Postoperative analgesia after low-frequency electroacupuncture as adjunctive treatment in inguinal hernia surgery with abdominal wall mesh reconstruction Maria Dalamagka, 1 Christos Mavrommatis, 2 Vassilios Grosomanidis, 3 Konstantinos Karakoulas, 3 Dimitrios Vasilakos 3 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ acupmed-2014-010689). 1 Anaesthesiology Department, General Hospital of Edessa, Edessa, Greece 2 Department of Rheumatologist, Private Clinic, Komotini, Greece 3 Department of Αnaesthesiology and Ιntensive care medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece Correspondence to Maria Dalamagka, Anaesthesiology Department, General Hospital of Edessa, Edessa 58200, Greece; mary.dalamaga@gmail.com Accepted 13 May 2015 To cite: Dalamagka M, Mavrommatis C, Grosomanidis V, et al. Acupunct Med Published Online First: [ please include Day Month Year] doi:10.1136/acupmed-2014- 010689 ABSTRACT Objective To determine whether an electroacupuncture (EA) technique that was developed for a surgical population under general anaesthesia reduces pain after mesh inguinal hernia open repair. Methods A total of 54 patients with right or left inguinal hernia were randomised to group I (preoperative, intraoperative, postoperative EA), group II (preoperative, postoperative EA), or a sham control group (group III; preoperative and postoperative placement of needles, but without skin penetration). The Visual Analogue Scale (VAS) (primary outcome) and the State-Trait Anxiety Spielberger Inventory were evaluated preoperatively and at 30 min, 90 min, 10 h and 24 h after surgery. Pain threshold and tolerance were evaluated using an algometer at these same time points and preoperatively before and after EA. Levels of the stress hormones cortisol, corticotrophin and prolactin were determined at 30 min, 90 min and 10 h after surgery and preoperatively before and after EA. Results The results showed significant differences between the true EA and control groups. The true EA groups (I and II) showed statistically significantly greater improvements in the primary (VAS pain, p<0.05) and secondary outcome measures (Anxiety scale; algometer measurements, p<0.05 and stress hormones, p<0.01) compared to the control group. There were no statistically significant differences between groups I and II. Conclusions Electroacupuncture reduces postoperative pain after mesh inguinal hernia repair and decreases stress hormone levels and anxiety during the postoperative period. Trial registration number ClinicalTrials.gov identifier NCT01722253. INTRODUCTION Postoperative pain after inguinal hernia surgery is attributed to surgical manipulation or placement of the preper- itoneal mesh. Trauma to the pudendal, iliohypogastric and ilioinguinal nerves is the most likely cause of pain, with neuro- pathic components in the femoral and genital regions. 12 According to Callesen, pain is most pronounced the day after surgery, and one-third of patients have moderate or severe pain after 1 week. 3 However, few studies have evaluated the potential contribution of acupuncture to the treatment of postoperative pain. 45 Acupuncture is mostly widely known for its analgesic effects. 6 A meta-analysis of 15 RCTs comparing acupuncture with sham control in the management of post- operative pain showed that acupuncture decreased both pain intensity and opioid consumption up to 72 h after surgery. 7 More evidence is provided by two trials 89 which suggest that the periopera- tive administration of acupuncture may be a useful adjunct for postoperative analgesia. The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain and provide add- itional information as to whether acu- puncture might serve as an important adjuvant for pain control. This trial studied the effect of EA in mesh inguinal hernia open repair, using the pain scale VAS (Visual Analogue Scale), the Anxiety Scale, evaluation of pain with an algometer and measurements of stress hormones. Original paper Dalamagka M, et al. Acupunct Med 2015;0:1–8. doi:10.1136/acupmed-2014-010689 1 Copyright 2015 by British Medical Journal Publishing Group. group.bmj.com on June 4, 2015 - Published by http://aim.bmj.com/ Downloaded from