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--- acupuncture:evaluation:soins peri-operatoires:04. douleur post-operatoire [12 Feb 2021 07:21]
Nguyen Johan [2.5. Société Française d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL, France) 2014 ⊕]
+++ acupuncture:evaluation:soins peri-operatoires:04. douleur post-operatoire [25 May 2025 10:48] (Version actuelle)
Nguyen Johan [1.3.7. Anorectal Surgery]
@@ Ligne 10: / Ligne 10: @@
 ===== Systematic Reviews and Meta-Analysis=====
-| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
-| ☆☆ | Evidence for effectiveness of acupuncture |
-| ☆ |Limited evidence for effectiveness of acupuncture |
-| Ø |No evidence or insufficient evidence |
 ==== Generic Acupuncture ====
+=== Liu 2025 ===
+Liu J, Li Y, Liu J, Zhang X. Efficacy of Acupuncture in Postoperative Pain-Relieving: A Systematic Review and Meta-Analysis. Pain Manag Nurs. 2025 Jan 14:S1524-9042(24)00327-8.  https://doi.org/10.1016/j.pmn.2024.12.014
+^Objectives| This study aimed to assess the efficacy of acupuncture in relieving postoperative pain.|
+^Methods|Design: Systematic review and meta-analysis. Data sources: The search strategy was designed according to the PICOS principle (population, intervention, comparison, outcome, and study). PubMed, Web of Science, Cochrane Library, and Embase were searched from the inception of databases to August 25th, 2022 to collect studies on acupuncture in the management of postoperative pain. Review methods: Two researchers independently screened the searched studies using the EndNote X9 software. Relevant data were extracted, and the risk of bias in included studies was assessed. RevMan 5.4 software was used for data analysis, and the Grading of Recommendations, Assessment, Development, and Evaluation was used to assess the quality of evidence.|
+^Results| A total of **25 studies** were included. This meta-analysis showed statistically significant differences in the pain scores (SMD=-0.38, 95 %CI [-0.69, -0.07], p = .02) and the dosage of analgesics (SMD = -0.53, 95% CI [-0.99, -0.06], I2 = 90 %, p < .00001] between the acupuncture group and the control group.|
+^Conclusion| Acupuncture is effective for alleviating postoperative pain and reducing the dosage of analgesics. More well-designed, and large-scale prospective studies are needed to further validate the efficacy of acupuncture in relieving postoperative pain.|
+^Nursing practice implications|Acupuncture is an acceptable choice for relieving postoperative pain since it is convenient, effective, and acceptable. Nurses can provide tailored guidance for patients to enhance their recovery and satisfaction.|
+=== Chen 2024 ===
+Chen J, Liu L, Xie Y, Yu G, Zhang X. Acupoint Stimulation for Pain Control in Enhanced Recovery After Surgery: Systematic Review and Meta-Analysis. J Integr Complement Med. 2024 Jun;30(6):493-506.  https://doi.org/10.1089/jicm.2023.0272
+^Introduction| Postoperative pain control is a challenge in enhanced recovery after surgery (ERAS). The current study reviewed the efficacy and safety of incorporating acupoint stimulation for postoperative pain control in ERAS. |
+^Methods| Ten databases for relevant randomized controlled trials (RCTs) published in English or Mandarin Chinese were searched from 1997 to 2022. The quality of each article was appraised using the Cochrane Collaboration Risk of Bias Criteria and the modified Jadad Scale. The primary outcome was pain control, measured using the visual analog scale 24 h after surgery. |
+^Results| **Eleven trials** met the eligibility criteria and were included in the study. Acupoint stimulation was found more effective than control treatments in terms of pain intensity (standardized mean difference [SMD] -0.94; 95% confidence interval [CI] -1.35 to -0.53), analgesic drug consumption (SMD -1.87; 95% CI -2.98 to -0.75), postoperative nausea (PON; SMD 0.31; 95% CI 0.13 to 0.73), postoperative vomiting (POV; SMD 0.57; 95% CI 0.11 to 2.92), and PON and POV (PONV; SMD 0.29; 95% CI 0.16 to 0.53). The Zusanli (ST36) and Neiguan (PC6) were the most-used acupoints in the included trials (8/11). The reported adverse reaction was only one case of bruising. |
+^Discussion|Acupoint stimulation improved pain control in patients undergoing ERAS more than control treatments. The findings provide an evidence-based premise for incorporating acupoint stimulation into ERAS strategies. More rigorous RCTs are needed in the future.|
 === Lederer 2018 ===
@@ Ligne 52: / Ligne 67: @@
 ^Conclusions| **Perioperative acupuncture may be a useful adjunct for acute postoperative pain management**. |
 ==== Special Acupuncture Techniques ====
+=== Intradermal acupuncture ===
+== Xu 2024 ==
+Xu N, Jiang K, Liu L, Yang X. Effect of intracutaneous pyonex therapy on postoperative pain management following perianal surgery: A systematic review and meta-analysis. PLoS One. 2024 Jan 19;19(1):e0296439.  https://doi.org/10.1371/journal.pone.0296439
+^Backgound| Intracutaneous pyonex therapy (IPT), a novel acupuncture technique also known as intradermal thumbtack needle embedding therapy, has been reported to optimize postoperative pain management following perianal surgery.|
+^Aim| This meta-analysis aimed to analyze the efficacy of IPT for postoperative pain management following perianal surgery. |
+^Methods|The Cochrane Library, PubMed, EMBASE, Web of Science, CNKI, SinoMed, Wanfang, and VIP databases were systematically searched for randomized controlled trials (RCTs) on IPT as a treatment for postoperative pain management following perianal surgery from inception until June 15, 2022. The analyzed outcomes from the eleven RCTs included in this meta-analysis were as follows: postoperative visual analogue scale(VAS), analgesic duration, ineffective cases following treatment, and adverse events. Subgroup analyses were conducted according to different time points. Risk-of-bias assessment, publication bias analysis, sensitivity analysis, and trial sequential analysis were performed. Of the 895 patients, 450 and 445 were included in the IPT and control groups, respectively.|
+^Results|The IPT group showed a better analgesic effect[standard mean difference (SMD) = -0.77, 95% CI: -1.00 to -0.53, P < 0.00001; P for heterogeneity = 0.009, I2 = 59%] and longer analgesic duration [SMD = 0.56, 95% CI: 0.31 to 0.82, P < 0.0001; P for heterogeneity = 0.6, I2 = 0%], fewer ineffective cases following treatment [risk ratio(RR) = 0.23; 95% CI: 0.13 to 0.39, P < 0.00001; P for heterogeneity = 0.76, I2 = 0%], and lower overall occurrence of postoperative complications [RR = 0.35; 95% CI: 0.17 to 0.70; P = 0.003; P for heterogeneity = 0.85, I2 = 0%] than the control group. |
+^Conclusion|Thus, our findings indicated that IPT can provide better pain management following perianal surgery compared to controls. This novel approach complements a reasonable modality for postoperative multimodal analgesia and is worth promoting.|
 === Auricular Acupuncture ===
+== Zhou 2025 ==
+Zhou Y, Bao Q, Yang C, Li S, Yin Z, Xiong J, Sun M, Yang J, Liu F, Liang F. Auricular Acupuncture for Perioperative Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pain Res. 2025 Jan 25;18:441-454.  https://doi.org/10.2147/JPR.S488525
+^Purpose|We conducted a more comprehensive systematic review and meta-analysis to evaluate the effectiveness of auricular acupuncture (AA) in perioperative pain management.|
+^Methods| Randomized controlled trials (RCTs) findings were retrieved from the Embase, Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Chinese Biomedical Literature Database, Wanfang, VIP, and China National Knowledge Infrastructure databases from their inception to March 2024 using the search terms "pain", "auriculotherapy", and "randomized controlled trial". The experimental group was treated with AA alone or in combination with analgesic drugs, whereas the control group was treated with sham auricular acupuncture, placebo, conventional treatment, or no treatment. The primary outcome was the perioperative pain score. The secondary outcomes were analgesic requirements, anxiety score, and adverse events (AEs). RevMan version 5.4 was used for data analysis.|
+^Results| The analysis included a total of **21 RCTs with 1527 participants**. AA was superior to the control group for reducing pain intensity (mean difference [MD]= -0.44; 95% confidence interval [CI]: -0.72 to -0.17) and analgesic requirement (standardized mean difference [SMD]= -0.88, 95% CI: -1.29 to -0.46). Perioperative anxiety improvement did not differ significantly between the AA and control groups (MD= -5.45, 95% CI: -32.99 to 22.09). Subgroup analysis showed that AA exerted a significant analgesic effect as a preoperative intervention and in orthopedic surgery. The results of the sensitivity analysis demonstrated the stability of the results of the meta-analysis. AA-related AEs were mainly nausea, vomiting, and drowsiness. None of the patients in the experimental group dropped out of the trial due to AA-related AEs.|
+^Conclusion| Current evidence suggests that AA may be a promising treatment option for improving perioperative pain with few AEs. However, owing to the low quality of the current evidence, large-sample, high-quality RCTs are needed to prove this conclusion.|
 == Usichenko 2008 ☆==
@@ Ligne 64: / Ligne 101: @@
 ^Conclusions| **The evidence that auricular acupuncture reduces postoperative pain is promising but not compelling**. |
+=== Electroacupuncture ===
+== Ge 2023 (gynecologic surgery )==
+Ge Y, Zheng J. The efficacy of transcutaneous electronic acupoint stimulation for improving postoperative recovery after gynecologic surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Sep 1;102(35):e34834.  https://doi.org/10.1097/MD.0000000000034834. https://pubmed.ncbi.nlm.nih.gov/37657060; PMCID: PMC10476788.
