Three HSS Studies Presented at ESRA Annual Meeting Show that Ear Acupuncture During Hip Replacement Surgery Reduces Opioid Use

Researchers at Hospital for Special Surgery (HSS) have found that a specialized form of acupuncture applied to the outer ear during hip replacement surgery reduces pain after the operation and lessens opioid use over the weeks to follow. The findings of three studies assessing ear acupuncture for inpatient and outpatient total hip arthroplasty were presented at the 42nd Annual Congress of the European Society of Regional Anaesthesia and Pain Therapy (ESRA) in Oslo, Norway.

"Acupuncture helps amplify the body's healing ability by increasing endorphins and decreasing inflammatory proteins," explained Stephanie Cheng, MD, anesthesiologist at HSS, and senior author of all three studies. "We found that among patients who received ear acupuncture during surgery, there was a significant decrease in the use of opioids in the recovery room, a significant reduction in pain scores immediately after surgery and one day later, and a trend toward lower opioid usage 30 days after the operation."

In addition to being an anesthesiologist at HSS, Dr. Cheng is a board-certified medical acupuncturist who designed the CHENG Protocol: the insertion of acupuncture needles in specific points of the outer ear and the conduction of an electrical signal through those needles to help relieve surgery-related pain. During such electroauricular acupuncture (EAA), controlled electrical stimulation of the needles enhances their therapeutic effects.

HSS is a pioneer in the use of EAA during joint replacement surgery. Dr. Cheng began evaluating the technique in 2018. HSS now routinely offers it to all patients having total knee and hip replacements at the hospital, and by request to patients who have other procedures.

Study: Intraoperative Auricular Acupuncture Among Patients Undergoing Total Hip Arthroplasty Surgery: Experience From A High-Volume Orthopedic Center

In this retrospective study, Dr. Cheng and her fellow investigators analyzed medical records for more than 2,193 inpatient and 1,075 outpatient hip replacement surgeries performed at HSS between 2021 and 2025. They compared patients who received CHENG Protocol acupuncture without a nerve block to those who received a nerve block without the acupuncture.

During the CHENG Protocol, the needles are inserted into eight points of the ear after the patient is asleep following initial induction anesthesia, but before the incision is made. The needles remain in place and the electrical current is applied for one hour.

Among inpatients in the study, those who had acupuncture used fewer opioids, reported less pain, and were discharged from the hospital nine hours sooner. No consistent differences were found among outpatient cases.

"When patients feel less pain, they may feel like they can go home a little sooner. Giving acupuncture during hip replacement surgery may help reduce pain and improve recovery, especially as more hospitals move toward performing this procedure on an ambulatory basis," Dr. Cheng suggested.

Study: Intraoperative Auricular Acupuncture Among Total Hip Arthroplasty Patients is Associated with Reduced Opioid Use in Opioid-Tolerant Patients

The management of pain in patients who already take opioids before surgery is especially challenging. In this retrospective study, Dr. Cheng and her team determined if EAA given through the CHENG Protocol could help reduce opioid use in such opioid-tolerant patients undergoing hip replacement. They examined the medical records of 2,372 elective inpatient total hip replacements performed between 2021 and 2025, again comparing patients who received acupuncture without a nerve block to those who received a nerve block without acupuncture.

Among opioid-tolerant patients, those who received ear acupuncture used significantly fewer opioids after surgery. There were no significant differences in opioid use among opioid-naïve patients. Given the complexities associated with managing pain in opioid-tolerant patients, these findings suggest the CHENG Protocol has promise for relieving pain in this group.

Study: Incorporating Acupuncture into Enhanced Recovery after Surgery (ERAS) for Ambulatory Total Hip Replacement Surgery

In this prospective randomized clinical trial, Dr. Cheng and her colleagues studied 484 patients receiving outpatient hip replacement surgery. All of them received standard anesthesia and pain-relieving medications, and half of them also had ear acupuncture according to the CHENG Protocol.

Patients who received acupuncture reported significantly lower pain scores in the recovery room and on the day after surgery. There was also a significant decrease in opioid use in the recovery room and a trend toward fewer opioids taken in the weeks after surgery. This study was one of the top 100 abstracts selected (out of 2,200 submissions) for presentation at the Annual Meeting of the American Association of Hip and Knee Surgeons in October in Dallas.

HSS offers an accredited continuing medical education program to train anesthesiologists how to perform the CHENG Protocol. Certification laws differ from state to state and among hospitals, but Dr. Cheng has been training physicians across the country and in other nations.

She concluded, "It's such a simple technique. It's eight needles at 2 cents each. Add a little current, and the outcomes are amazing."

References

Intraoperative Auricular Acupuncture Among Patients Undergoing Total Hip Arthroplasty Surgery: Experience From A High-Volume Orthopedic Center
Authors: Renee Ren, BA, Jashvant Poeran, MD, PhD, Alex Illescas, MPH, Christopher Li, MD, Eytan Debbi, MD, Elizabeth Gausden, MD, Michael Ast, MD, Stephanie Cheng, MD

Intraoperative Auricular Acupuncture Among Total Hip Arthroplasty Patients is Associated with Reduced Opioid Use in Opioid-Tolerant Patients
Authors: Renee Ren, BA, Jashvant Poeran, MD, PhD, Alex Illescas, MPH, Christopher Li, MD, Eytan Debbi, MD, Elizabeth Gausden, MD, Michael Ast, MD, Stephanie Cheng, MD

Incorporating Acupuncture into Enhanced Recovery after Surgery (ERAS) for Ambulatory Total Hip Replacement Surgery
Authors: Marko Popovic, BS, Christopher Li, MD, Junying Wang, PhD, Maya Tailor, BA, Haoyan Zhong, PhD, William Qiao, MD, Michael Ast, MD, Stephanie Cheng, MD