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Jiang SL, Jiang XM, Zheng QX, Liu XW. Auricular bean embedding improves urination in epidural labor analgesia: A single center randomized controlled study. Technol Health Care 2023:THC220660. [PMID: 36776083 PMCID: PMC10357180 DOI: 10.3233/thc-220660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Acupoint buried beans on the auricle is a feasible method to prevent and treat postpartum urinary retention. OBJECTIVE This study investigated the effect of auricular acupoint buried beans on postpartum urination and maternal and fetal outcomes following epidural analgesia for labor. METHODS Two hundred forty primiparas underwent vaginal trial labor analgesia from May 2020 to January 2021 and were randomly placed into the intervention and control groups. Both groups received epidural labor analgesia. Maternal urination during labor, 2 h postpartum, and the time for first postpartum urination were recorded as primary outcomes, with maternal and infant outcomes documented as secondary results. Statistical analysis was performed using the independent sample t-test, non-parametric rank-sum, or chi-square test using the SPSS Statistics 25.0 software. RESULTS Two hundred eight study participants were subsequently included in the results, i.e., 105 patients in the intervention group and 103 in the control group. The intervention group comprised a significantly lower number of patients with excessive residual urine volume at cervical dilatation of 5-6 cm (P< 0.05). The total postpartum score of the intervention group was lower than in the control group (P< 0.01), and the time to first urination was shorter compared with the control group (P< 0.05). In the intervention group, the time of labor analgesia, the duration of the first stage of labor, and the total labor time were shorter compared with the control group (P< 0.01). CONCLUSION Auricular acupoint embedded beans can improve the urination status at cervical dilatation of 5-6 cm and 2 h postpartum, as well as significantly shorten the duration of labor.
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Affiliation(s)
- Sheng Li Jiang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.,Labor Room, School of Nursing, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics, Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu Min Jiang
- Nursing Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics, Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Xiang Zheng
- Nursing Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics, Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu Wu Liu
- Labor Room, School of Nursing, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics, Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
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The Effect of Auriculotherapy on Situational Anxiety Trigged by Examinations: A Randomized Pilot Trial. Healthcare (Basel) 2022; 10:healthcare10101816. [DOI: 10.3390/healthcare10101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Auriculotherapy may activate the parasympathetic nerve system and reduce anxiety levels. Short-term auriculotherapy’s effects and safety on university students’ anxiety levels was assessed prior to exams. Methods: A randomized, controlled pilot trial was conducted. The day before the exam, university students were randomly allocated to the auriculotherapy group (AA, n = 13) or the waiting-list group (WG, n = 13). Baseline measures were taken 4 weeks before the exam at Time point (TP 0); at 7.30 a.m. on the day before the exam (TP I); at 11 a.m. before auriculotherapy (TP II); 30 min after AA (TP III); and at 7.30 a.m. before the exam (TP IV). The outcomes were the State-Trait-Anxiety Inventory (STAI); quality of night-sleep, Visual Analogue scale (VAS) for anxiety, and salivary cortisol. Adverse events were also recorded. Results: A total of 26 students participated in this study and became more anxious as assessed by STAI in TPII (p = 0.002) and TPIV (p = 0.000) than TP0. AA reduced the STAI in TPIII (p = 0.045) and PIV (p = 0.001) and the VAS (p = 0.012) in TPIV. Cortisol was reduced in TPIII (p = 0.004), and the AA slept better (p = 0.014) at TPIV. Discomfort at the auricular site was reported in only one AA participant. Conclusions: Auriculotherapy appeared safe and effective in reducing anxiety levels before university exams.
