A randomized, placebo-controlled study of magnetic acupuncture for supplementary analgesia after laparoscopic appendectomy in children

Abstract

Purpose: Magnetic acupuncture (MA) is a noninvasive technique potentially useful for postoperative pain reduction. While anecdotal case series have reported analgesic effects, this has not been systematically studied. We evaluated the analgesic properties of supplemental MA versus placebo and standard treatment in children who underwent laparoscopic appendectomy (LA).

Methods: Children age 2-18 years who underwent LA for acute appendicitis were recruited from 2018 through 2020. Standardized postoperative pain medication including Ibuprofen, Acetaminophen, and narcotics were given as needed. Patients were randomized to 3 groups: Group 1 had adhesive acupuncture magnets placed on 5 predetermined meridian points for 48 h. Group 2 had corresponding non-magnetic adhesive metal disks placed in the same locations. Group 3 received no supplemental treatment. Pain was measured every 4 h using a 1-10 Visual-Analog-Scale (VAS). Cumulative demand of as-needed pain medication was calculated. Patients and families were handed open questionnaires upon discharge assessing satisfaction with treatment.

Results: A total of 126 patients were randomized. Groups were similar in age and gender distribution. Differences of means of cumulative VAS scores were significantly lower for group 1 (8.0,SD5.2) compared to group 2 (12.8,SD4.4; -4.8[95%CI -7.1 to -2.5], p < 0.01), and group 3 (19.8,SD7.7; -11.8[95%CI -15.0 to -8.6], p < 0.01). Cumulative acetaminophen and ibuprofen use per patient during the entire hospital stay was lower for group 1 (1510 mg, 20 mg) than for group 2 (2950 mg, 1800 mg), and group 3 (6100 mg; 2300 mg), respectively. In contrast to groups 2 and 3, none of the patients in group 1 asked for narcotics. Patients were highly satisfied with MA.

Conclusions: Supplemental MA after LA in children had a beneficial effect on the postoperative pain perception and on-demand use of analgesics that could not be explained by placebo mechanism. MA is a safe, simple, and effective adjunct to standard postoperative care. Further studies are warranted.

Type of study: Prospective randomized, placebo-controlled trial LEVEL OF EVIDENCE: Level I.

Keywords: Acupuncture; Appendicitis; Children; Laparoscopy; Magnetic; Pain.