+^Background| This systematic review and meta-analysis aimed to evaluate the efficacy of transcutaneous electronic acupoint stimulation (TEAS) for improving postoperative recovery after gynecologic surgery.|
+^Methods| We performed a thorough search of 6 databases until March 2023, identifying 12 randomized controlled trials that met our predefined inclusion criteria and encompassed a total of 1510 patients. For continuous outcomes, we calculated the weighted mean difference (WMD), and for binomial outcomes, we used the risk ratio (RR). We evaluated heterogeneity among the included studies using Cochran I2 and Q statistics, utilizing a random-effects model when the I2 value exceeded 50%. To assess publication bias, we employed Egger test.|
+^Results| Our analysis found that TEAS significantly reduced the risk of postoperative nausea (RR: 0.60, 95% CI: 0.43-0.83, P = .002) and postoperative vomiting (RR: 0.54, 95% CI: 0.43-0.67, P < .001), **visual analogue scale (WMD: -0.47, 95% CI: -0.76 to -0.17, P = .002)**, as well as shortened the time to first bowel movement (WMD: -18.43, 95% CI: -20.87 to -15.99, P < .001) and time to first flatus (WMD: -8.98, 95% CI: -12.46 to -5.51, P < .001) compared to the conventional group.|
+^Conclusions| Our findings suggested that TEAS may improve postoperative recovery following gynecologic surgery. However, to confirm these results, larger randomized controlled trials encompassing a more diverse range of patient populations are urgently required.|
+== Yusi 2022 (laparoscopic surgery) ==
+Yusi H, Jiju Y, Xinyi LI, Huifeng H, Chong LI, Fan Z, Haiming L, Xianfei X, Ke HE, Guihua T. Effectiveness and safety of electroacupuncture for the treatment of pain after laparoscopic surgery: a systematic review. J Tradit Chin Med. 2022 Aug;42(4):505-512.  https://doi.org/10.19852/j.cnki.jtcm.2022.04.002
+^Objective|To evaluate the clinical effectiveness and safety of electroacupuncture for treating pain after laparoscopic surgery.|
+^Methods| The following databases were searched (since their establishment until November 16, 2021) for randomized controlled trials (RCTs) on electro-acupuncture for pain after laparoscopic surgery: PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, and Chinese Biomedical Literature Database. Data were screened independently and extracted by two reviewers. Two researchers independently extracted and cross-checked data and applied the modified Jadad scale and the Cochrane-recommended assessment method to evaluate the bias risk. The Meta-analysis was conducted using RevMan5.3 software.|
+^Results|Twelve RCTs enrolling 788 patients were included. (a) For postoperative 24 h visual analogue scale, five trials were included on electroacupuncture + routine analgesia therapy vs routine analgesia therapy with significance in electroacupuncture conducted after surgery [mean difference (MD) = -0.63, 95% confidence interval (CI) (-0.90, -0.37)], as well as in electroacupuncture conducted before and after surgery [MD = -1.01, 95% CI (-1.62, -0.41)] and in surgery. However, two trials were included in electroacupuncture conducted 24 h before surgery with no significant difference [MD = -0.16, 95% CI (-0.44, 0.12)]. (b) The anesthetics intake of electroacupuncture + routine analgesia therapy vs. routine analgesia therapy was significant [MD = -121.71, 95% CI (-164.92, -78.49)]. (c) The adverse effects of electroacupuncture + routine analgesia therapy vs. routine analgesia therapy were significant both in the incidence of postoperative nausea and vomiting [risk rate (RR) = 0.49, 95% CI (0.39, 0.61)] and postoperative dizziness and headache [RR = 0.14, 95% CI (0.04, 0.47)].|
+^Conclusion|The evidence showed that electro-acupuncture combined with routine analgesia therapy effectively treated pain after laparoscopic surgery. However, more rigorously designed RCTs are required due to the low quality of the included studies and the incomplete outcome evaluation system.|
+== Wang 2022 (Transcutaneous electroacupuncture) ==
+Wang D, Shi H, Yang Z, Liu W, Qi L, Dong C, Si G, Guo Q. Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials. Pain Res Manag. 2022 Apr 14;2022:7570533.  https://doi.org/10.1155/2022/7570533
+^Objective|This meta-analysis aims to evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) in treating post-operative pain.|
+^Methods|This meta-analysis was registered in PROSPERO (CRD42021286753). We searched PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs) about TEAS in treating postoperative pain that were published before November 2021. The primary outcome was visual analogue scale (VAS) within 24 h after surgery. The secondary outcomes included postoperative opioid analgesic drug consumption and the occurrence of adverse reactions within the postoperative 24-72 h. Adverse reactions included dizziness, nausea, and vomiting. Continuous variables were analyzed using mean difference (MDs) or standardized mean difference (SMDs) and 95% CIs. Relative risk (RR) and 95% CI were used for dichotomous data. The data were pooled and analyzed by RevMan 5.4 and STATA15.0 software.|
+^Results| **Seventeen trials with 1375 participants** were included. The current results suggested that application of TEAS showed obvious superiority in reducing VAS scores (SMD = -1.51, 95% CI = -2.20∼-0.82, I2 = 96%). Subgroup analysis was performed according to open surgery and minimally invasive surgery. VAS scores were decreased after surgery at 24 h (SMD = -0.84, 95% CI = -1.07∼-0.6, I2 = 96%; SMD = -0.88, 95% CI = -1.02∼-0.75, I2 = 96%). The incidence of postoperative dizziness and nausea and vomiting was significantly lower in the TEAS group within postoperative 24-72 h (RR = 0.48, 95% CI = 0.34∼0.68, I2 = 0%; RR = 0.66, 95% CI = 0.44∼1.01, I2 = 69%; and RR = 0.49, 95% CI = 0.24∼1.00, I2 = 51%). Postoperative opioid analgesics were also reduced in the TEAS group within 72 h after surgery (SMD = -2.10, 95% CI = -3.37∼-0.82, I2 = 96%).|
+^Conclusions| TEAS can reduce postoperative pain as well as the incidence of dizziness, nausea, and vomiting and the number of analgesics used after surgery. TEAS is a reasonable modality to incorporate into a multimodal management approach for postoperative pain.|
 === Comparison of Acupuncture Techniques ===
@@ Ligne 80: / Ligne 147: @@
 ==== Specific Conditions ====
+=== Postoperative sore throat after surgery under general anesthesia===
+== Jau 2022 ==
+Jau PY, Chang SC. The effectiveness of acupuncture point stimulation for the prevention of postoperative sore throat: A meta-analysis. Medicine (Baltimore). 2022 Jul 15;101(28):e29653.  https://doi.org/10.1097/MD.0000000000029653.