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Ketamine Compared With Fentanyl for Surgical Abortion: A Randomized Controlled Trial. Obstet Gynecol 2022; 140:461-469. [PMID: 35926204 DOI: 10.1097/aog.0000000000004903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare patient satisfaction with anesthesia after first-trimester surgical abortion among patients receiving intravenous (IV) ketamine compared with IV fentanyl for procedural sedation. METHODS This was a randomized noninferiority trial comparing IV ketamine to IV fentanyl for first-trimester surgical abortion up to 13 6/7 weeks of gestation. Patients were randomized to receive either ketamine 200-500 micrograms/kg IV over 2 minutes, repeated every 5 minutes until appropriate analgesia was achieved, or fentanyl 0.5-1 micrograms/kg IV over 2 minutes, repeated every 5 minutes until appropriate analgesia was achieved. All patients received midazolam 2 mg IV. The primary outcome, patient satisfaction, was measured using the Iowa Satisfaction with Anesthesia Scale immediately postprocedure. Secondary outcomes included postoperative pain, additional pain medication necessary during the procedure and on discharge, physician satisfaction, and time to discharge. We calculated a sample size of 84 with a noninferiority margin of 0.6 on the Iowa Satisfaction with Anesthesia Scale with 80% power, one-sided type 1 error of 0.025, and further increased this number to 110 to account for potential dropout. RESULTS From April to October 2021, 184 patients were screened and 110 were randomized (57 to ketamine and 53 to fentanyl). Demographics were similar between groups. The primary outcome, patient satisfaction with anesthesia, was noninferior in the ketamine group (mean score 2.4, SD 0.8) as compared with the fentanyl group (mean score 2.2, SD 0.9) with a risk difference of 0.20 (95% CI 0.11-0.52). More hallucinations were reported in the ketamine group. Otherwise, secondary outcomes were similar between the groups. CONCLUSION Compared with IV fentanyl, IV ketamine is noninferior for patient satisfaction with anesthesia when used for procedural sedation for first-trimester outpatient surgical abortion. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT04871425.
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Vieira A, Moreira A, Machado JP, Robinson N, Hu XY. Is auriculotherapy effective and safe for the treatment of anxiety disorders? – A systematic review and meta-analysis. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Moayedi G, Stevens K, Fontanilla T, Tschann M, Bednarek PH, Salcedo J, Kaneshiro B, Soon R. Intranasal Fentanyl for First-Trimester Uterine Aspiration Pain:A Randomized Controlled Trial. Contraception 2022; 113:101-107. [PMID: 35472333 DOI: 10.1016/j.contraception.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether administration of intranasal fentanyl reduces reported pain during first-trimester uterine aspiration. STUDY DESIGN We conducted a multicenter, randomized, double-blind, placebo-controlled trial of patients with pregnancies less than or equal to 14 weeks gestation seeking uterine aspiration for induced abortion, early pregnancy loss, or failed medication abortion. We randomized participants 1:1 to either intranasal fentanyl 100 mcg or intranasal placebo. All participants received ibuprofen and a standardized paracervical block. The primary outcome was pain indicated at the time of uterine aspiration on a 100 mm visual analog scale (VAS). We designed the study to detect a 15 mm difference in mean pain scores, which required 53 people in each arm for a total of 106 participants. Secondary outcomes included post-procedure pain and patient satisfaction with pain control. RESULTS From March 2017 through June 2018, we screened 355 people for eligibility and enrolled 107 participants. Those who received intranasal fentanyl reported similar uterine aspiration pain to participants receiving placebo (58.4±28.0 fentanyl vs 58.6±24.5 placebo, p=0.97). Participants receiving intranasal fentanyl also reported similar post-procedure pain scores compared to participants receiving placebo (19.1±19.4 fentanyl vs 17.2±19 placebo, p=0.63), and were equally satisfied with procedure pain control (66.8±31.2 fentanyl vs 63.3±29.2 placebo, p=0.57). CONCLUSION Intranasal fentanyl did not decrease reported pain with first-trimester uterine aspiration, nor did it decrease post-procedure pain compared to placebo. As an adjunct to ibuprofen and paracervical block, intranasal fentanyl did not improve patient satisfaction with pain control.
