M, Thomas M. Increased postoperative pain and consumption of analgesics following acupuncture. Pain. 1991;44(3):241–247.

18.       Norheim AJ, Liodden I, Alræk T. Acupuncture in ambulatory anesthesia: A review. Ambulatory Anesthesia. 2015;2:79.