Postoperative Analgesic Efficacy of Ear Acupuncture in Patients Undergoing Abdominal Hysterectomy

A Randomized Controlled Trial

Hamdy A. Hendawy; Mohamed E. Abuelnaga


BMC Anesthesiol. 2020;20(279) 

In This Article


Acupuncture is considered as a traditional therapeutic technique with a long history of 4000 years. Electro-acupuncture (EA) is a new type of hand acupuncture that can deliver effective analgesia with a minute physiological disturbance.[1,2] It was used effectively for pain management in different disorders including post-surgical pain following cesarean section, gastrostomy, and enterectomy.[1,3,4] Acupuncture and Transcutaneous electrical nerve stimulation (TENS) were showed to have valuable efficacy in increasing the somatic pain threshold.[5] Kitade and Hyodo[6] investigated the effect of auricular acupuncture stimulation on the threshold of somatic pain. They found the Shen-Men, lungs, sympathicus, and kidney points showed a significant pain threshold rise when compared to non-acupuncture auricular points. Even though the results differ greatly depending on the individual and body region, to some degree they elucidated that auricular acupuncture points had parallels in specific body regions and the authors concluded that auricular acupuncture stimulation can achieve an analgesic effect. It is believed that the human body encompasses energy pathways or channels representing the internal organs. Energy is thought to stream continuously through these pathways ending to the body surface with acupuncture points that work as gateways to these channels. Stimulation of these acupoints is claimed to activate the body's inherent healing power.[7]

Generally, acupuncture can boost physical and emotional health through the release of certain neurochemicals from the nervous system, as well as affecting cerebral areas responsible for reducing pain and anxiety.[7,8] Acupuncture can help in postoperative pain reduction by altering the brain's chemistry, increasing endorphins and neuropeptide Y levels, and reducing serotonin levels.[7] Systematic reviews revealed the effectiveness of acupuncture as a useful adjuvant for post-surgical pain relief. Randomized controlled trials have found that acupuncture can ameliorate postoperative pain, reduce the use of patient-controlled analgesia (PCA), and postoperative nausea and vomiting.[8] Several publications have found the analgesic effectiveness of body acupuncture in gynaecologic surgery including hysterectomy.[9–12] Tsang et al. reported that a single session of auricular TENS delivered 24 hours after surgery was effective in reducing post-hysterectomy pain for at least 30 min.[13] This study aims to investigate the role of preoperative electric ear acupuncture (EEA) in reducing post-operative pain in patients undergoing hysterectomy by fine acupuncture needles (10 mm × 30 gauge) for four points of ear acupuncture. We hypothesize that EAA will reduce the required postoperative analgesia following abdominal hysterectomy.