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Affiliation(s)
- Ghazaleh Moayedi
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826.
| | - Katelyn Stevens
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Tiana Fontanilla
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Mary Tschann
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Paula H Bednarek
- Department of Obstetrics and Gynecology, Oregon Health & Science University; 3181 SW Sam Jackson Park Rd; Portland, OR, 97239; Planned Parenthood Columbia Willamette; 3727 NE Martin Luther King Jr Blvd; Portland, OR, 97212
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
| | - Reni Soon
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine; 1319 Punahou St #824; Honolulu, HI, 96826
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Ng DYT, Lo A, So EWS, Wong GCY, Li RHW, Wong YY, Ng EHY. A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia. Acupunct Med 2021; 40:224-231. [PMID: 34894771 DOI: 10.1177/09645284211057567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. METHODS In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. RESULTS The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). CONCLUSION Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.
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Affiliation(s)
- Dorothy Yuet Tao Ng
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
| | - Alexandra Lo
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
| | - Emily Wing Sze So
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
| | | | - Raymond Hang Wun Li
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
| | - Yu Yeuk Wong
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong
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Abstract
PURPOSE OF REVIEW To review the current literature focusing on pain management and experiences during abortion care. RECENT FINDINGS Analgesic options in abortion care address pain associated with the procedure, osmotic dilator insertion, and cervical preparation. The paracervical block (PCB) is effective for pain control in first and second trimester abortions. Lower volume PCBs demonstrate non inferiority with osmotic dilator placement compared with higher volume PCBs with lower potential for toxicity. Self-administered vaginal lidocaine gel is noninferior to PCB in first trimester abortions. Preoperative oral narcotics and sedation do not reduce pain in first trimester abortions; however, the latter may reduce anxiety. For second trimester abortions, narcotics or gabapentin do not improve postoperative pain, yet up to half of patients will use narcotics if offered. Nonpharmacological methods have shown success in pain management. Music and doula support do not improve pain; however, patients would recommend these modalities, indicating some benefit that went unmeasured. Auricular acupuncture and transcutaneous electrical nerve stimulation (TENS) reduce pain and anxiety during first trimester abortions. SUMMARY Several modalities reduce pain during abortion care; however, pain alone does not reflect patient satisfaction. Development of multidimensional measures for pain control assessment has the potential to capture the patient's overall experience.
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Wang XQ, Xiao L, Duan PB, Xu Q, Yang LH, Wang AQ, Wang Y. The feasibility and efficacy of perioperative auricular acupuncture technique via intradermal needle buried for postoperative movement-evoked pain after open radical gastrectomy: A randomized controlled pilot trial. Explore (NY) 2021; 18:36-43. [PMID: 34642104 DOI: 10.1016/j.explore.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Auricular acupuncture is widely used in the treatment of pain. Recently, the most commonly used method of auricular acupuncture is to embed an intradermal needle into the skin to enhance analgesia through continuous stimulation. We aimed to explore the efficacy and feasibility of this form of auricular acupuncture in the treatment of postoperative movement-evoked pain. METHODS This single-blind randomized controlled pilot trial was conducted between 23/8/2019 and 10/1/2020. Forty patients were recruited and randomised to either the control group (n = 20) or the experimental group (n = 20). Patients in the control group received sham auricular acupuncture, while patients in the experimental group received auricular acupuncture. A standard routine analgesia was performed in both groups. The patients with NRS score≥4 were given rescue analgesia. Postoperative pain, use of opioids and other analgesics, postoperative recovery and patient's satisfaction were recorded. RESULTS The credibility and feasibility of auricular acupuncture for postoperative pain were high in both groups. After auricular acupuncture, the scores of the postoperative movement-evoked pain had a tendency to decrease, but no significant difference was observed between two groups at any time point (P = 0.234∼0.888). The data on postoperative pain at rest confirmed that no significant difference was observed between two groups within 48 h of surgery (P = 0.134∼0.520), and the postoperative pain at rest scores decreased over time; however, from the third day, the pain at rest scores of the experimental group were decreased, and significant differences were observed between the two groups (P = 0.039∼0.047). As for use of rescue analgesic, total opioid consumption and the incidence of postoperative nausea and vomiting, there were no significant differences between the two groups (P = 0.311, P = 0.101, P = 0.661) . In terms of patients' satisfaction, the score of the experimental group was higher than that of the control group, and a significant difference was observed between the two groups (P = 0.000). As for adverse events, two participants reported pain and one patient reported discomfort at the insertion sites during the process of auricular acupuncture intervention, but they both were minor and tolerable. CONCLUSION Auricular acupuncture may have a relief effect on mild postoperative pain at rest with pain score below 3, suggesting that it may be a feasible adjuvant method to relieve mild pain at rest. However, more multi-centre and large-sample studies are needed to verify this result.
