Total knee replacement (TKR) is a common surgical procedure that has low levels of mortality and entails surgical complications. There may be severe postsurgical trauma, prolonged hospitalisation, and impaired patient rehabilitation especially in elderly patients. Moreover, consequences of uncontrolled pain can lead to myocardial ischemia and infarctions, pulmonary infections, paralytic ileus, urinary retention, thromboembolisms, impaired immune functions, etc. Auriculotherapy/ear acupuncture has recently shown a favourable effect on perioperative and postoperative pain and disability in patients who have undergone TKR.
A study was conducted to examine the adjuvant effects of auricular acupuncture on persisting pain and disability in patients. The ear represents the whole body. Specific area of the ear represents specific body area. Three auricular points where needles were used helped in identifying the points with lower resistance. An acupuncture needle (0.22 mm diameter x 1.5mm length), which were insdrted before surgery and retained until the following morning.
And on the other ear, acupressure was applied by repeatedly pressing the acupoints with the fingertips for three minutes per point, four times per day. As several areas of the auricle may be associated with different disorders and dysfunctions in elderly patients, auricular diagnosis in these patients was restrained to the upper and the lower area of the ear. The region of the upper auricle includes ear points where the French and the Chinese represent the knee. Both ears were examined with an electrical skin resistance test and a pressure pain test.
A group of 17 patients who had undergone TKR and who had been admitted to a hospital in Italy, for postoperative rehabilitation, were treated with one session of ear acupuncture. Nine of them were operated on the left side and eight on the right side. On the morning of treatment, the patients reported a pain level in the sitting position; this level varied from 4.5 to 10 (mean average of 5.9). The average time for sit-to-stand was scored on three consecutive standing movements. The same movement tests were repeated after the auricular acupuncture session and again six hours later. After auricular acupuncture and six hours later, the reported pain levels decreased significantly both in the sitting and standing positions. There was a positive effect on reducing knee pain after arthroscopy and surgery.
The points identified may be effective for reducing pain and disability in elderly people. These points are spread out through an area that tends to overlap with the representations of the knee joint, according to French and Chinese researchers. This study was done by Marco Romoli, MD, Prato, Italy.
The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, Delhi.
This treatment is now being made available in India.