Randomized sham-controlled trial of acupuncture for postoperative pain control after stapled hemorrhoidopexy.

Background:  Hemorrhoidectomy usually causes moderate to strong postoperative pain. Chinese studies have found that acupuncture may have an analgesic effect in post-hemorrhoidectomy patients. This is the first Western study to assess the efficacy of acupuncture as an adjunct analgesic therapy after stapled hemorrhoidopexy. Methods:  In a randomized controlled trial, 50 patients were allocated to three groups. Conventional drug therapy (oral diclofenac and metamizol, local lidocaine) served as baseline analgesia. In the control group (n= 17), only this regimen was used. In addition to baseline analgesia, 17 patients received verum acupuncture. Sham acupuncture was performed on 16 patients. Being the primary outcome measure, pain was measured twice daily using the numerical rating scale (NRS) and compared statistically by repeated-measures analysis of variance. The study was registered (DRKS00003116). Results:  After verum acupuncture, pain intensity was not significantly lower when compared to conventional analgesia (primary hypothesis, p= 0.057), but was when compared to sham acupuncture (p= 0.007). In the afternoon of postoperative day 1, for example, NRS was 2.7 (SD 1.5) in the verum group, but 4.0 (1.0) in the sham group and 4.1 (1.9) under conventional analgesia. Furthermore, significantly less rescue analgesics were necessary, if verum acupuncture was applied. Cardiovascular parameters were stable in all three groups, and no complications were recorded. Conclusions:  In post-hemorrhoidectomy patients, acupuncture appears to be an effective adjunct to conventional analgesia. Further studies are necessary to confirm these observations and to refine acupuncture technique.
Copyright © 2012 The Association of Coloproctology of Great Britain and Ireland.
PMID: 22330010