Prevention of postoperative sore throat using capsicum plaster applied at the Korean hand acupuncture point

The effectiveness of acupuncture point stimulation for the prevention of postoperative sore throat: A meta-analysis

BACKGROUND

Enhanced recovery pathways can be further improved for postoperative sore throat (POST) that occurs after surgery under general anesthesia. Medications have shown some effectiveness in preventing POST, but acupuncture or related techniques with better safety and lower cost can be used as an alternative or adjuvant therapy to treat perioperative symptoms by stimulating acupuncture point (acupoint). Therefore, we aimed to conduct a meta-analysis to assess whether acupoint stimulation helps patients prevent POST in adults undergoing tracheal intubation for general anesthesia.

METHODS

Publications in PubMed, the Cochrane Central Register, ScienceDirect, and ClinicalTrial.gov were surveyed from January 2000 through August 2020. Studies that compared interventions between true acupoint stimulation and no or sham acupoint stimulation were included. The primary outcomes were the incidence and severity of POST at 24h.

RESULTS

Four randomized control trials and 1 comparative study involving 1478 participants were included. Compared with the no or sham acupoint stimulation, the true acupoint stimulation was associated with a reduced incidence (risk ratio, 0.32; 95% confidence interval (CI), 0.18-0.55; P < .001) and decreased severity (standardized mean difference, -2.79; 95% CI, -4.59 to - 0.99; P = .002) of POST. There were no significant adverse events related to acupoint stimulation. The finding for POST was assured by subgroup, sensitivity, and trial sequential analyses.

CONCLUSIONS

Acupoint stimulation may reduce the occurrence of POST. It can be considered as one of nonpharmacological methods to prevent POST in enhanced recovery pathways. Further rigorous studies are needed to determine the effectiveness of acupoint stimulation.

Acupuncture in Preventing Postoperative Anaesthesia-Related Sore Throat: A Comparison with No Acupuncture

Background

Postoperative sore throat occurs frequently in surgical patients as a result of tracheal intubation. Despite advances in medical and anaesthetic care, the incidence of postoperative sore throat remains high. Our study aimed to assess the efficacy of acupuncture in the prevention of postoperative sore throat following general anaesthesia.

Methods

A non-randomised clinical study (NRS) was carried out in a tertiary care hospital in Tehran, Iran on 228 consecutive patients undergoing elective surgeries under general anaesthesia. Of these, 114 patients were assigned to the acupuncture group and treated with body acupuncture at the PC6 point, while the remaining 114 patients received no preventive care and were treated with routine medical treatment where necessary. The incidence of sore throat within the first 24 h postoperatively was then compared between the two study groups.

Results

Of the 114 patients in the acupuncture group, 16 patients (14%) experienced sore throat within the first 24 h postoperatively, which was significantly lower compared to the 34 patients (29.8%) with sore throat in the medical treatment group (p<0.05). However, the frequency of patients with severe sore throat requiring medical treatment did not differ significantly (12.3% vs 16.7%, p>0.05).

Conclusions

Our study suggests that acupuncture could be considered as an option in prevention of postoperative anaesthesia-related sore throat.

Treating pediatric post-tonsillectomy pain and nausea with complementary and alternative medicine

OBJECTIVES

Although tonsillectomy is a common and largely safe procedure, pain management in children remains a controversial topic. In addition to the challenge of choosing appropriate analgesia, there is often low parent and child adherence. This article presents a review, and evaluates the potential role, of a range of complementary and alternative therapies that may be sought out by parents.

METHODS

A literature review of complementary and alternative interventions performed using PubMed, Cochrane Library, and EMBASE, supplemented by searches from Google and hand searches of cross-references of selected articles, yielded 32 studies for qualitative analysis.

RESULTS

The studies included for analysis investigated a wide variety of alternative treatment modalities: acupuncture and related therapies, aromatherapy, homeopathy, honey, intravenous fluid, speech therapy, hyaluronic acid, behavioral therapies, ice/cold, hydrogen peroxide rinse, and chewing gum.

CONCLUSION

At this time, stronger conclusions cannot be made about the therapies investigated because there are many methodology limitations of the studies analyzed. However, our results suggest merit for these treatments as adjuvant therapies that can enhance analgesia and decrease requirements of controversial medications. Honey and acupuncture have the greatest amount of evidence for postoperative pain and nausea; however, all interventions examined were cost-effective and safe. We recommend against hydrogen peroxide rinses and chewing gum. Laryngoscope, 2625-2634, 2018.

Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to evaluate the effectiveness of Acupuncture-point stimulation (APS) in postoperative pain control compared with sham/placebo acupuncture or standard treatments (usual care or no treatment). Only randomized controlled trials (RCTs) were included. Meta-analysis results indicated that APS interventions improved VAS scores significantly and also reduced total morphine consumption. No serious APS-related adverse effects (AEs) were reported. There is Level I evidence for the effectiveness of body points plaster therapy and Level II evidence for body points electroacupuncture (EA), body points acupressure, body points APS for abdominal surgery patients, auricular points seed embedding, manual auricular acupuncture, and auricular EA. We obtained Level III evidence for body points APS in patients who underwent cardiac surgery and cesarean section and for auricular-point stimulation in patients who underwent abdominal surgery. There is insufficient evidence to conclude that APS is an effective postoperative pain therapy in surgical patients, although the evidence does support the conclusion that APS can reduce analgesic requirements without AEs. The best level of evidence was not adequate in most subgroups. Some limitations of this study may have affected the results, possibly leading to an overestimation of APS effects.

Korean hand therapy for tonsillectomy pain in children

OBJECTIVES

Severe throat pain can result from tonsillectomy and last up to 10 days in children. Codeine has recently been banned by the FDA in light of a recently recognized risk of death in these patients. Acupuncture has previously been associated with decreased pain in children after tonsillectomy. However, about 1 in 5 patients will refuse traditional acupuncture because of fear of needles. We explored Korean Hand Therapy (KHT), an acupuncture technique which does not involve needles, to see if this would also be associated with pain relief and be more widely accepted by children.

METHODS

This was a retrospective review of children who underwent tonsillectomy over a 4-month window. No narcotics were prescribed after surgery. Patients who wanted help with pain relief were offered KHT. Perceived pain level was assessed before and after the KHT treatment. Following the 10-day recovery for tonsillectomy, patients or their parents were queried as to how long the pain relief from the KHT intervention was perceived to last.

RESULTS

Fifty-six children underwent tonsillectomy; 29 of these patients (1-14 years) presented for pain relief after tonsillectomy and received KHT. 100% of patients (29 of 29) who were offered KHT accepted the intervention. The mean reported pain level before KHT was 5.03 (SD=2.69) out of 10. This fell to 3.06 (SD=3.15) after KHT. Statistical analyses supported the general conclusion that pain reports decline after KHT in the sampled population. 15 patients who received KHT - or their parents - provided a post-recovery report for how long they believed the KHT intervention lasted. The mean duration of perceived KHT benefit was 78.20h, though the standard deviation was large (64.38h). With the exception of one child reporting a slight increase in pain, no adverse effects were associated with KHT.

CONCLUSIONS

The data tentatively suggest KHT is associated with decreases in perceived pain after tonsillectomy and is widely accepted by children. These data - combined with the cost effectiveness, safety and ease of administering KHT - suggest that further studies exploring the effectiveness of KHT for pain relief after tonsillectomy are merited.

Potential benefits of acupuncture for enhanced recovery in gynaecological surgery

We aimed to evaluate if acupuncture can improve clinical benefits and patient satisfaction after gynaecological surgery supported by enhanced recovery after surgery (ERAS) programmes. Therefore, we evaluated patient as well as clinical outcome in patient recovery after surgery. We searched MEDLINE, PubMed and EMBASE for articles dealing with post-operative acupuncture and extracted 9 suitable studies. We expected acupuncture to alleviate surgical stress, reduce emetic symptom and accelerate recovery from complications in pre-, intra-, and post-operative phases. Gastrointestinal motility and coldness achieved the full improvement rate of 50%. With regard to post-operative nausea and vomiting, 3 studies showed more than 30% and 1 showed 16% improvement. Sore throat and urinary retention achieved a mild improvement rate of 16% and 12%, respectively. In this study, we demonstrated that acupuncture can enhance recovery in gynaecological surgery without adverse effects and thus should be considered in ERAS.

