Effectiveness of Acupuncture for Pain Control After Cesarean Delivery: A Randomized Clinical Trial

This randomized, placebo-controlled clinical trial investigated the efficacy of acupuncture as adjunctive therapy for postoperative pain control in women undergoing elective cesarean delivery. Conducted in Germany between 2015 and 2018, the study included 180 participants divided into three groups: real acupuncture, placebo, and standard care. The acupuncture protocol used a combined approach of body and auricular points with semi-permanent needles that remained in situ for three days. The primary outcome was pain intensity on movement on the first postoperative day, measured on an 11-point verbal scale.

The results demonstrated that the acupuncture group had lower pain intensity on movement on the first postoperative day (4.7 points) compared with the placebo group (6.0 points) and the standard care group (6.3 points), with a moderate-to-large effect size (Cohen d = 0.73 vs placebo; d = 1.01 vs standard care). More impressive was the impact on mobilization: 98% of patients in the acupuncture group were fully mobilized on the first postoperative day, compared with 83% in the placebo group and only 58% in the standard care group. Early urinary catheter removal was also more frequent in the acupuncture group (93% vs 72% placebo vs 70% standard care). Analgesic consumption was similar across groups, suggesting that acupuncture provided additional benefits without the need to reduce medications.

Adverse events were minimal and comparable across groups. Patient blinding was partially effective, with significant differences in perception of which treatment they received. Limitations include the single-center design, homogeneous population (only White women), use of a non-randomized control group, and inability to fully blind acupuncturists. The study also used short-acting spinal sufentanil, and it is unclear whether the results would apply with long-acting spinal morphine.

Proposed mechanisms include stimulation of Aβ, Aδ, and C afferent fibers, and possible stimulation of the auricular branch of the vagus nerve in auricular acupuncture. The findings suggest that preoperative acupuncture is a safe and effective intervention that can be recommended as routine supplementary therapy for pain control after elective cesarean delivery, considering the personnel and time resources required.