+^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.|
+=== Cardiac surgery ===
+== Yıldız 2024 ==
+Yıldız T, Oyuktaş M, Avcu Ç. The effect of non-pharmacological methods on pain in patients undergoing open heart surgery: A systematic review and meta-analysis. Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Jul 23;32(3):291-306.  https://doi.org/10.5606/tgkdc.dergisi.2024.25603
+^Backgound| In this meta-analysis, we aimed to determine the effect of non-pharmacological methods on pain in patients undergoing open heart surgery.|
+^Methods| Scientific articles published between January 2002 and April 2022 were scanned in ScienceDirect, Scopus, PubMed, Web of Science, Google Scholar, Mendeley, Wiley Online Library databases. The keywords "open heart surgery," "cardiovascular surgery," "non-pharmacological," "complementary medicine," and "pain" were used in Turkish and English language. As a result of the search, 7,952 studies were identified and analyzed. Research data were obtained from 49 scientific articles.|
+^Results| The total sample size of the studies included in the analysis was 3,097. The total effect size was found to be 3.070, with a 95% confidence interval of 2.522 at the lower limit and 3.736 at the upper limit. Non-pharmacological pain methods in open heart surgery included positive environmental experience, distraction, massage therapy, hand massage, foot massage, **acupuncture therapy**, lavender essential oil inhalation, cold application, music therapy, breathing and relaxation exercises, neurolinguistic programming, guided visualization, imagery, therapeutic touch, osteopathic treatment, and transcutaneous electrical nerve stimulation.|
+^Conclusion| The pain of patients who underwent open heart surgery with non-pharmacological methods combined with pharmacological methods was three times less than those without non-pharmacological methods. Based on these findings, non-pharmacological methods are recommended for use due to their ease of application, and low side effects.|
+=== Pediatric Laparoscopic Appendectomy ===
+== Slouha 2023 ==
+Slouha E, Krumbach B, Gregory JA, Biput SJ, Shay A, Gorantla VR. Pain Management Throughout Pediatric Laparoscopic Appendectomy: A Systematic Review. Cureus. 2023 Nov 28;15(11):e49581.  https://doi.org/10.7759/cureus.49581
+^Background| Opioid-related fatalities are a leading cause of accidental death in the United States. Appendicitis is a common cause of abdominal pain in children and adolescents. The management of pain throughout the laparoscopic appendectomy (LA) in the pediatric population is a critical concern. |
+^Methods| This study aimed to evaluate trends in analgesic use and patient satisfaction following LA, with a focus on reducing the reliance on opioids for pain management. From 2003 to 2023, 18258 articles were filtered for all types of analgesic use with LA. The publications were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 19 studies were included for analysis and review. The study included peer-reviewed experimental and observational studies involving individuals under 18 years. |
+^Results| Pain management strategies varied across studies, involving a combination of analgesics, nerve blocks, and wound infiltrations. Analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids were administered before and after surgery. Some studies implemented patient-controlled analgesia (PCA) pumps. Other studies explored non-pharmacological interventions like **magnetic acupuncture**. The results showed a reduction in the need for postoperative analgesics in patients treated with LA, particularly when using non-opioid medications and novel analgesic techniques. Pediatric patients who received gabapentin reported lower opioid use, shorter hospital stays, and high satisfaction rates. However, the reliance on opioids remained significant in some cases, particularly among patients with peritonitis who required more morphine. Pain management in pediatric patients is multifaceted, involving preoperative and postoperative analgesics, nerve blocks, and PCA pumps. Efforts to improve pain management following pediatric LA while reducing opioid reliance are essential in the context of the ongoing opioid epidemic. |
+^Conclusions| The findings from this study highlight the potential benefits of non-opioid analgesics, nerve blocks, and alternative methods for managing postoperative pain in <18 appendectomy patients. Further research and standardization of pain management protocols are needed to ensure optimal patient outcomes and minimize the risk of opioid-related complications.|
+=== Colorectal cancer resection ===
+== Qi 2023 ==
+Qi L, Shi H, Zhang Y, Zhang X, Jia H, Tian H. The effect of acupuncture on recovery after colorectal cancer resection: A systematic review meta-analysis of randomized controlled trials. Medicine (Baltimore). 2023 Sep 1;102(35):e34678.  https://doi.org/10.1097/MD.0000000000034678
+^Background| To evaluate the efficacy and safety of acupuncture by systematically reviewing the literature on colorectal cancer resection. |
+^Methods| Seven electronic databases were searched from inception to February 28, 2023. Randomized controlled trials on acupuncture in patients after CRC resection were included. Two reviewers independently selected relevant trials, extracted data, and assessed the risk of bias. A random-effects meta-analysis model was used to obtain summary effect estimates. The data were pooled and analyzed using RevMan 5.3. The heterogeneity of selected studies was evaluated by evaluating the I-squared (I2) statistics. |
+^Results| **Twenty-two studies with 1878 patients** were included. Results of the meta-analysis showed there was a low level evidence that acupuncture may improve early postoperative symptoms, such as time to first flatus (n = 876, MD -0.77h, 95% CI -1.22 to -0.33 h, I2 = 89%), time to first bowel movement (n = 671, MD -1.41h, 95% CI -2.20 to -0.63 h, I2 = 95%), time to first defecation (n = 556, MD -1.03h, 95% CI -1.88 to -0.18 h, I2 = 95%), and nausea/vomiting (n = 1488, RR 0.72, 95% CI 0.59-0.89, I2 = 49%) compared with usual care and sham acupuncture. However, there were no statistically significant differences in** postoperative pain** (n = 1188, MD-0.21, 95% CI -0.59 to 0.17, I2 = 74%). And there was no sufficient evidence of improving long-term functional outcomes. There was substantial heterogeneity across trials. The adverse events associated with acupuncture stimulation were minor in include studies. |
+^Conclusion subsections| There is currently low-level evidence supporting the use of acupuncture on postoperative symptoms for patients after colorectal cancer resection. More investigations should be established based on the STRICTA statement strictly. |
+=== Breast cancer surgery ===
+== Ma 2023 ==
+Ma T, Xue G, Zhang J, Qin X. Effects of acupuncture on postoperative pain in patients undergoing breast cancer surgery: A systematic review and meta-analysis [letter]. Asian J Surg. 2023 Nov;46(11):5029-5031.  https://doi.org/10.1016/j.asjsur.2023.06.060
+| Ten randomized controlled trials (RCTs) met the inclusion criteria for qualitative study and meta-analysis. A total of 944 subjects was included in the study, of which 573 subjects underwent acupuncture. Details of the basic characteristics of each study are presented in Table 1. Meta-analysis results showed that there were statistically significant differences in the pain scale scores (first postoperative pain assessment: SMD = -0.60, 95%CI -1.00 to -0.20, P = 0.003; postoperative pain assessment at 24 h: SMD = -0.21, 95%CI -0.37 to -0.06, P = 0.007. Fig. 1) between the acupuncture and control groups.|
+== Tola 2021 ==
+Tola YO, Chow KM, Liang W. Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review. J Clin Nurs. 2021 Dec;30(23-24):3369-3384.  [[https://doi.org/10.1111/jocn.15827]]
+^Background|Poorly managed preoperative anxiety and pain were reported to slow the postoperative recovery of breast cancer patients. Thus, proactive management using non-pharmacological interventions becomes essential for decreasing opioid or anxiolytics consumption, anxiety level, pain intensity, postoperative complications and improving patients’ haemodynamics and satisfaction with care.|
+^Purpose|To identify, analyse and synthesise the effects of non-pharmacological interventions on preoperative anxiety and acute postoperative pain in women undergoing breast cancer surgery.|
+^Method|For this systematic review, 12 databases including Ovid Nursing, PsycInfo, British Nursing Index, CINAHL, Cochrane Library were searched to identify relevant studies. A total of 6,012 articles were identified from the search, six RCTs and one quasi-experimental study that met the inclusion criteria were included after eligibility screening. Narrative synthesis was used to analyse data extracted from the included articles. The review adhered to the PRISMA guideline.|
