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.
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"Acupuncture helps amplify the body's healing ability by increasing endorphins and decreasing inflammatory proteins," explained Stephanie Cheng, MD, 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
About HSS
HSS is the world's leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 16th consecutive year), No. 3 in rheumatology by U.S. News World Report (2025-2026), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News World Report "Best Children's Hospitals" list (2024-2025). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fifth consecutive year (2025). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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