Edited by Richard Saitz, MD, MPH, FACP, DFASAM
Electrotherapy and acupuncture might help decrease opioid use for pain relief after total knee arthroplasty, according to a meta-analysis in JAMA Surgery.
Researchers examined data from 39 randomized trials in which nonpharmacological interventions to reduce pain after knee arthroplasty were compared with routine pharmacotherapy either alone or combined with nonpharmacological treatments. Nearly 2400 adults were included, and five nonpharmacological interventions were studied: continuous passive motion, preoperative exercise, cryotherapy, acupuncture, and electrotherapy (transcutaneous electrical nerve stimulation or pulsed electromagnetic fields).
There was moderate-certainty evidence that electrotherapy within 48 hours of surgery reduced opioid consumption (mean reduction, 3.5 mg/kg/48 hr. morphine equivalents), and that acupuncture delayed the time to first opioid use (mean delay, 46 minutes). These benefits were considered clinically significant.
Evidence for the effects of other interventions on pain relief or opioid use was deemed of low or very low certainty.