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Affiliation(s)
- Xiao-Qing Wang
- Department of surgical oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, Jiangsu 210029, China.
| | - Lei Xiao
- Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, Jiangsu 210029, China.
| | - Pei-Bei Duan
- Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, Jiangsu 210029, China.
| | - Qian Xu
- Anesthesiology and Pain Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, Jiangsu 210029, China.
| | - Li-Hua Yang
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, Jiangsu 210029, China,.
| | - A-Qin Wang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, Jiangsu 210046, China.
| | - Yan Wang
- Department of Nursing, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing, Jiangsu 210029, China.
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Jan AL, Aldridge ES, Visser EJ, Rogers IR, Hince DA, Woosey MV, Bulsara MK, Suen LK. Battlefield acupuncture added no benefit as an adjunct analgesic in emergency department for abdominal, low back or limb trauma pain. Emerg Med Australas 2021; 33:434-441. [PMID: 32969169 DOI: 10.1111/1742-6723.13642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To ascertain whether ear acupuncture (modified Battlefield technique) as an adjunct (Adj-BFA) to standard analgesia care (SAC) significantly reduces pain scores compared with sham acupuncture (Adj-Sham) or SAC alone, when delivered by medical and nursing practitioners in an ED. METHODS A randomised controlled trial using a convenience sample of 90 patients attending an ED with acute abdominal, limb trauma or low back pain were allocated to three treatment arms: Adj-BFA, Adj-Sham and SAC. The primary outcome of change in pain scores out-of-10 (NPRS-10) from triage were assessed immediately after intervention and at 1 and 2 h post-intervention. Secondary outcomes were the percentage of patients reporting 'adequate analgesia' or ≥30% reduction in pain score, analgesic medication use (in morphine equivalent dose [milligrammes]), analgesics and needle costs (Australian dollars), adverse effects and patient satisfaction (Likert scale). RESULTS There was no significant difference in pain scores (P = 0.582) or secondary outcomes measures between Adj-BFA, Adj-Sham and SAC. CONCLUSION The present study on 90 patients did not show a significant difference in analgesia outcomes in the first 2 h using Adj-BFA for acute pain in the ED, and there were no significant differences for secondary outcomes between treatment arms. Given the mixed results of recent BFA trials, further research using the original BFA technique on different painful conditions, as either stand-alone or as-adjunct to non-opioid analgesia are needed before BFA can be recommended as a technique for acute pain management in the ED.
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Affiliation(s)
- Andrew L Jan
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Emogene S Aldridge
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Eric J Visser
- Chronic Pain Education and Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Ian R Rogers
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Dana A Hince
- Department of Biostatistics, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Michael V Woosey
- Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Max K Bulsara
- Department of Biostatistics, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Lorna Kp Suen
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Hou X, Xiong W, Lin X, Zhu Y, Yang R, Huang J, Chen Z, Ma H. Auricular acupuncture for shoulder pain: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25666. [PMID: 33907132 PMCID: PMC8084003 DOI: 10.1097/md.0000000000025666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Shoulder pain is a common problem in outpatient medical practice. Recent studies show that acupuncture has therapeutic effect on releasing symptoms of shoulder pain. The aim of this systematic review and meta-analysis is to access the efficacy and safety of auricular acupuncture for shoulder pain. METHODS Eight databases will be searched for randomized controlled trials of auricular acupuncture in the treatment of shoulder pain with retrieval time up to September 2020, including PubMed, Embase, The Cochrane Library, Web of science, CNKI, VIP, CBM, and Wangfang Data databases. We will evaluate the methodological quality of the included studies by using Cochrane Risk of Bias tool and conduct data analysis with Review Manager Software. RESULTS The results of this study will be disseminated through a peer-reviewed journal publication. CONCLUSION The systematic review will provide up-to-date evidence for the efficacy and safety of auricular acupuncture in treating shoulder pain. PROSPERO REGISTRATION NUMBER CRD 42021238797.
