Can ear acupuncture during hip replacement surgery reduce opioid use and speed recovery?

Why are researchers testing ear acupuncture as a tool for reducing opioid use after hip replacement surgery?

Hospital for Special Surgery (HSS), the New York-based orthopedic medical center ranked number one in the U.S. for orthopedics, presented three new studies at the 42nd Annual Congress of the European Society of Regional Anaesthesia and Pain Therapy (ESRA) in Oslo, Norway. The research focused on whether ear acupuncture could meaningfully reduce post-operative opioid consumption among hip replacement patients.

The timing of these findings is significant. Hip replacement surgery is among the most common orthopedic procedures worldwide, and concerns about opioid dependence have pressured health systems to seek safer, non-pharmacological pain management alternatives. By investigating ear acupuncture, HSS has positioned itself at the forefront of integrating complementary medicine into mainstream surgical practice.

What is the CHENG Protocol and how does it differ from traditional acupuncture methods?

The trials tested a method known as the CHENG Protocol, developed by anesthesiologist and medical acupuncturist Dr. Stephanie Cheng. The protocol involves inserting acupuncture needles into eight specific points on the outer ear once the patient is under anesthesia. A mild electrical current is then applied to the needles for one hour, a technique known as electroauricular acupuncture (EAA).

Unlike traditional acupuncture, which is often performed for generalized wellness or pain relief, this method is precisely timed and targeted to coincide with surgery. According to Dr. Cheng, the electrical stimulation enhances the release of endorphins while reducing inflammatory proteins, both of which are thought to reduce pain perception.

HSS has been piloting this technique since 2018 and now routinely offers it for hip and knee replacements, and in some cases for other surgeries by patient request. The hospital has also begun training anesthesiologists in the protocol through accredited programs.

How did ear acupuncture affect opioid use and pain in inpatient and outpatient hip replacement cases?

One of the retrospective studies reviewed more than 2,193 inpatient and 1,075 outpatient hip replacement procedures performed at HSS between 2021 and 2025. Patients who received the CHENG Protocol were compared against those who underwent standard anesthesia with nerve blocks but without acupuncture.

Among inpatients, those who received ear acupuncture required fewer opioids after surgery, reported lower pain scores, and were discharged an average of nine hours earlier. These differences were not consistently observed in outpatient cases, though the researchers noted that faster discharge trends were more visible among those who experienced less pain.

The results suggest that the approach could complement enhanced recovery after surgery (ERAS) protocols, which prioritize shorter hospital stays and reduced reliance on narcotics.

What do the findings mean for opioid-tolerant patients undergoing hip replacement surgery?

A second study presented at ESRA specifically examined opioid-tolerant patients, a population often difficult to manage post-surgery due to pre-existing dependence. The team reviewed 2,372 elective inpatient hip replacement records between 2021 and 2025, comparing outcomes with and without the CHENG Protocol.

Patients who were already opioid-tolerant and received ear acupuncture required significantly fewer opioids after their operations. In contrast, opioid-naïve patients did not show substantial differences. The results carry weight for surgeons and anesthesiologists struggling to balance effective pain control with the risks of long-term opioid use.

Institutional sentiment indicates that such non-pharmacological strategies are being closely monitored, as they could become valuable tools in lowering opioid prescribing rates across orthopedic surgery practices.

How effective was ear acupuncture in prospective clinical trials for outpatient surgery settings?

The third study, a prospective randomized clinical trial, tracked 484 outpatient hip replacement patients. All participants received standard anesthesia and pain relief protocols, but only half were treated with the CHENG Protocol.

Patients who underwent ear acupuncture reported significantly lower pain levels in the recovery room and on the following day. They also required fewer opioids in the immediate recovery period, with a downward trend in opioid usage in the weeks after surgery.

This study was selected as one of the top 100 abstracts at the upcoming American Association of Hip and Knee Surgeons annual meeting in Dallas, highlighting its clinical and academic relevance.

For outpatient surgery, which is increasingly common due to cost pressures and patient preference, methods that reduce post-operative complications are highly sought after. Acupuncture could become a differentiator in hospital protocols that aim to improve patient experience while reducing medication reliance.

What institutional and expert perspectives are shaping adoption of acupuncture in surgical recovery programs?

Analysts and healthcare professionals observing the studies suggest that while acupuncture is still viewed by some as complementary or alternative medicine, its incorporation into structured recovery protocols gives it a new legitimacy. The evidence of reduced opioid consumption in both inpatient and outpatient settings aligns with broader healthcare strategies to combat opioid misuse.

Institutional sentiment reflects cautious optimism. Payers, hospitals, and policymakers are keen to see interventions that reduce hospital stays and cut down pharmacy costs without compromising pain control. However, wider adoption will require additional prospective trials, consistent training of anesthesiologists, and regulatory clarity on certification requirements.

How might acupuncture fit into the future of orthopedic surgery and pain management protocols?

Looking ahead, hospitals are expected to monitor outcomes from centers like HSS closely before expanding acupuncture protocols more broadly. As enhanced recovery pathways evolve, interventions that reduce opioid use while supporting faster mobilization and shorter hospital stays are likely to gain favor.

The simplicity of the CHENG Protocol—eight needles at minimal cost and a short electrical stimulation cycle—makes it accessible even to high-volume surgical centers. Institutional investors and healthcare systems see potential in its scalability, though integration into national guidelines will take time.

For patients, the approach may offer a safer path to recovery without the lingering concerns tied to opioid dependency. For hospitals, it could provide an additional layer of value-based care, helping align clinical outcomes with financial incentives tied to lower readmission and complication rates.

Looking ahead, hospitals are expected to monitor outcomes from centers like HSS closely before expanding acupuncture protocols more broadly. As enhanced recovery pathways evolve, interventions that reduce opioid use while supporting faster mobilization and shorter hospital stays are likely to gain favor.

The simplicity of the CHENG Protocol—eight needles at minimal cost and a short electrical stimulation cycle—makes it accessible even to high-volume surgical centers. Institutional investors and healthcare systems see potential in its scalability, though integration into national guidelines will take time.

For patients, the approach may offer a safer path to recovery without the lingering concerns tied to opioid dependency. For hospitals, it could provide an additional layer of value-based care, helping align clinical outcomes with financial incentives tied to lower readmission and complication rates.

Beyond orthopedics, experts suggest that similar electroauricular acupuncture techniques could eventually be tested in other surgical specialties such as cardiac, spine, or abdominal procedures, where post-operative pain management remains a challenge. If results prove consistent, the method could transform perioperative pain care across multiple disciplines, positioning acupuncture not just as a complementary therapy but as an integral component of modern surgical recovery.