+^Results|Twelve outcomes were measured in the included studies, including preoperative anxiety, and acute postoperative pain. Music, massage, aromatherapy and **acupuncture** were the interventions delivered. Music had a small-to-large effect size and aromatherapy had a small effect size on reducing preoperative anxiety. Also, music had a large effect size whilst **acupuncture had a medium effect size on minimising postoperative pain in women undergoing breast cancer surgery**.|
+^Conclusion|Music, aromatherapy and acupuncture appeared to be effective for reducing preoperative anxiety and postoperative pain in women undergoing breast cancer surgery. However, the small number of studies available for each intervention prevents conclusive statements about which the most effective method.|
+^Implication for clinical practice|A nursing care pathway that standardises the use of non-pharmacological interventions for the management of both preoperative anxiety and postoperative pain in breast cancer surgery patients should be developed.|
 === Caesarean ===
@@ Ligne 93: / Ligne 232: @@
 ^ Main results|We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. **Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low**. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women). |
 ^Authors' conclusions|Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales. |
+=== Abdominal Surgeries ===
+== Staff 2025 ==
+Staff S, Yang C, Greten J, Braun V, Reissfelder C, Herrle F, Ghanad E. Manual Acupuncture for Postoperative Pain and Recovery after Abdominal Surgeries: A Systematic Review. J Integr Complement Med. 2025 Feb;31(2):112-121.  https://doi.org/10.1089/jicm.2023.0750
+^Introduction| Acupuncture's role in surgical and postoperative contexts is gaining traction. However, the evidence remains patchy and is often of low-grade quality, particularly in the context of postintestinal surgery. |
+^Purpose|To assess acupuncture's efficacy in pain relief and functional recovery after abdominal surgery. |
+^Methods| We searched PubMed, Cochrane, Web of Science, and Google Scholar for randomized trials using manual acupuncture as the main intervention. Outcomes included postoperative pain, analgesic use, nausea, gastrointestinal (GI) regeneration, and length of hospital stay. For risk of bias assessment Cochrane risk of bias tool 2 was employed. Registered with PROSPERO: CRD42022311718. |
+^Results| Of 700 records till May 2023, **8 trials (551 patients**; 16-200/trial) were included. Due to factors such as varying experimental settings and unpublished protocols, there was high risk of bias and heterogeneity, making meta-analysis unfeasible. Safety data were documented sufficiently by two trials. However, acupuncture showed marked benefits in pain relief, less analgesic use, fewer nausea cases, and improved GI recovery. One study reported reduced hospitalization time. |
+^Conclusion| Due to the varied methodologies and potential biases in existing studies, the definitive effectiveness of acupuncture remains unclear. To confirm the potential benefits of acupuncture as suggested by the reviewed studies, it's imperative to have more standardized study protocols, well-defined interventions and controls, and objective measures of efficacy.|
 === Anorectal Surgery ===
+== Huang 2024 ==
+Huang Q, Wang Y, Wang X, Xiang Z, Wang H, Wang A, Liu W, Gu Y. Efficacy and Safety of Snap Needles in the Treatment of Postoperative Hemorrhoidal Pain: A Systematic Review and Meta-Analysis. J Pain Res. 2024 Jun 7;17:2015-2028.  https://doi.org/10.2147/JPR.S464176
+^Purpose| The aim of this study is to evaluate the efficacy and safety of Snap Needles (SN) in the management of Postoperative Hemorrhoidal Pain (POHP).|
+^Patients and methods|A systematic search was conducted in various databases, including EMBASE, Web of Science, PubMed, WanFang database, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and China Science and Technology Journal Database (VIP), spanning from their inception to August 2023, to identify relevant randomized controlled trials (RCTs) on SN for POHP. The primary outcome measure was the Visual Analog Scale (VAS), while secondary outcomes encompassed the Total Effective Rate (TER), Wound Healing Time (WHT), Pain Relief Time (PRT), Pain Disappearance Time (PDT), and Adverse Events (AEs). The Cochrane Risk of Bias Tool was employed to assess the quality of individual studies. A meta-analysis was conducted using RevMan 5.4.1 software.|
+^Results| The meta-analysis included **11 RCTs involving 1188 POHP patients**, with an overall assessment of study quality ranging from very low to moderate. The findings revealed that the SN group exhibited significant improvements in treatment outcomes when compared to the control group (CG). These improvements were reflected in reduced VAS scores (mean difference [MD] = -1.10, 95% confidence interval [CI]: -1.31, -0.89, P < 0.05), shorter WHT (MD = -2.55, 95% CI: -3.02, -2.09, P < 0.05), quicker PRT (MD = -7.99, 95% CI: -8.48, -7.49, P < 0.05), fewer AEs (risk ratio [RR] = 0.38, 95% CI: 0.22, 0.67, P < 0.05), improved TER (RR = 1.18, 95% CI: 1.09, 1.27, P < 0.05), and faster PDT (MD = 19.24, 95% CI: 14.17, 24.31, P < 0.05).|
+^Conclusion| The use of SN appears to yield favorable outcomes in the treatment of POHP, and is potentially an alternative therapy to western drug therapy.|
+== Du 2022 ==
+Du B, Xu Z, Zhong X. Electroacupuncture for postoperative pain in mixed hemorrhoids: A meta-analysis. Medicine (Baltimore). 2022 Dec 16;101(50):e32247.  https://doi.org/10.1097/MD.0000000000032247
+^Background| To investigate the efficacy of electroacupuncture for postoperative pain in mixed hemorrhoids.|
+^Methods|Randomized controlled trials were searched in PubMed and Cochrane Library. The risk of bias assessment tool was used to assess methodological quality. Stata 14.0 software was used for meta-analysis. Weighted mean differences were calculated if all outcome variables were reported the same way, while standardized mean differences (SMD) were calculated if they were different.|
+^Results|From 27 identified studies, **5 Chinese studies (465 patients) **were included in this meta-analysis. The electroacupuncture group had significantly lower postoperative pain scores compared with the control group at 6 hours postoperatively (SMD = -0.89, 95% CI: -1.091 to -0.692; P < .001), at 12 hours postoperatively (SMD = -1.089, 95% CI: -1.336 to -0.843; P < .001), at 24 hours postoperatively (SMD = -0.548, 95% CI: -0.721 to -0.374; P = .547), and 72 hours postoperatively (SMD = -1.089, 95% CI: -1.336 to -0.843; P < .001).|
+^Conclusion|Electroacupuncture can improve pain after surgery for mixed hemorrhoids. It is an effective method to improve the pain after hemorrhoidectomy, which deserves further research and promotion.|
+== Chen 2022 ==
+Chen H, Zhang W, Sun Y, Jiao R, Liu Z. The Role of Acupuncture in Relieving Post-Hemorrhoidectomy Pain: A Systematic Review of Randomized Controlled Trials. Front Surg. 2022 Mar 28;9:815618. doi: 10.3389/fsurg.2022.815618. PMID: 35419404; PMCID: PMC8995644.
+^Background|Post-hemorrhoidectomy pain (PHP) remains one of the complications of hemorrhoidectomy and can delay patient's recovery. Current clinical guideline on PHP remains skeptical on the effectiveness of acupuncture, which has been applied for PHP in practice with inconsistent evidence.|
+^Objectives|This systematic review aimed to evaluate the effectiveness of acupuncture on PHP by reviewing existing evidence.|
+^Methods| Nine databases such as PubMed and Embase were searched for randomized controlled trials (RCTs) from inception to 30th September 2021. The outcome measures on pain level after hemorrhoidectomy, dose of rescue analgesic drug used, quality of life, adverse events, etc., were extracted and analyzed in a narrative approach.|
+^Results|** Four RCTs involving 275 patients** were included in the analysis. One study showed that the visual analog scale (VAS) score was significantly lower in the electro-acupuncture (EA) group compared to that in the sham acupuncture (SA) group at 6, 24 h after surgery and during the first defecation (p < 0.05). Similar trends were found in the verbal rating scale (VRS) and Wong-Baker Faces scale (WBS) score but at different time points. Another study also found EA was effective on relieving pain during defecation up to 7 days after surgery when compared with local anesthetics (p < 0.05). However, two studies evaluating manual acupuncture (MA) compared with active medications for PHP showed inconsistent results on effectiveness. Variability was found in the quality of included studies.|
+^Conclusions| Although benefit of acupuncture on PHP, especially EA on defecation after surgery, was observed at some time points, evidence on effectiveness of acupuncture on PHP was not conclusive.|
+== Ye 2022 ==
+Ye S, Zhou J, Guo X, Jiang X. Three Acupuncture Methods for Postoperative Pain in Mixed Hemorrhoids: A Systematic Review and Network Meta-Analysis. Comput Math Methods Med. 2022 Sep 26;2022:5627550.  https://doi.org/10.1155/2022/5627550.
