(P 312) APOSST: A PROSPECTIVE TRIAL TO EVALUATE ACUPUNCTURE AFTER SURGERY OF EXTREMITY SOFT TISSUE TUMORS

Author(s)

Jens Jakob, MD (he/him/his)

Consultant Sarcoma Surgeon
Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany

Co-Author(s)

EG

Erfan Ghanad, MD

Pain Centre, Department of Anesthesiology and Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
HF

Hannah Fischer, Cand. Med.

Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
CW

Christel Weiss, MD

Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
MD

Martin Dusch, MD

Pain Centre, Department of Anesthesiology and Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
Franka Menge, MD

Dr.
Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
HW

Helene Weigl, MD (she/her/hers)

Oncological Surgeon
Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
CR

Christoph Reissfelder, MD

Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany
CY

Cui Yang, MD

Department of Surgery, Medical Faculty Mannheim, Mannheim School of Medicine, Heidelberg University
Mannheim, Baden-Wurttemberg, Germany

Objective: There is little prospective data available on acute pain management after resection of soft tissue tumors (STT). Current pain management guidelines recommend pharmacological treatment but also highlight the importance of non-pharmacologic therapies. The primary aim of the APOSTT Trial was to investigate the effect of acupuncture on pain relief after STT surgery of the extremities (German Clinical Trials Register identifier DRKS00032703).

Methods: This prospective single-arm, single-centre study included 25 patients who underwent surgery of soft tissue tumors (STT) of the extremities. Standard pain management regimen consisted of orally administered dipyrone (metamizole, 4x1g) or acetaminophen (paracetamol, 4x1g) plus ibuprofen (4x400mg). Additional opioids were prescribed upon request. Acupuncture was performed on the first postoperative day (POD). We assessed feasibility of postoperative acupuncture, postoperative pain intensity via numeric pain scale, and extremity function and quality of life using validated questionnaires.

Results: Twenty-five patients (median age 68years) were included. Tewenty-two of 25 (88%) tumors were malignant. Twenty-one of 25 (84%) tumors were located in the lower extremity. The median tumor size was 8.5 cm. Acupuncture was administered on POD 1 in all cases. In 8 of 25 (32%) patients, optimal acupuncture point selection was limited due to patient positioning and presence of surgical drainages or wound dressings. Postoperative pain was low (median NRS 3 on POD 1). The lowest pain scores were documented on POD 2. Opioid prescriptions declined over time. Six patients had wound complications; wound healing disorders were not related to acupuncture in any case.

Conclusion: In general, pain levels and opioid use after STT resection were rather low. Acupuncture was safe, and well accepted in the postoperative setting of STT resection. The ability to perform acupuncture at the optimal point is limited postoperatively by dressings and drains. Further randomized controlled trials are warranted to evaluate the efficacy of acupuncture in the context of STT resection.

Pain after soft tissue tumor resection
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