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Affiliation(s)
| | | | | | - Yu Zhu
- Nanchang Hongdu Hospital of TCM
| | - Ruifeng Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | | | - Ziyin Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Complementary and Alternative Medicine for Threatened Miscarriage: Advantages and Risks. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021. [DOI: 10.1155/2021/5589116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Threatened miscarriage is one of the most common complications causing pregnancy loss, and it affects approximately 20% of confirmed pregnancies. More and more women are seeking treatment with complementary and alternative medicine (CAM) for this common complication, and it has been reported that women have had successful pregnancies after threatened miscarriage when being treated with CAM, which mainly includes Chinese herbal medicines, acupuncture, and nutritional supplements as well as psychological interventions and other approaches. However, many experts are concerned about the safety and adverse events of certain CAM approaches in women with threatened miscarriage. Therefore, this review focuses on the status of CAM for threatened miscarriage and presents the potential therapeutic efficacy and safety of CAM based on some clinical and experimental studies. We thus hope to provide some instructive suggestions for the application of CAM for treating threatened miscarriage in the future.
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Oviedo JD, Marquez E, Gold MA, Westhoff CL. Auricular acupressure and auricular acupuncture as an adjunct for pain management during first trimester aspiration abortion: A randomized, double-blinded, three-arm trial. Contraception 2021; 103:342-347. [PMID: 33607119 DOI: 10.1016/j.contraception.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To measure pain and anxiety during first trimester uterine aspiration when using auricular acupressure or acupuncture as an adjunct to usual care. METHODS This randomized, double-blinded, three-arm trial enrolled patients undergoing an aspiration procedure for an induced abortion, a miscarriage, or other abnormal intrauterine pregnancy. Trial participants received auricular acupressure, auricular acupuncture, or placebo immediately prior to their procedures. The study began with 1:1:1 randomization, but later overenrolled into the acupressure group after providing retraining for greater fidelity to that intervention. All participants received ibuprofen and a paracervical block. Participants reported pain and anxiety levels via visual analog scores (0-100). Our analysis compared pain scores of those receiving acupressure versus placebo, and those receiving acupuncture versus placebo. RESULTS We randomized 177 participants over nine months and excluded data from four participants. We analyzed data from 70 participants who received acupressure, 51 who received acupuncture, and 52 who received placebo. The groups had similar baseline characteristics, including baseline pain and anxiety scores. For acupressure, acupuncture, and placebo groups, respectively, immediate post-procedure median pain scores were 50, 55, 47.5 (p = 0.88); maximum pain scores during the procedure were 77, 79, 79.5 (p = 0.96); postprocedure anxiety scores were 26, 28, and 21 (p = 0.47). The acupressure group results were similar before and after retraining. CONCLUSIONS Receiving auricular acupressure or acupuncture did not result in lower pain or anxiety scores among women undergoing vacuum aspiration compared to a placebo group. IMPLICATIONS The results of this trial were null, thus differing from our previous study that had shown a benefit from auricular acupuncture. Given the conflicting results, incorporating these acupuncture techniques into abortion practice would be premature.
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Affiliation(s)
- Johana D Oviedo
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (CUIMC), NY, United States
| | - Emma Marquez
- Mailman School of Public Health, CUIMC, NY, United States
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, CUIMC, NY, United States; Department of Pediatrics, CUIMC, NY, United States
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (CUIMC), NY, United States; Mailman School of Public Health, CUIMC, NY, United States; Heilbrunn Department of Population & Family Health, Mailman School of Public Health, CUIMC, NY, United States.
