Efficacy of electroacupuncture combined with intravenous patient-controlled analgesia after cesarean delivery: a randomized clinical trial

BACKGROUND: Electroacupuncture is a nonpharmacologic interven-tion for analgesia that is widely recognized as therapy for pain. However, the clinical efficacy of electroacupuncture combined with patient-con -trolled intravenous analgesia for postoperative analgesia after cesarean delivery remains unclear. OBJECTIVE: This study aimed to assess the efficacy of electroacu-puncture + patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery, determine the optimal frequency for the best analgesic effect, and explore the underlying mechanism of action. STUDY DESIGN: This single-center, randomized, single-blinded, sham acupuncture controlled clinical trial was conducted at a tertiary uni-versity hospital in China. Female patients who underwent cesarean deliv-ery and received fentanyl as patient-controlled intravenous analgesia for postoperative analgesia were enrolled. Patients were after surgery ran-domized to receive 2 Hz electroacupuncture treatment (n=53), 20/100 Hz electroacupuncture treatment (n=53), or sham electroacupuncture treat-ment (n=52) (controls). The 2 electroacupuncture groups received electro-acupuncture treatment at 2 or 20/100 Hz at the ST36 and SP6 points, whereas, in the sham electroacupuncture group, sham electroacupunc-ture was performed at nonmeridian points with nonenergized electroacu-puncture instruments. Of note, 4 electroacupuncture treatments were performed in all groups at 6, 12, 24, and 48 hours after surgery. The primary outcome was the number of analgesic pump compressions at 48 hours after surgery. The secondary outcomes included number of anal-gesic pump compressions at 6, 12, and 24 hours after surgery; pain scores at 6, 12, 24, and 48 hours after surgery; fentanyl consumption at 48 hours after surgery; interleukin 6 and procalcitonin levels at 12 and 48 hours after surgery; and time to first exhaust. RESULTS: Overall, 174 primigravida women were included in the inten-tion-to-treat analysis. The number of analgesic pump compressions and pain scores at all 4 time points and fentanyl consumption at 48 hours after surgery were significantly lower in the electroacupuncture treatment groups than in the sham electroacupuncture group (P<.001). CONCLUSION: Electroacupuncture + patient-controlled intravenous analgesia had a significantly better analgesic effect than sham electroacu-puncture + patient-controlled intravenous analgesia within 48 hours after surgery. Thus, electroacupuncture can be considered safe and effective and may improve the efficacy of patient-controlled intravenous analgesia for pain management after cesarean delivery. Electroacupuncture can be recommended as a routine complementary therapy for pain control after cesarean delivery.