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LETTER TO THE EDITOR

Hemorrhage After Auricular Acupuncture due to Postoperative Dilutional Thrombocytopenia

Department of Anesthesiology and; Intensive Care Medicine; Ernst Moritz Arndt University of Greifswald; Germany; taras{at}uni-greifswald.de

To the Editor:

Auricular acupuncture offers multiple, beneficial effects for perioperative medicine (1–3). We report a case where postoperative dilutional thrombocytopenia caused bleeding at the sites of auricular acupuncture.

An otherwise healthy 78-yr-old man with hip osteoarthritis and normal preoperative coagulation tests underwent a total hip replacement. Unilateral auricular acupuncture with 0.22-gauge x 1.5 mm needles (Fig. 1A) was performed for postoperative pain relief. Four needles were placed before surgery (Fig. 1B) and left in place for 4 days.

View larger version (102K): [in this window] [in a new window]   Figure 1. Auricular acupuncture press needle (A), anatomic position of the needled points (B) with corresponding hemorrhage site (C).

Over the 12 h following surgery the patient received 7000 mL of fluids, without signs of volume overload. On the following day, he developed bleeding from the surgical field, accompanied by scrotum and ear hematomas (Fig. 1C). His platelet count was 92 x 10⁹/L (normal range 140–440 x 10⁹/L), partial thromboplastin time 48 s (normal 25–33 s) and International Normalized Ratio 1.36 (normal 1.00–1.20). The needles were immediately withdrawn, local treatment applied, and the IV fluids restricted. The following day the patient’s coagulation parameters returned to normal, and 1 wk later he was discharged with skin discolorations in the scrotal and auricular regions.

Even minimal chondral lesions might be deleterious, causing irreversible ear deformity and life-threatening infections (4,5). Auricular acupuncture with permanent needles is not recommended for patients with cardiac valve disease, diabetes mellitus, or suppressed immunity (6). Major surgery with extensive volume replacement and subsequent dilutional coagulation disorders should be considered a relative contraindication for auricular acupuncture. Daily inspection of permanent needles after surgery is recommended. Acupressure with steel spheres or auricular seeds might be optional in perioperative conditions.

REFERENCES

1. Wang SM, Peloquin C, Kain ZN. The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg 2001;93: 1178–80.[Abstract/Free Full Text]
2. Taguchi A, Sharma N, Ali SZ, et al. The effect of auricular acupuncture on anaesthesia with desflurane. Anaesthesia 2002;57:1159–63.[Web of Science][Medline]
3. Usichenko TI, Dinse M, Hermsen M, et al. Auricular acupuncture for pain relief after total hip arthroplasty – a randomized controlled study. Pain 2005;114:320–7.[Web of Science][Medline]
4. Allison G, Kravitz E. Auricular chondritis secondary to acupuncture. N Engl J Med 1975;293:780.[Web of Science][Medline]
5. Lee RJ, McIlwain JC. Subacute bacterial endocarditis following ear acupuncture. Int J Cardiol 1985;7:62–3.[Web of Science][Medline]
6. Savage Jones H. Clinical records: auricular complications of acupuncture. Acupunct Med 1988;5:25–7.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Usichenko, T. I. Articles by Lehmann, C. Search for Related Content PubMed PubMed Citation Articles by Usichenko, T. I. Articles by Lehmann, C.