+^Background| Mixed hemorrhoids are a common anorectal disorder, surgery is the most effective means of eradicating hemorrhoids, and pain is the most common postoperative complication of mixed hemorrhoids.|
+^Objective| To compare the clinical efficacy of auricular plaster, acupoint application, and acupoint catgut embedding for treating postoperative pain in mixed hemorrhoids.|
+^Method|PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM databases were searched for randomized controlled trials (RCTs) of three acupuncture-related therapies for postoperative pain in mixed hemorrhoids from the time of database creation to October 2021. After screening the literature, extracting information, and evaluating the risk of bias of included studies, statistical analysis was performed using RevMan 5.3 and Stata 15.0.|
+^Result| **Forty-seven RCTs** with a total of **5121 patients** were included. Network meta-analysis (NMA) showed that auricular plaster (OR = 5.90, 95% CI = (2.02, 17.21)) and acupoint catgut embedding therapy (OR = 5.55, 95% CI = (1.01, 30.40)) were more effective than analgesics in the treatment of postoperative pain in mixed hemorrhoids. The cumulative ranking probability (SUCRA) showed that acupoint application (73.6%) had the best overall efficacy and the rest were auricular plaster (68.7%), acupoint catgut embedding therapy (64.6%), auricular plaster combined with acupoint application (63.4%), and pain medication (8.9%) in that order. Secondly, auricular plaster (OR = -0.93, 95% CI = (-1.66, -0.20)), acupoint catgut embedding (OR = -0.8, 95% CI = (-1.50, -0.10)), and acupoint application (OR = -1.4, 95% CI = (-2.50, -0.31)) all led to a significant decrease in pain scores and were all more effective than analgesics. As ranked by SUCRA, the results showed that the efficacy of acupoint application (73.5%) was optimal and the rest were auricular plaster (56.1%), acupoint catgut embedding (50.2%), and pain medication (15.3%) in that order. In terms of pain degree, acupoint application (OR = 3.83, 95% CI = (1.25, 11.74)) was significantly better than pain medication.|
+^Conclusion|Acupoint application can improve the overall efficiency, reduce pain scores, and relieve the degree of postoperative pain in mixed hemorrhoids.|
@@ Ligne 116: / Ligne 306: @@
 ^Result| Totally, **15 articles** were included in this study, including **1 321 patients**. The homogeneity was good, with the combined effect (OR=3. 55, 95% CI: 2. 06-6. 12), and the combined effect Z=4. 57, P<0. 000 01, which had statistical significance. It indicated that the combined drug anesthesia of acupuncture was superior to the simple drug anesthesia in anorectal surgery. The homogeneity of ADR analysis was good (OR=0. 16, 95% CI: 0. 11, 0. 24, Z=8. 88, P<0. 000 01), which showed that the ADR rate of acupuncture combined with drug anesthesia group was lower than that of simple drug anesthesia group in anorectal surgery.|
 ^Conclusion| Acupuncture combined with drug anesthesia can improve the anesthetic effect and reduce the incidence of adverse reactions in anorectal surgery compared with simple drug anesthesia.|
+=== surgical herniorrhaphy ===
+== Shekouhi 2023 ==
+Shekouhi R, Farz F, Sohooli M, Mohammadi S, Abbasi A, Razaghi M, Fereydouni M, Sohrabi M, Seyed-Alagheband SA, Darabi MH. Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis. Hernia. 2023 Dec;27(6):1363-1373.  https://doi.org/10.1007/s10029-023-02861-5
+^Purpose| Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000-48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain.|
+^Methods| A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient's clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported.|
+^Results| A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and **acupuncture-assisted** (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments.|
+^Conclusion| Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.|
+=== Post-thoracotomy pain ===
+== Park 2021 ==
+Park S, Lyu YR, Park SJ, Oh MS, Jung IC, Lee EJ. Electroacupuncture for post-thoracotomy pain: A systematic review and meta-analysis. PLoS One. 2021;16(7). [220251]. [[https://doi.org/10.1371/journal.pone.0254093|doi]]
+^ Background|Thoracotomy is an invasive surgical procedure that produces intense postoperative pain. Electroacupuncture has been used to induce analgesia in various situations, including after surgery. The aim of the following systematic review and meta-analysis was to evaluate the effect of electroacupuncture on post-thoracotomy pain.|
+^ Methods| The studies for the systematic review were searched using the following 9 databases: PubMed, Cochrane Library, EMBASE, MEDLINE Complete, Google Scholar, China National Knowledge Infrastructure (CNKI), Korean Medical Database (KMBASE), Koreanstudies Information Service System (KISS), and OASIS, without language restriction. Randomized controlled trials (RCTs) that met the inclusion criteria were selected. The quality assessment was performed using the Cochrane risk-of-bias tool, and RevMan 5.3 was used for meta-analysis. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42019142157.|
+^ Results| **Eleven randomized controlled trials** were included in the systematic review. The meta-analysis was performed for two outcome measures: pain score 24 hours after surgery and total dose of opioid analgesics. A subgroup analysis was performed according to the control group: sham acupuncture and conventional analgesia group. Pain score 24 hours after surgery of electroacupuncture group showed a standard mean difference of -0.98 (95% CI: -1.62 to -0.35) compared to sham acupuncture. The standard mean difference was -0.94 (95% CI: -1.33 to -0.55) compared to conventional analgesia. The total dose of opioid analgesics of electroacupuncture group showed a standard mean difference values of -0.95 (95% CI: -1.42 to -0.47) compared to sham acupuncture. The standard mean difference was -1.96 (95% CI: -2.82 to -1.10) compared to conventional analgesia. |
+^Conclusion| Current evidence suggests that electroacupuncture might provide useful pain relieving effect on post-thoracotomy patients. However, due to low quality and high heterogeneity of existing data, further rigorously designed studies should be performed to confirm the safety and efficacy.|
 === Orthopedic Surgery ===
+== Chen 2023 (Wrist-Ankle Acupuncture) ==
+Chen M, Xu Y, Fu X, Xie J, Cao X, Xu Y. Wrist-ankle acupuncture for the treatment of acute orthopedic pain after surgery: a meta-analysis. J Orthop Surg Res. 2023 Feb 15;18(1):106.  https://doi.org/10.1186/s13018-023-03569-z
+^Background|Wrist-ankle acupuncture (WAA) has been reported in the treatment of acute pain in orthopedic surgery. However, the effects of WAA on acute pain were controversial in the current studies. Therefore, the purpose of this meta-analysis was to critically evaluate the effects of WAA on acute pain in orthopedic surgery.|
+^Methods| Several digital databases were searched from the inception of databases to July 2021, including CNKI, VIP, Wanfang, CBM, Pubmed, Cochrane Central Register of Controlled Trials, Embase, Medline, and Web of Science Core Collection. The risk of bias was evaluated using the Cochrane collaboration criteria. The primary outcome indicators included pain score, pain killer dosage, analgesia satisfaction, and adverse reaction incidence. All analyses were performed with Review Manager 5.4.1.|
+^Result|A total of **10 studies with 725 patients** with orthopedic surgery (intervention group: 361, control group: 364) were included in this meta-analysis. The results demonstrated that the pain score of the intervention group was lower than the control group, and the difference was statistically significant [MD = - 0.29, 95%CI (- 0.37, - 0.21), P < 0.0001]. Compared with the control group, the patient in the intervention group used smaller amounts of pain killer [MD = - 0.16, 95%CI (- 0.30, - 0.02), P = 0.02]. The satisfaction of patients on pain relief was also higher in the intervention group, and the difference was statistically [OR = 0.25, 95%CI (0.15,0.41), P < 0.0001].|
+^Conclusion|WAA has a certain effect on acute pain in orthopedic surgery, and the effect of WAA combined with other therapies is better than that of not using WAA therapy.|
+== Xu 2022 (Wrist-Ankle Acupuncture)==
+Xu N, Liu LL, Rong W. Wrist-Ankle Acupuncture as Additional Therapy for Postoperative Multimodal Analgesia in Orthopedic Surgery: Systematic Review and Meta-Analysis. Pain Med. 2022 Sep 30;23(10):1654-1669. doi: 10.1093/pm/pnac065. PMID: 35482527.
