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Case report
style acupuncture. Our patient was trea-
Postoperative pain management and ted by use of eight points unilateral,
connected in pairs (ST36,SP10,
acupuncture: a case report of meniscal cyst BL39,GB34, ST34,SP9, BL38,KI10)
with electrical stimulation at about
excision 25 minutes at 80 Hz/2 Hz at the highest
tolerable intensity.
Nikiforos Galanis, Chara Stavraka, Triantafyllia Boutsiadou, The needles we used (Wujiang Shen Li
Medical & Healthmaterial Co., Ltd) were
John M Kirkos, George Kapetanos sterile, disposable, with 0.2560.25 mm
gauge and inserted at a depth of 1–1.5
We report a case of pain management after a meniscal cyst excision, with the use of cun perpendicularly.
electroacupuncture (EA). There are a few reports which indicate that postoperative pain Acupuncture treatment consisted of
management is prerequisite for the patient’s optimal recovery, but surveys in the UK and the USA three sessions per week for two weeks
have identified an unacceptable prevalence of poor pain control after surgery, which might increase followed by four additional sessions, once a
the risk of a chronic pain state. The conventional treatment of postoperative pain includes systemic week, to maintain the acupuncture results.
medications such as opioids, non-steroidal anti-inflammatory drugs and other non-opioid agents. In After the first session the patient
our case, the rehabilitation lasted for 6 months without significant benefit. After that period our responded to the therapy and two ses-
patient was treated with EA. By the end of the first EA session the relief of pain was notable and sions later the pain was sufficiently
after a course of 10 treatments the patient reported complete relief of the symptoms with no reduced (at about level 2). By the comple-
recurrence during a 2 year follow up period. In conclusion, this might indicate that EA could be tion of acupuncture sessions the patient
useful for postoperative pain management. reported no further discomfort. After two
years follow-up period the patient
reported no recurrence.
CASE HISTORY Routine blood and urine examination
A 62-year-old woman was admitted to our showed no abnormalities. x Rays and MRI
hospital reporting pain varying in severity were ordered due to suspicion of either: DISCUSSION
from 6 to 8, registered using 0–10 point (1) any kind of mass as a lipoma or A meniscal cyst is a cystic lesion of the
numerical rating scale. The pain had started synovial sarcoma, (2) any kind of menis- meniscus, varying in prevalence from 1–
gradually 3 months ago and was located in cal cyst such as parameniscal or synovial 2%3 4 to 7–8%5 6 according to arthroscopic
the lateral aspect of the head of left fibula. cyst. and surgical findings. Meniscal cysts can
She described it as dull, aching and also No abnormalities were detected in the be divided into three categories: intrame-
cramping with radiation in the distribution x ray. MRI revealed a parameniscal cyst niscal, parameniscal and synovial cysts.
of the L5 dermatome. Nocturnal pain was with no serious meniscal lesion. Two days Parameniscal cysts are more common in
later our patient underwent a minimal comparison to intrameniscal and synovial
reported whilst the patient stated its
invasive excision. The cyst was removed cysts.7
aggravation during walking and remission
and the histopathological examination A number of theories regarding the
when resting. Following her GP’s prescrip-
confirmed the diagnosis. aetiology of meniscal cysts have been
tion she was under pharmacological treat-
The patient followed the conventional proposed. The most widely accepted
ment with systemic medication such as
physiotherapy and pharmacological1 2 theory describes that meniscal cysts ori-
paracetamol and non-steroidal anti-inflam-
pain control for 3 months. After that ginate from the extrusion of synovial fluid
matory drugs for the last 3 months with no
time the patient reported similar discom- through an adjacent meniscal tear.6 8–12
improvement.
fort as preoperatively. The pain initially Pain that deteriorates by activity is the
The patient’s medical history included main clinical symptom accompanying
seasonal allergic asthma under treatment intermittent, gradually became constant
and its intensity sometimes reached 8 out meniscal cysts. In our case, the severity
with desloratadine. Routine gynaecologi- of pain was affecting the quality of her
cal examination had recently revealed a of 10 (0–10 pain scale) with additional
accompanying symptoms such as numb- life. Large meniscal cysts usually appear as
unilocular ovarian cyst, 3 cm in size with painful palpable masses along the ante-
benign characteristics, requiring no treat- ness, pins and needles. The physical
examination, the postoperative MRI and rolateral aspect of the knee joint, whereas
ment. The patient also suffered from small ones can also be asymptomatic.8 13
chronic hepatitis C, with alanine amino- the electromyogram did not reveal any
abnormalities. Being disappointed about