Quality of reporting of randomised controlled trials of herbal interventions in ASEAN Plus Six Countries: a systematic review

Background

Many randomised controlled trials (RCTs) of herbal interventions have been conducted in the ASEAN Communities. Good quality reporting of RCTs is essential for assessing clinical significance. Given the importance ASEAN placed on herbal medicines, the reporting quality of RCTs of herbal interventions among the ASEAN Communities deserved a special attention.

Objectives

To systematically review the quality of reporting of RCTs of herbal interventions conducted in the ASEAN Plus Six Countries.

Methods

Searches were performed using PubMed, EMBASE, The Cochrane Library, and Allied and Complementary Medicine (AMED), from inception through October 2013. These were limited to studies specific to humans and RCTs. Herbal species search terms were based on those listed in the National List of Essential Medicines [NLEM (Thailand, 2011)]. Studies conducted in the ASEAN Plus Six Countries, published in English were included.

Results

Seventy-one articles were identified. Thirty (42.25%) RCTs were from ASEAN Countries, whereas 41 RCTs (57.75%) were from Plus Six Group. Adherence to the recommended CONSORT checklist items for reporting of RCTs of herbal interventions among ASEAN Plus Six Countries ranged from 0% to 97.18%. Less than a quarter of the RCTs (18.31%) reported information on standardisation of the herbal products. However, the scope of our interventions of interest was limited to those developed from 20 herbal species listed in the NLEM of Thailand.

Conclusions

The present study highlights the need to improve reporting quality of RCTs of herbal interventions across ASEAN Plus Six Communities.

Capsicum plasters on acupoints decrease the incidence of emergence agitation in pediatric patients

AIM

To detect the effect of capsicum plasters on bilateral HT 7 acupoints for decreasing Emergence agitation (EA) in pediatric patients undergoing tonsillectomy and/or adenoidectomy.

BACKGROUND

Emergence agitation with its incidence of 10% to 80% may have deleterious effects in postoperative period. Children may harm themselves and/or care providers who require extra nursing care and additional sedatives and/or analgesics that may cause a delay in discharge from hospital. The studies dealt with the potential benefits of the use of adjuvant drugs have yielded controversial results. Some may have side effects as well as the absence of a positive effect on EA.

METHODS/MATERIALS

Fifty patients undergoing elective adenoidectomy and/or tonsillectomy who aged between 2 and 10 were included to the study. Patients were divided into two groups, and capsicum plasters (acupuncture) or inactive plasters (sham) were applied on bilateral HT 7 points preoperatively. Pain, emergence agitation, and side effects were evaluated for 15 min postoperatively.

RESULTS

Incidence of EA (PAED scale) (28.0% vs 60.0) and postoperative side effects was lower in acupuncture group than in sham group while there was no significant difference in the severity of EA between groups. Duration of recovery was shorter in acupuncture group. Pain scores (CHEOPS scale) were comparable between groups. EA patients were noted to have greater age and more retching than non-EA patients. Postoperative side effects such as retching, laryngospasm, and vomiting were seen more frequently in the patients with EA.

CONCLUSIONS

Application of capsicum plasters on acupoints offers a valuable choice in the prevention of EA in children.

Capsicum plaster at the Hegu point reduces postoperative analgesic requirement after orthognathic surgery

BACKGROUND

Capsicum plaster at classical Chinese acupoints is an alternative to acupuncture, which has been used as an effective method for preventing postoperative nausea and vomiting, sore throat, and pain. In this study, we investigated the postoperative analgesic efficacy of capsicum plaster at Hegu (LI 4) acupoints in patients after bilateral sagittal split ramus osteotomy.

METHODS

A double-blind, sham-controlled study was conducted with 84 patients undergoing orthognathic surgery, and who were randomly assigned to three treatment regimens (n = 28 each): Hegu group = capsicum plaster at Hegu acupoints and placebo tape on the shoulders as a nonacupoint; sham group = capsicum plaster on the shoulders and placebo tape at Hegu acupoints; and control group = placebo tape at Hegu acupoints and on the shoulders. The capsicum plaster was applied before induction of anesthesia and maintained for 8 h per day for 3 postoperative days.