+^Background| The present meta-analysis analyzed the efficacy and safety of wrist-ankle acupuncture (WAA) as an additional therapy for postoperative multimodal analgesia after orthopedic surgery.|
+^Methods|Electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science, CNKI, SinoMed, Wanfang, and VIP, were searched to identify randomized controlled trials and cohort studies that reported details of WAA as an additional therapy for postoperative multiple analgesia in orthopedic surgery before October 1, 2021. Analyzed outcomes included time points of the visual analog scale, use of patient-controlled intravenous analgesia (PCIA), and postoperative adverse events. Subgroup analysis was performed according to time points and complication type.|
+^Results| ** Eleven randomized controlled trials** and one cohort study were included in the meta-analysis. Among a total of **845 patients**, there were 422 patients in the WAA groups and 423 patients in the control groups. The WAA groups showed a better analgesic effect (standard mean difference [SMD] = -1.34; 95% confidence interval [CI]: -1.76 to -0.91; P < 0.00001; I2 = 0.94), lower use of PCIA (SMD = -1.48; 95% CI: -2.26 to -0.69; P = 0.0002; I2 = 0.94), and lower occurrence of postoperative adverse events (risk ratio = 0.38; 95% CI: 0.30 to 0.49; P < 0.00001; I2 = 0) than did the control groups.|
+^Conclusion|WAA as an additional therapy for postoperative multimodal analgesia in orthopedic surgery showed advantages over control treatment in terms of pain relief, use of PCIA, and occurrence of postoperative adverse events.|
 == Roberts 2012 Ø==
@@ Ligne 132: / Ligne 372: @@
 === Vertebral Surgery ===
+== Zhang 2022 (lumbar disc herniation) ==
+Zhang W, Liu H, Le X, Song K, Yang F, Cui Z, Zhao W. Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore). 2022 Dec 9;101(49):e32016.  https://doi.org/10.1097/MD.0000000000032016
+^Background|Evidence for the effects of acupuncture on postoperative pain of Lumbar disc herniation (LDH) is inconsistent. We conducted this systematic review and meta-analysis to evaluate the efficacy of acupuncture for postoperative pain of LDH.|
+^Methods|We performed a comprehensive search on PubMed, Embase, Web of Science, Cochrane Central, and four Chinese databases (CNKI, Wan Fang, CBMdisc, and VIP) for articles published before September 2021. The data extraction table was made for the ten included studies, and the risk of bias was assessed using the Cochrane collaboration tool, followed by statistical analysis using RevMan 5.3.|
+^Results|A total of **ten studies involving 838patients **were included. The statistical meta-analysis showed that acupuncture treatment was significantly better than drugs in improving cure rate (OR = 2.24, 95% CI = [1.58, 3.19], P < .00001) and the total effectiveness rate (OR = 4.85, 95% CI = [2.59, 9.08], P < .00001). And the results from the meta-analysis showed that acupuncture group was superior to control group in debasing visual analog scale score (MD = -1.26, 95% CI = [-1.72, -0.79], P < .00001) and improving Japanese Orthopaedic Association score (MD = 4.21, 95% CI = [1.53, 6.90], P < .00001). In addition, acupuncture was statistically significantly better than drugs (OR = 0.27, 95% CI = [0.11, 0.62], P = .002) in the incidence of adverse events, However, there was no statistically significant difference between acupuncture and rehabilitation (OR = 0.36, 95% CI = [0.07, 1.98], P = .24).|
+^Conclusion|Acupuncture is an effective and safe treatment for postoperative pain of LDH. It can be recommended to manage patients with postoperative pain of LDH. However, considering the unsatisfactory quality of the included studies, more high-quality randomized controlled trials with a large sample size are needed to elucidate this issue.|
@@ Ligne 142: / Ligne 390: @@
 ^ Results| **Five trials**, including 3 of high quality, met our inclusion criteria. The meta-analysis showed positive results for acupuncture treatment of pain after surgery in terms of the visual analogue scale (VAS) for pain intensity 24 hours after surgery, when compared to sham acupuncture (standard mean difference -0.67 (-1.04 to -0.31), P = 0.0003), whereas the other meta-analysis did not show a positive effect of acupuncture on 24-hour opiate demands when compared to sham acupuncture (standard mean difference -0.23 (-0.58 to 0.13), P = 0.21). |
 ^Conclusion| Our systematic review finds **encouraging but limited evidence** for the effectiveness of acupuncture treatment for acute postoperative pain after back surgery. Further rigorously designed clinical trials are required. |
+=== Hip surgery ===
+== Li 2022 ==
+Li M, Sun W, Zhou R, Huang Y, Meng F, Luo L, Yan Z, Shi X, Huang F, Fan C, Jiang Z. Non-pharmaceutical treatments to relieve pain or reduce opioid analgesic intake and improve quality of life after total hip replacement: a meta analysis. Am J Transl Res. 2022 Oct 15;14(10):6828-6845. https://pubmed.ncbi.nlm.nih.gov/36398259
+^Objective|To reduce pain after total hip replacement (THR), researchers are interested in drug-free interventions. However, there is still a lack of consensus on their prevention efficacy. |
+^Methods|We performed a meta-analysis to evaluate the use of nonpharmaceutical interventions for postoperative pain management after THR. We searched the Cochrane Library, MEDLINE, EMBASE, Web of Science, PEDRO, and ClinicalTrials.gov databases for articles published between and 1991 and 2020. The main outcome measures were postoperative pain, opioid consumption, and quality of life (QoL). |
+^Results|In total, **1,942 patients** were studied. We found moderate evidence indicating postoperative pain relief measured by the Western Ontario and McMaster Universities Arthritis Index Scale, with mean differences (MDs) of -0.28 (95% confidence interval [CI], -0.49 to -0.07; P=0.01; I2 =0%) within three months, -0.19 (95% CI, -0.40 to 0.02; P=0.07; I2 =0%) between 3-6 months, and -0.13 (95% CI, -0.35 to 0.08; P=0.21; I2 =0%) between 6-12 months. Additionally, we found that **acupuncture** therapy could reduce opioid analgesic consumption (MD, -0.98; 95% CI, -1.18 to -0.79; fentanyl [mg/h]; P<0.01; I2 =72.2%) and significantly improve pain relief with an MD of 0.90 (95% CI, 0.47 to 1.33; P<0.01; I2 =0%) measured using the visual analog scale. Electrotherapy slightly improved perceived pain with an MD of 0.22 (95% CI, -0.27 to 0.70; P=0.37; I2 =0%). Moreover, moderate evidence has shown that preoperative exercises improve QoL.|
+^Conclusions|This meta-analysis suggested that continuous passive motion did not improve pain or QoL. Postoperative exercise was associated with pain relief and improved QoL.** Acupuncture** therapy after THR has been shown to reduce opioid analgesic consumption.|
@@ Ligne 148: / Ligne 413: @@
+== Jin 2025 ==
+Jin Z, Tang Y, Huang H, Chen L, Zhang Z, Ma T, Wang Z, Su H, Zhou H, Lv S, Tong P. Comparison of Therapeutic Effects of Different Rehabilitation Methods on Patients Undergoing Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials. Orthop Surg. 2025 Feb;17(2):348-360.  https://doi.org/10.1111/os.14332
+^Objective| The rehabilitation methods after total knee arthroplasty (TKA) can affect the recovery of complications and joint function, and the selection and comparison of rehabilitation methods after TKA still need further research.|
+^Methods| A comprehensive search of five databases and two clinical trial registration platforms was conducted from inception through March 31, 2024, and conducted to identify eligible randomized controlled trials (RCTs). We extracted the required data according to the Cochrane Handbook for Systematic Reviews of Interventions. Finally, 32 trials involving 2292 patients were included, the mean age of the enrolled patients was ~69.10 years, the sex ratio of males was (31.6%), and the longest follow-up time was 2 years. And we have summarized nine rehabilitation intervention measures: conventional physical therapy (CPT), cryotherapy, thermal therapy (TT), **acupuncture**, hydrotherapy, neuromuscular training (NT), electrotherapy, continuous passive motion (CPM), continuous active motion (CAM). And use the range of motion (ROM), visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) as the outcome measure to evaluate the effectiveness of various interventions. A Bayesian network meta-analysis (NMA) was carried out for calculating standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of improvement of knee joint function after TKA by different rehabilitation methods.|
+^Result| After treatment, the ROM results showed that cryotherapy, electrotherapy, and NT had better therapeutic effects. Among them, cryotherapy (WMD = 10.3, 95% CI 1.63-18.2) had a significant therapeutic effect. In terms of VAS, NT and TT showed good therapeutic effects. Among them, NT had a more significant therapeutic effect, while CAM had less effect. After treatment, in terms of WOMAC, TT, hydrotherapy, cryotherapy, and NT had better therapeutic effects. TT had the best therapeutic effect, while Hydrotherapy and Cryotherapy also had certain advantages.|
+^Conclusion| NT, TT, cryotherapy, hydrotherapy, and electrotherapy rehabilitation therapies have good therapeutic effects for TKA patients compared with other interventions. Among them, NT may be the best postoperative rehabilitation therapy.|
+== Li 2025 ==
