Acupuncture may improve pain, reduce opioid use after THA

Efficacy of Intraoperative Acupuncture in Reducing Early Postoperative Opioid Consumption and Pain Following Total Hip Arthroplasty: A Randomized Clinical Trial

Importance

The integration of Enhanced Recovery After Surgery (ERAS) protocols has revolutionized the mana   gement of patients undergoing total hip arthroplasty (THA), emphasizing early mobilization, reduced length of hospital stay, and the mitigation of postoperative complications. A central pillar of ERAS is multimodal analgesia designed to minimize reliance on systemic opioids, which are associated with adverse effects such as nausea, ileus, respiratory depression, and the potential for long-term dependency. Intraoperative auricular acupuncture presents a promising, non-pharmacologic adjunct to regional and systemic analgesia, yet large-scale, rigorous, triple-blinded clinical trials evaluating its efficacy within modern ERAS pathways remain scarce. 

Objective

To determine whether the administration of intraoperative acupuncture, as an adjunct to a standardized ERAS protocol, significantly reduces postoperative pain scores and oral morphine equivalent (OME) consumption in the immediate and short-term recovery periods following primary THA.

Design, Setting, and Participants

This triple-blind, randomized controlled clinical trial was conducted at the Hospital for Special Surgery. The findings were presented at the American Academy of Medical Acupuncture (AAMA) Annual Symposium in Denver, where the study was awarded first place in the annual research paper competition. The investigation enrolled 484 adult patients scheduled for primary total hip arthroplasty. Furthermore, a highly detailed subset analysis was performed on 185 patients who underwent the surgical procedure between January 2024 and March 2025 to evaluate secondary metrics including total length of hospital stay and absolute opioid avoidance.

Interventions

Participants were randomly assigned in a 1:1 ratio to receive either intraoperative auricular acupuncture in addition to the standard of care ERAS protocol or the standard of care alone without acupuncture. The auricular approach targets specific microsystem acupoints on the external ear, theorized to modulate central pain pathways via cranial and cervical nerve afferents.

Stephanie I. Cheng, MD, DABMA, FAAMA, explicitly highlighted the anatomical and clinical advantages of this specific intervention:

“This is something that is very, very safe. The safety profile is good. It is performed on the ear, it is away from the surgical site and you are not dealing with infection. Anything that can help us decrease opioid usage, increase patient satisfaction and decrease their length of stay is something that we should try.”

Main Outcomes and Measures

The primary clinical endpoints were postoperative pain intensity, measured utilizing standardized numerical rating scales (NRS), and cumulative opioid consumption, calculated in oral morphine equivalents (OME). Secondary outcomes assessed included the total hospital length of stay and the proportion of patients capable of entirely avoiding opioid medications during their inpatient recovery. Data were captured on postoperative day (POD) 0, POD 1, and at a 30-day follow-up.

Table 1. Trial Design and Cohort Allocation

Results

The integration of intraoperative acupuncture yielded immediate and clinically significant postoperative benefits. Patients randomized to the acupuncture arm demonstrated a statistically significant reduction in both numerical pain scores and total opioid consumption on postoperative day 0 and postoperative day 1 when compared to the standard of care cohort. While these acute benefits were pronounced, longitudinal follow-up indicated that trends toward decreased opioid utilization at postoperative day 30 did not achieve statistical significance between the two groups.

The subset analysis of 185 patients provided deeper insights into the trajectory of inpatient recovery. Within this group, the acupuncture cohort experienced consistently lower pain scores and a significantly reduced length of hospital stay. Most notably, the intervention drastically increased the likelihood of a completely opioid-free hospital admission.

Table 2. Clinical Outcomes in the Subset Cohort (n = 185)

Conclusions and Relevance

Intraoperative auricular acupuncture is a safe, highly tolerable, and efficacious non-pharmacologic adjunct that significantly enhances the early postoperative pain profile for patients undergoing total hip arthroplasty. By effectively suppressing acute postoperative pain, the intervention drastically curbs early opioid demand and facilitates the achievement of rigorous ERAS milestones, including same-day or next-day discharge.

Addressing the systemic and economic implications of these findings, Dr. Cheng stated:

“Acupuncture allows patients to get up and moving, and get out of the hospital within that 23-hour period instead of having a multiple day hospital stay that may not get paid by insurance. The helps hospitals, doctors and the patients not incur those costs of staying an extra couple of days because their pain is not controlled.”

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