Electrotherapy and acupuncture were both found to reduce and delay opioid consumption after total knee arthroplasty, in a recent meta-analysis published in JAMA Surgery.1
To evaluate the evidence on nonpharmacologic postoperative pain management following total knee arthroplasty, researchers performed a meta-analysis of 39 randomized clinical trials (with a total of 2391 patients). Continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture were the most common nonpharmacologic interventions studied.
Electrotherapy and acupuncture reduced the use of opioids (mean difference, −3.50 morphine equivalents in milligrams per kilogram per 48 hours; 95% CI, −5.90 to −1.10; P =.004) and delayed opioid use (mean difference to the first patient-controlled analgesia, 46.17 minutes; 95% CI, 20.84-71.50; P <.001), based on moderate-certainty evidence.
Acupuncture was found to improve pain (mean difference, −1.14 on a visual analog scale at 2 days; 95% CI, −1.90 to −0.38; P =.003), based on low-certainty evidence. According to very low-certainty evidence, cryotherapy reduced opioid use (mean difference, −0.13; 95% CI −0.26 to −0.01; P =.03) and improved pain (mean difference, −0.51; 95% CI −1.00 to −0.02; P <.05).
Passive motion and preoperative exercise reduced opioid consumption but had no effect on pain, based on low- and very low-certainty evidence.
Corresponding author on the study, Tina Hernandez-Boussard, PhD, MPH, concluded that “acupuncture and electrotherapy following total knee replacement reduced or delayed patients’ opioid use.” She called the findings “significant” in light of the ongoing opioid epidemic in the United States.
Dr Hernandez-Boussard, however, cautioned that “strong, unbiased evidence is needed to further support the results from this meta-analysis.”
- Tedesco D, Gori D, Desai KR, et al. Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: A systematic review and meta-analysis [published August 16, 2017]. JAMA Surg. doi: 10.1001/jamasurg.2017.2872