{
  "abstract": "Background and Aims Nonpharmacologic analgesic adjuncts like acupuncture remain underutilized in the perioperative period. Although opioids are effective, they have undesirable side-effects like nausea, vomiting, pruritis, sedation, and decreased gut motility, delaying discharge readiness. This is essential in orthopedic surgeries like total joint arthroplasty (TJA), where recovery times are substantially different depending on opioid consumption. Given the move towards ambulatory TJA, exploring potential effectiveness of non-opioid approaches like acupuncture in treating post-operative pain should be prioritized.Methods This triple-blinded randomized controlled trial (IRB approval #2021–1496), enrolled 484 patients (242 per group). Both groups received a standard mepivacaine spinal anesthetic with propofol sedation. Intraoperative medications were standardized to midazolam, ketamine, ondansetron, famotidine, dexamethasone, and ketorolac. Patients randomized to the intraoperative acupuncture group received the CHENG Protocol - auricular acupuncture with electrostimulation at 30 Hz after induction but prior to incision ( figure 1).Results Acupuncture patients showed lower total opioid consumption at 14/30 days (p>0.05, figure 2(A)), and reported significantly lower average PACU NRS scores (median+/-IQR: 4+/-3 vs 5+/-3, p=0.002, figure 2(B)), compared to patients without acupuncture. Other demographics and outcomes were included in table 1.Abstract EP015 Figure 1Acupuncture setupAbstract EP015 Figure 2Acupuncture vs. no acupuncture. (A) Boxplots for total opioids consumptions and (B) Violin plots for NRS scores over timeAbstract EP015 Table 1Descriptive table for patients’ baseline demographics and post-operative outcomes by acupuncture vs no acupunctureConclusions Significant progress has been made toward making ambulatory TJA feasible and attractive for select patients without compromising safety or satisfaction. Patient perception and pain scores, especially during initial recovery, are very important for discharge and cumulative opioid consumption. Although the decrease in opioid consumption was not statistically significant, it may be still clinically meaningful. As we refine approaches to reduce opioid use and recovery time after joint surgery, it is important to consider acupuncture as part of a multimodal fast-track protocol.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA"
      ],
      "name": "Marko Popovic"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA",
        "Department of Anesthesiology, Weill Cornell Medicine, New York, USA"
      ],
      "name": "Christopher Li"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA"
      ],
      "name": "Junying Wang"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA"
      ],
      "name": "Maya Tailor"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA"
      ],
      "name": "Haoyan Zhong"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA",
        "Department of Anesthesiology, Weill Cornell Medicine, New York, USA"
      ],
      "name": "William Qiao"
    },
    {
      "affiliations": [
        "Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA"
      ],
      "name": "Michael Ast"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA",
        "Department of Anesthesiology, Weill Cornell Medicine, New York, USA"
      ],
      "name": "Stephanie Cheng"
    }
  ],
  "title": "EP015 Incorporating acupuncture into enhanced recovery after surgery (ERAS) for ambulatory total hip replacement surgery",
  "uid": "525622f8-f134-5d64-a9da-e3d2d8625f9e"
}