+Li WX, Wu CQ, Feng W, Zhan YJ, Yang L, Jia HJ, Pei J, Li KP. Acupuncture for rehabilitation after total knee arthroplasty: a systematic review and network meta-analysis. Int J Surg. 2025 Jan 1;111(1):1373-1385.  https://doi.org/10.1097/JS9.0000000000002006
+^Backgound| The increasing interest in acupuncture for promoting postoperative rehabilitation has encouraged its use in rehabilitation after total knee arthroplasty (TKA), but its effectiveness remains controversial.|
+^Objective| This study aims to assess the efficacy of different models of acupuncture-related therapies on pain relief, motor function, inflammation, and overall rehabilitation of the knee after TKA.|
+^Methods| Databases PubMed, Embase, Cochrane, Web of Science, Scopus, and Clinicaltrials.gov were searched to screen eligible randomized controlled trials (RCTs). All RCTs that used acupuncture/moxibustion on TKA patients were included by two researchers independently after rigorous quality evaluation, with data extracted. The statistics were performed by using R 4.2.3 and Stata 17.|
+^Results| The network meta-analysis incorporated **28 RCTs**, 21 of which were conducted in mainland China and Taiwan. Evidence of the relation of several common acupuncture/moxibustion treatments was shown by the network meta-analysis (NMA). The results of NMA showed that electroacupuncture was the preferred therapy for soothing pain symptoms (standardized mean difference=0.58, 95% CI=0.36-0.81). Auricular acupressure was the best treatment to improve the knee motor function. Electroacupuncture was superior to special acupuncture in relieving knee joint stiffness and inflammation.|
+^Conclusion| Acupuncture intervention, especially electroacupuncture, can effectively alleviate pain, improve motion, reduce stiffness, and decrease inflammation in post-TKA patients with no serious adverse events.|
+== Chu 2024 (function) ==
+Chu WM, Cao Y, Li SY, Wu Q, Gao XY. Rehabilitation with or without acupuncture for improving the knee function after total knee arthroplasty: A systematic review and meta-analysis: 全膝关节置换术后康复基础上有无针刺对改善膝关节功能的影响:一项系统评价和meta分析. World J Acupunct Moxibustion. 2024 Apr;34(2):95-102.|
+^Objective|To assess the effect and safety of acupuncture on the base of rehabilitation for knee function after total knee arthroplasty.|
+^Methods| Relevant articles were collected from CNKI, Sinomed, Wanfang, VIP, Cochrane Library, Medline and Embase. The search was conducted by using a combination of subject terms and free words. The data were analyzed by Revman 5.4 software, and the included studies were evaluated in compliance with the Cochrane Collaboration's tool for assessing risk of bias in randomized trials.|
+^Results| A total of **10 studies** of randomized controlled trial (RCT) were included, with **785 participants** involved, of which, 393 cases in experiment group and 392 cases in control group. The interventions were electroacupuncture in 4 RCTs, filiform needling in 4 RCTs and transcutaneous electrical acupoint stimulation in 2 RCTs. Meta-analysis results showed that, compared with rehabilitation alone, acupuncture combined with rehabilitation improved the score of Hospital for Special Surgery (HSS) (MD=4.27, 95% CI=[2.77, 5.78], Z=5.58, P<0.00001), increased the range of motion (ROM) of the knee (MD=3.09, 95% CI=[1.47,4.70], Z=3.75, P<0.001), and decreased the postoperative score of visual analogue scale (VAS) (MD=-0.53, 95%CI=[-0.74, -0.33], Z=5.04, P<0.00001), but the difference in VAS score between groups only indicated statistical significance, without clinical importance. The sensitivity analysis showed the results were stable. In subgroup analysis, the stability of VAS score was relatively poorer in electroacupuncture group and filiform needle group, which may be associated with the differences in waveform of electroacupuncture and trial setting.|
+^Conclusion| Compared with rehabilitation alone, acupuncture in combination with rehabilitation could effectively improve the knee function for the patients after total knee arthroplasty.|
+== Liu 2024 (network meta-analysis) ==
+Liu N, Liu G, Chang X, Xu Y, Hou Y, Zhang D, Wang L, Chen S. Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials. Front Neurol. 2024 Mar 18;15:1361037.  https://doi.org/10.3389/fneur.2024.1361037
+^Objective| This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context.|
+^Methods| We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value.|
+^Results| We conducted an analysis of **41 qualifying studies** encompassing **3,003 patients**, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS+MA (SMD: 0.67; 95%CI: 0.01, 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU + MA (SMD: 6.45; 95%CI: 3.30, 9.60), EA + MA (SMD: 4.89; 95%CI: 1.46, 8.32), and TEAS+MA (SMD: 5.31; 95%CI: 0.85, 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU + MA was more efficacious than EA + MA, TEAS+MA, and AAT + MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU + MA (OR = 4.98; 95%CI: 1.01, 24.42) was observed to be higher compared to that after AAT + MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS+MA (OR = 0.36; 95%CI: 0.18, 0.70) and AAT + MA (OR = 0.20; 95%CI: 0.08, 0.50). The SUCRA ranking indicated that ACU + MA, EA + MA, TEAS+MA, and AAT + MA displayed superior SUCRA scores for each outcome index, respectively.|
+^Conclusion| For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA + MA and TEAS+MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU + MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT + MA is recommended for preventing postoperative adverse reactions.|
+== Xin 2024 ==
+Xin W, Miao Y, Yu M, Xing X, Ying-Ying X, Yan Z, Dai L, Hongshi H, Yu Y, Jian-Quan W, Bao-Hua L. Acupuncture Provides Short-Term Functional Improvements and Pain Relief for Patients After Knee Replacement Surgery: A Systematic Review and Meta-analysis. J Pain. 2024 Dec;25(12):104669.  https://doi.org/10.1016/j.jpain.2024.104669
+^Aim|The impact of acupuncture on knee function and pain intensity following knee replacement remains controversial. |
+^Methods|Therefore, we categorized the postsurgery recovery period into 3 phases: short-term (≤2 weeks), intermediate-term (2 weeks-3 months), and long-term (>3 months), and then assessed the effectiveness of acupuncture in improving function and alleviating pain at different stages following knee replacement. This meta-analysis included randomized controlled trials that compared acupuncture intervention with either no treatment or a sham group after knee replacement. Six databases were searched from inception to December 31, 2023, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and 2 Chinese databases (Chinese National Knowledge Infrastructure and WanFang Data). |
+^Results|A total of **23 studies comprising 1,464 participants** were included. Significant improvement of active range of motion was observed on day 7 and week 2 after operation. Lower pain intensity at rest was noted in patients receiving acupuncture in short-term periods after operation (12 hours, day 1, day 2, day 5, and week 2). A reduction in pain intensity during movement with acupuncture was observed on postoperative day 1 and day 7. Auricular acupuncture did not show not significant effectiveness in improving range of motion and pain intensity. For conventional acupuncture, the combination of distal and local point selection was found to be the most effective. Early application of acupuncture, in conjunction with physical therapy, starting before postoperative day 1 or day 2, was recommended. Further high-quality researches are warranted to validate the findings in this meta-analysis.|
+^Perspective|This article demonstrates that acupuncture has short-term effects (≤2 weeks) on improving active range of motion and reducing pain during rest and during movement following knee replacement surgery. The findings support the early application of acupuncture in hospital settings after knee replacement. REGISTRATION ID: The study was registered on PROSPERO (CRD42024503479).|
+== Chen 2021 (Total Knee Arthroplasty) ==
+Chen Z, Shen Z, Ye X, Xu Y, Liu J, Shi X, Chen G, Wu J, Chen W, Jiang T, Liu W, Xu X. Acupuncture for Rehabilitation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne). 2021.   [216629]. [[https://doi.org/10.3389/fmed.2020.602564|doi]]
+^ Background| There is an increasing interest in acupuncture for promoting post-operative rehabilitation, but the effectiveness of acupuncture for rehabilitation after total knee arthroplasty (TKA) remains controversial. Objective: This study aims to investigate the effect of acupuncture on rehabilitation after TKA. |
+^Methods|Database searches of PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI) were conducted to obtain articles published until August 2020. All identified articles were screened, and data from each included study were extracted independently by two investigators. Meta-analysis was performed to examine the effects of acupuncture on pain, range of knee motion, function, and nausea/vomiting after TKA. |