RESULTS

The total amount of patient-controlled analgesia, containing 6.5 microg/mL fentanyl and 1.2 mg/mL ketorolac, administered in the first 24 h after the operation was decreased in the Hegu group (26.8 +/- 3.4 mL) compared with the control (44.2 +/- 7.3 mL) and sham (42.1 +/- 6.9 mL) groups (P < 0.01). The incidence of postoperative nausea and vomiting and the need for rescue medication were reduced, and the overall satisfaction score was greater in the Hegu group compared with other groups (P < 0.01).

CONCLUSION

The capsicum plaster at the Hegu acupoints decreased the postoperative opioid requirements and opioid-related side effects in patients after orthognathic surgery.

The effect of capsicum plaster in pain after inguinal hernia repair in children

BACKGROUND

Capsicum plaster at a classical Chinese acupoint is an alternative to acupuncture, which has been used as a supplemental therapy to opioid analgesics for pain control during the postoperative period. We investigated the postoperative analgesic efficacy of capsicum plaster at Zusanli (ST-36) points after pediatric hernia repair.

METHODS

This double-blind, sham-controlled study was designed in 108 children, aged 4 month to 9 year, undergoing unilateral hernia repair, and was randomly assigned to three treatment regimens: group Zusanli (Z)=capsicum plaster at Zusanli acupoints and placebo tape on the shoulder as a nonacupoint, group Sham (S)=capsicum plaster on the shoulders and placebo tape at Zusanli acupoints, and group control (C)=placebo tape at Zusanli acupoints and on the shoulder. The postoperative pain scores and analgesic requirements during 24 h postoperatively were assessed.

RESULTS

Total meperidine consumption was significantly lower in group Z (0.87+/-0.35 mg.kg-1) compared with group C (1.27+/-0.41 mg.kg-1) and S (1.22+/-0.45 mg.kg-1) (P<0.001). The pain scores on both the objective pain scale (OPS) and the Children Hospital of Ontario Pain Scale (CHEOPS), were significantly lower in group Z compared with the other groups at 6 and 24 h postoperatively, but not at the 10 min and 1 h postoperative time periods.

CONCLUSIONS

Placement of capsicum plaster at the Zusanli points reduces pain and postoperative opioid consumption in children undergoing inguinal hernia repair, but not in the first six postoperative hours.

The analgesic effects of capsicum plaster at the Zusanli point after abdominal hysterectomy

BACKGROUND

Acupuncture has been used to supplement opioid analgesics for postoperative pain control. We designed this double-blind, sham-controlled study to assess the effectiveness of capsicum plaster (PAS) at Zusanli (ST-36) acupoints on postoperative opioid analgesic requirement, side effects, and recovery profile.

METHODS

Ninety women undergoing total abdominal hysterectomy were randomly assigned to 3 treatment regimens (n = 30 each): group Zusanli = PAS at Zusanli acupoints, group sham = PAS at the nonacupoints on the shoulders, and group control = placebo tape at Zusanli acupoints. The PAS was applied before induction of anesthesia and maintained for 8 h per day for 3 postoperative days.

RESULTS

The total amount of morphine administered in the first 24 h after the operation was significantly decreased in group Zusanli (31.5 +/- 6.8 mL) compared with groups control (44.3 +/- 10.1 mL) and sham (44.6 +/- 10.4 mL) (P < 0.01). The incidence of postoperative side effects and the use of rescue antiemetics during the 72 h after surgery were significantly reduced in group Zusanli compared with other groups (P < 0.01).

CONCLUSION

PAS at Zusanli points decreased the postoperative opioid requirement and opioid-related side effects of patients undergoing abdominal hysterectomy.

Acupuncture and anaesthesia

Acupuncture and related techniques are increasingly practised in anaesthesia. This paper reviews the current evidence and applicability of acupuncture and related techniques for anaesthetic procedures and postoperative nausea and vomiting. Recent evidence suggests that manual acupuncture is effective for reducing preoperative anxiety and for postoperative pain relief. Current available data do not support the use of acupuncture as an adjunct to the general anaesthetic in the intraoperative setting. There are extensive and good quality data to support the use of P6 acupoint stimulation techniques for preventing postoperative nausea and vomiting in combination with or as an alternative to conventional anti-emetics. The use of acupuncture for labour pain management appears promising but requires further research. Patient selection, acupoint selection, needling techniques, and mode of acupuncture need to be considered when applying acupuncture and related techniques in the perioperative setting. There are guidelines for the conduct and reporting of acupuncture research, and these should be followed to improve the quality of studies.