|The analgesic effect of wrist-ankle acupuncture in patients with fractured ribs : a randomized controlled study
|Hong Kong Polytechnic University -- Dissertations
Ribs -- Fractures
Wrist -- Acupuncture
Ankle -- Acupuncture
|Department of Rehabilitation Sciences
|xiv, 71 p. : ill. (some col.) ; 30 cm.
|Rib fracture is a common injury associated with chest trauma. The pain caused by the fracture can lead to secondary pulmonary insufficiency especially in the elderly and patients with poor respiratory reserve. The highly compromised respiratory mechanics significantly contributes to the morbidity and mortality of these patients. Provision of adequate analgesia for the pain is of prime importance in the management of multiple fractured ribs. Various invasive analgesic techniques with pharmacological agents had shown their efficacy in the relief of pain associated with fractured ribs. Despite the effectiveness in pain control, these methods have the corresponding complications and undesirable side effects. Their application demands highly accurate expertise and requires post-institution close monitoring. Acupuncture is a relatively simple, safe and less labour-intensive analgesic technique. The evidence on its effectiveness in pain control has been established by various animal, clinical and radiological studies. The newly evolved needling technique of wrist-ankle acupuncture involves subcutaneous needling to acupoints on the wrist or ankle. Compared with the traditional acupuncture, it is even simpler in application. The use of acupuncture for treatment of pain associated with fractured ribs has scarcely been investigated. This study aims to examine whether wrist-ankle acupuncture is effective in the control of fractured rib pain.
The study adopted a prospective, randomized, double-blinded, controlled pretest and posttest design. Thirty four patients diagnosed with rib fractures were recruited and randomized into the true acupuncture group (N=18) and the sham group (N=16). The acupuncture group involved subcutaneous needling to the chosen acupoint(s) while the sham group had no puncturing and the needle was placed over the skin surface over the acupoints chosen. The application site was covered with sterile gauze. Acupoints on the wrist were chosen according to the site over the chest where the patient complained of pain. The intervention lasted for 30 minutes before the needles were removed. Outcome measurements were taken before and after the intervention. Primary outcomes were the pain score rated by numerical rating scale, and lung function tests, namely forced vital capacity, forced expiratory velocity in first second and peak expiratory flow rate. Secondary outcomes were heart rate, blood pressure, respiratory rate and oxyhaemoglobin saturation by pulse oximetry. Results of this study showed a significant reduction in pain score in both groups (p<0.05) but the between-group difference was not statistically significant. The pre- and post-intervention lung function tests and the secondary outcomes showed no significant changes. To conclude, this study provided evidence to support wrist-ankle acupuncture is effective in reduction of fractured rib pain. Significant pain relief was also found in the sham group. However, the post-intervention lung function tests demonstrated no statistically significant improvement in both groups. This suggests that wrist-ankle acupuncture could be a choice of adjunct for pain control in patients with fractured ribs.
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