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Acupuncture and acupressure points correlate well with sites on the body that have low transcutaneous electrical resistance (TER). Using lightly sedated, adult Sprague-Dawley rats, we identified an acupoint (i.e. site with low TER) located on the hind limb of the rat and compared the effects of acupressure at this site on the nociceptive threshold to an adjacent, non-acupoint site (i.e. site with high TER). Focal pressure (55.42±2.2 g) was applied to the site for 10 minutes and the tail flick response (TFR) was determined by draping the distal portion of the tail over a heated wire (75±5°C). Three trials were performed during each of three randomized conditions (i.e. acupoint, placebo and control) and the trials were averaged. All rats tested (5/5) showed a statistically significant increase in TFR following 10 minutes of acupressure at the acupoint compared to placebo or control trials (p=0.007). Acupressure at the placebo point resulted in a TFR that was not statistically different from the control. Systemic administration of naloxone completely abolished the tail-flick inhibition induced by acupressure at the acupoint. These data suggest that acupressure elicits an antinociceptive effect in rats that is mediated by the endogenous release of opioids.

Background: Opioids are frequently used for pain control after carpal tunnel release (CTR). However, few studies have examined whether the use of opioids is necessary for pain control after CTR. The aim of this study is to compare the effectiveness of codeine versus paracetamol for pain control after CTR.

Methods: This is a prospective comparison of consecutive patients’ subjective perception of pain after outpatient CTR. Patients were randomised to receive either codeine or paracetamol for pain control after CTR. Visual analogue scale for pain of both groups was compared on the day of surgery and the first three post-operative days (POD) using non-inferiority test.

Results: In the codeine group, the mean pain score was 5.2, 4.0, 2.6 and 1.6 on the day of surgery and the first, second and third days after surgery, respectively. In the paracetamol group, the mean VAS score in the same period was 4.3, 3.5, 2.8 and 2.3. There was no significant difference in the mean visual analogue pain scores between the two groups from the day of surgery to the third POD.

Conclusions: Paracetamol was as effective as codeine for relieving the pain after outpatient CTR. Our results suggest that the clinicians might avoid unnecessary prescription of the opioid after outpatient CTR.

Level of Evidence: Level III (Therapeutic)