Effectiveness and safety of auricular acupuncture on adjuvant analgesia in patients with total knee arthroplasty: a randomized sham-controlled trial.

Objective: This study aimed to evaluate the effectiveness and safety of auricular acupuncture (AA) on postoperative analgesia, the degree of postoperative nausea, and the effect of inflammation after total knee arthroplasty (TKA). Methods: This was a single-center, placebo-controlled, randomized clinical trial. In total, 96 patients were randomly divided into an AA group with an indwelling intradermal needle (n = 48) and a sham auricular acupuncture (SAA) group with a non-penetrating placebo needle (n = 48). Intra-spinal anesthesia was adopted in both groups during surgery, and an epidural analgesic pump was implanted after surgery for 48 h. The primary outcome was the post-surgery visual analog score (VAS) of resting and movement states (at 6, 12 h and 1, 2, 3, 5, and 7 days). The secondary outcomes included additional doses of analgesic injection during the treatment, C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count on the 1st, 3rd, and 7th day after the operation, nausea on the 1st, 2nd, and 3rd day after the operation, the Hospital for Special Surgery Knee Score (HSS) on the 2nd and 12th week after the operation, and adverse events. Results: The VAS in the AA group at 6 h, 12 h, 2, 3, and 5 days after surgery were lower than those of the SAA group (p < 0.05). Among the secondary outcomes, the total dose of additional analgesic injection after surgery in the AA group was lower than that in the SAA group (p < 0.05). The serum CRP on the 1st day after operation in the AA group was lower than that in the SAA group (p < 0.05). The degree of nausea on 2nd day after surgery in the AA group was lower than that in the SAA group (p < 0.05). There was no significant difference in other outcomes (p > 0.05). Conclusion: In this study, AA was shown to be an effective and safe complementary and alternative therapy for pain relief after TKA, which was able to reduce the total postoperative dose of additional painkillers, decrease serum CRP 1 day after surgery, and improve the degree of postoperative nausea. Clinical trial registration: www.chictr.org.cn, ChiCTR2100054403.

[Effects of different acupuncture and moxibustion methods on articular cartilage morphology and NF-κB p65/NLRP3 pathway in rats with knee osteoarthritis].

OBJECTIVE: To compare the effects of filiform needling, electroacupuncture (EA) and moxibustion on articular cartilage morphology and nuclear transcription factor-κB (NF-κB) p65/ Nod-like receptor protein 3 (NLRP3) pathway in rats with knee osteoarthritis (KOA). METHODS: Wistar rats were randomly divided into blank control， model, filiform needling, EA and moxibustion groups, with 8 rats in each group. The KOA model was established by injecting sodium iodoacetate into the right knee cavity. Filiform needling, EA and moxibustion groups were treated with the right side of "Dubi" (ST35) and "Neixiyan" (EX-LE5), and were given filiform needling, EA and mild moxibustion therapies for 15 min respectively, once every other day, for a total of 4 weeks. The diameter of the right knee joint was observed. The ultrastructure of knee chondrocytes was observed by transmission electron microscope. The contents of serum tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß and IL-18 were determined by ELISA. The expression levels of NF-κB p65, NLRP3, apoptosis-related speckle like protein (ASC) and TNF-α in knee cartilage were dectected by Western blot. RESULTS: Compared with the blank control group, the right knee joint cavity was narrowed, chondrocytes were constricted significantly, mitochondria were moderately swollen, the diameter of the right knee was increased, and the contents of serum TNF-α, IL-1ß and IL-18 were increased (P<0.01), the expressions of NF-κB p65, NLRP3 and TNF-α in knee cartilage were increased (P<0.01) while the expression of ASC was decreased (P<0.01) in the model group.Compared with model group, the narrowed knee joint cavity and chondrocyte injury were improved， knee diameter decreased (P<0.01, P<0.05), and the content of serum TNF-α and the expression of NLRP3 in knee cartilage were decreased (P<0.05, P<0.01) in 3 treatment groups; the contents of serum IL-1ß and IL-18, and the expression of TNF-α in knee cartilage were decreased (P<0.01, P<0.05), while the expression of ASC in knee cartilage was increased (P<0.01) in EA and moxibustion groups; the expression of NF-κB p65 in knee cartilage was decreased (P<0.01) in moxibustion group. Compared with EA group, the content of serum IL-18 was decreased (P<0.05) in moxibustion group. CONCLUSION: Filiform needling, EA and moxibustion can all reduce the formation of knee osteophytosis in KOA rats, alleviate joint cavity narrowing, improve the ultrastructure of articular cartilage, reduce the level of inflammatory factors, regulate the NF-κB p65/NLRP3 pathway. Moxibustion has the most obvious regulatory effect among the 3 treatment methods.

[Complex network analysis on regularities of acupoint combinations and application characteristics of acupuncture and moxibustion in the treatment of knee osteoarthritis].

OBJECTIVE: To analyze the regularities of combination of acupoints in the existing clinical trial literature by using complex network technique, so as to provide reliable evidence for selecting appropriate acupoint recipes in the treatment of knee osteoarthritis (KOA) with acupuncture and moxibustion therapies. METHODS: Clinical papers about acupuncture treatment of KOA published from January of 2000 to April of 2020 were searched from Chinese and English databases including CNKI, Wanfang, VIP, Pubmed and ScienceDirect by using keywords of "acupuncture", "moxibustion" and "knee osteoarthritis". According to the inclusive and exclusive criteria, the collected papers were screened out to set up a database. SPSS Modeler18.0 software was used to analyze the association rules of acupoints (including the core acupoint nodes and compatibility relationship), and Gephi0.9.2 software was employed to conduct a complex network analysis about the compatibility rules of acupoints and their application characteristics of moxibustion and needling methods in the treatment of KOA (shown by a complex network schematic diagram). RESULTS: A total of 444 acupuncture prescriptions were extracted, including 6 single-acupoint prescriptions (1.35%) and 438 multiple-acupoint prescriptions (98.65%). A total of 112 acupoints were involved, with the application frequency of 3 389. Among them, the application frequency of the Neixiyan (EX-LE4)is the highest (354 times, 10.45%), followed by Dubi (ST35), Xuehai(SP10), Yanglingquan(GB34), Liangqiu(ST34), Zusanli(ST36), etc. The mainly involved meridians are the Stomach Meridian of Foot-Yangming and the Spleen Meridian of Foot-Taiyin. The involved specific acupoints are the Five-shu (stream) acupoints, being the most commonly used, followed by the crossing points, and lower confluent (sea) acupoints. CONCLUSION: In the treatment of KOA with acupuncture and moxibustion, the regularities and characteristics of acupoint combinations (acupoint prescriptions) are: 1) often selecting local acupoints at the lower limbs, 2) frequently applying the Five-shu acupoints (specific acupoints), and 3) matching the acupoints of the outside meridians and inside meridians, especially those of the Spleen Meridian and Stomach Meridian.