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Westhoff CL, Nelson IS, Suarez-Rodriguez A, Gold MA. Auricular acupressure and acupuncture as adjuncts for pain management during first trimester medication abortion: A randomized three-arm trial. Contraception 2020; 103:348-355. [PMID: 33340496 DOI: 10.1016/j.contraception.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To measure pain during first trimester medication abortion using auricular acupressure or auricular acupuncture as an adjunct to pain management. We measured anxiety as a secondary outcome. STUDY DESIGN This randomized, double-blinded, 3-arm trial enrolled women seeking medication abortion with mifepristone and misoprostol. Participants received auricular acupressure, auricular acupuncture, or inert auricular placebo patches immediately after receiving mifepristone. In addition, all participants received ibuprofen to use at home as needed. The study started with 1:1:1 randomization, but later overenrolled into the acupressure group after retraining for greater fidelity to that intervention. Participants reported pain and anxiety using numeric rating scales via text message for 4 days, and using a visual analog scale at follow-up. Analyses compared median pain scores of those receiving acupressure, acupuncture, or placebo. RESULTS We randomized 136 participants of whom 57 received acupressure, 40 received acupuncture, and 39 received placebo. Groups had similar baseline characteristics. One hundred thirty-two participants (97%) reported outcomes by text message and 120 (88%) completed a follow-up interview. For acupressure, acupuncture and placebo groups the median maximum pain scores reported via text message were 60.0, 75.0, and 55.0 (p = 0.38); median maximum pain scores reported at follow-up were 76.5, 60.0, and 71.0 (p = 0.97), respectively. Acupressure results were similar before and after retraining. Maximum anxiety scores reported via text message were 10.0, 45.0, and 30.0 (p = 0.57). Maximum anxiety scores reported at follow-up were 10.5, 20.0, and 13.0 (p = 0.59). CONCLUSIONS Pain and anxiety during medication abortion were similar among women receiving acupressure, acupuncture or placebo. IMPLICATIONS We found no benefit in administering auricular acupressure or auricular acupuncture during medication abortion. These modalities are intended to be simple to use, but perhaps the brief provider training for this study was insufficient. These modalities should not be used in clinical practice without further study.
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Affiliation(s)
- Carolyn L Westhoff
- Department of Ob-Gyn, Columbia University Irving Medical Center (CUIMC), New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, CUIMC, New York, NY, United States; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, CUIMC, New York, NY, United States.
| | - Isabel S Nelson
- Department of Epidemiology, Mailman School of Public Health, CUIMC, New York, NY, United States
| | - Anderson Suarez-Rodriguez
- Department of Ob-Gyn, Columbia University Irving Medical Center (CUIMC), New York, NY, United States
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, CUIMC, New York, NY, United States; Department of Pediatrics, CUIMC, New York, NY, United States
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Chin J, Kaneshiro B, Elia J, Raidoo S, Savala M, Soon R. Buffered lidocaine for paracervical blocks in first-trimester abortions: a randomized controlled trial. Contracept X 2020; 2:100044. [PMID: 33196038 PMCID: PMC7644856 DOI: 10.1016/j.conx.2020.100044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective was to evaluate if buffered lidocaine decreases injection pain as compared to plain lidocaine for paracervical blocks during first-trimester outpatient surgical abortions. Study design We conducted a randomized, double-blind, placebo-controlled trial among women undergoing outpatient uterine aspiration of a first-trimester pregnancy or an early pregnancy loss. Subjects received a paracervical block with either lidocaine 1% 20 mL or lidocaine 1% 18 mL plus sodium bicarbonate 8.4% 2 mL. The primary outcome was pain from injection of the paracervical block measured on a 100-mm visual analog scale (VAS). Secondary outcomes included pain after cervical dilation, uterine aspiration and overall satisfaction with pain control. Scores were compared using the Mann–Whitney U test. We aimed to detect a 15-mm difference in pain from injection of the paracervical block. Results From May 2017 to October 2018, 48 women received plain lidocaine and 50 women received buffered lidocaine. Groups were similar in demographics. We found no clinically or statistically meaningful difference in pain when evaluating median VAS scores for paracervical block injection between the buffered and plain lidocaine [30.0 (interquartile range (IQR) 15.3–64.5); 44.5 (IQR 18.3–65), respectively, p = .32]. We found no difference in secondary outcomes between buffered and plain lidocaine. Conclusion Buffered lidocaine for paracervical blocks in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine. Implications statement Buffering the paracervical block in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine, nor does it increase patient satisfaction. Eliminating sodium bicarbonate allows for a more cost-effective and readily available solution for paracervical blocks.
