Effects of contralateral versus ipsilateral electroacupuncture for analgesia and rehabilitation after unilateral total knee arthroplasty: a randomized controlled trial.
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Abstract
Purpose: Total knee arthroplasty (TKA) is a treatment for advanced knee osteoarthritis. Since postoperative pain affects rehabilitation, this study aimed to determine whether electroacupuncture (EA) contralateral to the surgical site is more effective than ipsilateral EA or sham EA in terms of relieving postoperative pain and promoting post-TKA rehabilitation.
Methods: In this parallel, single-blind randomized controlled trial, 114 patients undergoing unilateral TKA were assigned to the contralateral EA (EA on the contralateral side + sham EA on the ipsilateral), ipsilateral EA (EA on the ipsilateral + sham EA on the contralateral side), or sham EA (sham EA on both sides) groups (n = 38 each). Treatment was performed once daily on postoperative days 1-3. The visual analog scale (VAS) scores, additional opioid doses via patient-controlled analgesia (PCA) pump, Hospital for Special Surgery (HSS) knee scores, active/passive range of motion (AROM/PROM), swelling around the knee joint, and Hamilton anxiety scale (HAMA) scores were used for postoperative evaluation.
Results: At 3 days postoperatively, the VAS scores, HSS scores, AROM/PROM, swelling around the knee, and HAMA scores in the contralateral EA and ipsilateral EA groups were significantly improved compared with baseline. In addition, VAS scores, HSS scores, PROM and swelling around the knee were significantly better in the contralateral and ipsilateral EA groups than in the sham EA group, but similar in the two true EA groups. Furthermore, PCA additional dose release was significantly higher in the sham EA group than in the two true EA groups (which did not significantly differ). At 10 days postoperatively, the HSS scores, AROM/PROM, and HAMA scores were better in the contralateral and ipsilateral EA groups than in the sham EA group, but similar in the two true EA groups.
Conclusion: Contralateral EA is more effective than sham EA for treating postoperative pain following TKA, but has an analgesic effect similar to that of ipsilateral EA.
目的：全膝关节置换术（TKA）是一种治疗晚期膝关节骨性关节炎的方法。由于术后疼痛会影响康复，本研究旨在确定在缓解术后疼痛和促进 TKA 术后康复方面，手术部位对侧的电针（EA）是否比同侧 EA 或假 EA 更有效：在这项平行、单盲随机对照试验中，114 名接受单侧 TKA 手术的患者被分配到对侧 EA 组（对侧 EA + 同侧假 EA）、同侧 EA 组（同侧 EA + 对侧假 EA）或假 EA 组（两侧假 EA）（各 38 人）。术后第 1-3 天每天治疗一次。术后评估采用了视觉模拟量表（VAS）评分、患者自控镇痛泵（PCA）额外阿片类药物剂量、特殊外科医院（HSS）膝关节评分、主动/被动活动范围（AROM/PROM）、膝关节周围肿胀和汉密尔顿焦虑量表（HAMA）评分：术后3天，对侧EA组和同侧EA组的VAS评分、HSS评分、AROM/PROM、膝关节周围肿胀和HAMA评分与基线相比均有显著改善。此外，对侧 EA 组和同侧 EA 组的 VAS 评分、HSS 评分、PROM 和膝关节周围肿胀明显优于假 EA 组，但两个真 EA 组的情况相似。此外，假 EA 组的 PCA 额外剂量释放明显高于两组（两组无明显差异）。术后10天，对侧和同侧EA组的HSS评分、AROM/PROM和HAMA评分均优于假EA组，但两组的情况相似：结论：对侧EA治疗TKA术后疼痛比假EA更有效，但镇痛效果与同侧EA相似：试验注册号：ChiCTR1800020297（中国临床试验注册中心）。
期刊介绍：
Acupuncture in Medicine aims to promote the scientific understanding of acupuncture and related treatments by publishing scientific investigations of their effectiveness and modes of action as well as articles on their use in health services and clinical practice. Acupuncture in Medicine uses the Western understanding of neurophysiology and anatomy to interpret the effects of acupuncture.
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