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Affiliation(s)
- Jennifer Chin
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Bliss Kaneshiro
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Jennifer Elia
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Shandhini Raidoo
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Michael Savala
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Reni Soon
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
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15
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Jan AL. Lessons Learned in Teaching Battlefield (Ear) Acupuncture to Emergency Medicine Clinicians. Med Acupunct 2020; 32:253-262. [PMID: 33101569 DOI: 10.1089/acu.2020.1436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Acupuncture, in general, is being proclaimed as an alternative analgesic amid the opioid crisis, and along with this, within emergency departments (EDs) there is a specific interest in a form of ear acupuncture called Battlefield Acupuncture (BFA). It is expected that BFA will be used more widely in emergency medicine as it is easy to learn and can be applied both promptly and easily. Teaching programs will be required to sustain this increased demand and upskill emergency clinicians in this skill. Objectives: This article provides experiences and recommendations, based on faculty experiences from teaching BFA in Australia to ED clinicians combined with formal participant feedback. Main Points: BFA courses were adjusted to suit ED doctors and nurses, along with their unique case mix and associated challenging environment. The content of the BFA courses included evidence, pain indications, contraindications, application, safety, mechanism of action, and how to negotiate barriers of credentialing. Workshops used the latest and most effective teaching methods that encompassed problem-based learning, infotainment, simulation, "four stage skills teaching," and "teaching on the run." Conclusion: It is hoped that the experiences gained, and lessons learned in educating this new frontier of BFA to emergency clinicians will assist others in teaching BFA and its related techniques as a viable analgesic alternative in emergency medicine.
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Affiliation(s)
- Andrew L Jan
- School of Medicine, University of Notre Dame, Fremantle, Australia.,Emergency Department, St. John of God Murdoch Hospital, Murdoch, Australia
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Peterson SF, Lerma K. Advances in abortion care technology and management. Curr Opin Obstet Gynecol 2020; 32:424-430. [PMID: 32769804 DOI: 10.1097/gco.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review emerging evidence specific to abortion care, including diagnostic testing and pain management. RECENT FINDINGS Recent advances in abortion care include improvements in gestational age dating, Rh status testing, and pain management methods. When ultrasound technology is available, the use of crown-rump length (CRL)-based dating is more accurate up to 13 weeks and composite CRL and biometry between 13 and 14 weeks. Evidence supports using updated fetal foot length-to-gestational age reference ranges for postprocedure gestational age confirmation. Serum tests for two placental proteins, pregnancy-associated plasma protein A and a disintegrin and metalloproteinase 12, show potential for identifying pregnancies with gestational age more than 70 days. Early research using flow cytometry demonstrates that fetal RBC exposure after first-trimester uterine aspiration is insufficient to cause maternal Rh-sensitization, supporting elimination of Rh testing and anti-D-immunoglobulin provision prior to 8 weeks gestation. Recent studies exploring pain management strategies have not generated a standardized approach. Auricular acupuncture appears to be promising. SUMMARY Emerging data on improvements in gestational age dating and eliminating laboratory testing prior to early abortion procedures could have important implications for expanding access to early abortion care and telemedicine. Person-centered, novel pain management modalities, such as auricular acupuncture, help to improve client experience, by addressing both pain and anxiety.
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Affiliation(s)
- Sarah F Peterson
- Department of Obstetrics and Gynecology, Division of Family Planning Services and Research, School of Medicine, Stanford University, Stanford, California, USA
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