+^ Results| A total of **nine randomized clinical trials** were included according to the inclusion and exclusion criteria in this review. Compared with routine treatment, acupuncture combined with routine treatment showed a significantly greater pain reduction at 8, 12, 24, and 48 h post-operatively after TKA. Meanwhile, we found that the acupuncture groups showed a significant function improvement and a lower percentage of nausea/vomiting in comparison with the control groups after operation. However, acupuncture groups demonstrated no statistically significant improvement in post-operative pain at 4 h, 7 days, 14 days, and more than 21 days, and no significant difference in range of knee motion was observed between the acupuncture groups and control groups after surgery. |
+^Conclusions|Acupuncture, as a supplementary treatment after TKA, could improve function and reduce nausea/vomiting. However, the effect of acupuncture on pain relief may be mainly achieved within post-operative 48 h, and it had no efficacy in improving range of knee motion. More large-scale and high-quality studies are warranted. |
+== Chen 2021 (Electroacupuncture, Total Knee Arthroplasty) ==
+Chen W, Chen Z, Li J, Wang Y, Chen G, Jiang T, Wu Z, Ye Z, Zhang J, Shan J, Wu H, Shen Z, Liu W, Xu X.. Electroacupuncture as an Adjuvant Approach to Rehabilitation during Postacute Phase after Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2021.   [220833]. [[https://doi.org/10.1155/2021/9927699]]
+^Background.| Increasing attention has been paid to electroacupuncture (EA) for promoting postoperative rehabilitation, but the effectiveness of EA for rehabilitation after total knee arthroplasty (TKA) remains obscure. |
+^Objective|To examine the effect of EA on rehabilitation after TKA. Methods. Database searches on PubMed, CINAHL, Embase, and China National Knowledge Infrastructure (CNKI) were carried out to obtain articles, from inception to 15 October 2020. All identified articles were screened, and data from each included study were extracted independently by two investigators. Meta-analysis was conducted to assess the effects of acupuncture on pain, range of knee motion, and postoperative vomiting after TKA. |
+^Results|In the current study, a total of **ten randomized clinical trials** were included according to the inclusion and exclusion criteria. Compared to basic treatment, EA combined with basic treatment showed a significantly greater pain reduction on 3, 7, and 14 days postoperatively after TKA. However, we found that EA had no significant improvement in enhancing the range of knee motion and decreasing the percentage of vomiting. Subgroup analysis suggested that a combination of EA and rehabilitation training was superior to rehabilitation training in pain relief, while EA combined with celecoxib capsules showed no significant difference in improving pain compared to celecoxib capsules alone. |
+^Conclusions| In the postacute phase after TKA, EA, as a supplementary treatment, could reduce postoperative pain, but no evidence supported the benefits of EA for improving ROM of knee and decreasing the ratio of vomiting. Additional high-quality and large-scale RCTs are warranted.|
+== Ko 2021 (Total Knee Replacement) ==
+Ko HF, Chen CH, Dong KR, Wu HC. Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis. Pain Med. 2021;22(9):2117-2127.   [223023]. [[https://doi.org/10.1093/pm/pnab201]]
+^Objective|To identify the analgesic effectiveness of acupuncture after total knee replacement by systematic review.|
+^Methods|A search of randomized controlled trials was conducted in five English medical electronic databases and five Chinese databases. Two reviewers independently searched in five English medical electronic databases and five Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed with all-time-points meta-analysis.|
+^Results|A total of **seven studies with 891 participants** were included. The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief (standardized mean difference = −0.705, 95% CI −1.027 to −0.382, P = 0.000). The subgroup analysis results showed that acupuncture’s effects on analgesia had a statistically significant influence (standardized mean difference= −0.567, 95% CI −0.865 to −0.269, P = 0.000). The main acupuncture points that produced an analgesic effect when they were used after total knee replacement included the Xuehai, Liangqiu, Dubi, Neixiyan, Yanglingquan, and Zusanli points. Electroacupuncture frequency ranged between 2 and 100 Hz.|
+^Conclusions|As an adjunct modality, the use of acupuncture is associated with reduced pain and use of analgesic medications in postoperative patients. In particular, ear acupuncture 1 day before surgery could reduce analgesia .|
+== Lindsey 2021 (Knee Arthroplasty) ==
+Lindsey MH, Mortensen S, Xu H, McNichol M, Abdeen A. The Role of Acupuncture in Postoperative Pain Management of Patients Undergoing Knee Arthroplasty Surgery: A Systematic Review and Meta-Analysis. JBJS Rev. 2021;9(8).   [221678]. [[https://doi.org/10.2106/jbjs.rvw.20.00252]]
+|Acupuncture after total knee arthroplasty (TKA) may decrease the incidence of postoperative nausea and vomiting (PONV).\\ Acupuncture did not decrease visual analog scale (VAS) scores in the 0 to 48-hour interval but did decrease VAS scores at >48 hours after TKA.\\ The heterogeneity of the studies prevented meta-analysis of opioid use with acupuncture after TKA; a systematic review demonstrated mixed results. Additional studies are needed to investigate opioid reduction with acupuncture after TKA.|
 == Yue 2018 (Total Knee Arthroplasty) ==
@@ Ligne 207: / Ligne 556: @@
 ^ Results     | Nineteen RCTs enrolling a total of 1,805 patients were included. Most of the retrieved studies were of moderate to good methodological quality. Systemic pharmacological intervention was assessed in 14 RCTs. Opioids (5 RCTs) provided superior pain relief to other analgesics with no significant side-effects, but the quality of studies was low. Diclofenac (3 RCTs) presented adequate craniotomy pain control without any adverse effects, while the use of parecoxib is not supported. Dexmedetomidine (3 RCTs) provided adequate transitional analgesia, but further research is needed. Data on the analgesic efficacy of gabapentin, pregabalin, and intravenous lidocaine is very limited (1 RCT for each). Scalp infiltration/block (3 RCTs) provided adequate analgesia in the early postoperative period, while **more studies are needed to verify the analgesic benefit obtained from nonpharmacological interventions, such as multipoint electro-acupuncture, in craniotomy surgery (2 RCTs)**.  |
 ^ Conclusions  | No definite recommendations can be made based on this systematic review of pharamacological interventions following craniotomy due to significant divergence in the methodology of available studies. Limited evidence on scalp infiltration/block suggests an adequate analgesic effect in the early postoperative period. **Analgesic efficacy of dexmedetomidine and multipoint electro-acupuncture needs further evaluation.**  |
@@ Ligne 220: / Ligne 570: @@
 | <color #00a2e8>**⊕**</color> positive recommendation (regardless of the level of evidence reported) \\ <color #00a2e8>**Ø**</color> negative recommendation (or lack of evidence) |
+==== Association of Anaesthetists and the British Pain Society (UK, 2024) ⊕ ====
+El-Boghdadly K, Levy NA, Fawcett WJ, Knaggs RD, Laycock H, Baird E, Cox FJ, Eardley W, Kemp H, Malpus Z, Partridge A, Partridge J, Patel A, Price C, Robinson J, Russon K, Walumbe J, Lobo DN. Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia. 2024 Nov;79(11):1220-1236. https://doi.org/10.1111/anae.16391
+| |Acupuncture and acupressure. Some evidence in specific settings for analgesic benefit. |
+==== College of Medicine and Health Science, Hawassa University (Ethiopia) 2023 ⊕ ====
+Tageza Ilala T, Teku Ayano G, Ahmed Kedir Y, Tamiru Mamo S. Evidence-Based Guideline on the Prevention and Management of Perioperative Pain for Breast Cancer Peoples in a Low-Resource Setting: A Systematic Review Article. Anesthesiol Res Pract. 2023 Nov 3;2023:5668399.  https://doi.org/10.1155/2023/5668399
+| //Postoperative pain management//: Acupuncture (Grade of recommendation B, Strength of evidence 1c) |
+==== European Society of Regional Anaesthesia and Pain Therapy 2023 ⊕ ====
+**PROSPECT (PROcedure-SPECific postoperative pain managemenT) [craniotomy]**
+Mestdagh FP, Lavand'homme PM, Pirard G, Joshi GP, Sauter AR, Van de Velde M; PROSPECT Working Group∗ of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). Pain management after elective craniotomy: A systematic review with procedure-specific postoperative pain management (PROSPECT) recommendations. Eur J Anaesthesiol. 2023 Jul 7.  https://doi.org/10.1097/EJA.0000000000001877
+| Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol, NSAIDs, intravenous dexmedetomidine infusion, regional analgesia techniques, including incision-site infiltration, scalp nerve block and **acupuncture**. |
+==== American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF, USA) 2021 ⊕ ====
+Anne S, Mims JW, Tunkel DE, Rosenfeld RM, Boisoneau DS, Brenner MJ, Cramer JD, Dickerson D, Finestone SA, Folbe AJ, Galaiya DJ, Messner AH, Paisley A, Sedaghat AR, Stenson KM, Sturm AK, Lambie EM, Dhepyasuwan N, Monjur TM.  Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations Executive Summary. Otolaryngol Head Neck Surg. 2021;164(4):687-703.   [217698]. [[https://doi.org/10.1177/0194599821996303|doi]].
+| STATEMENT 5. MULTIMODAL THERAPY: Clinicians should develop a multimodal treatment plan for managing postoperative pain. Recommendation based on observational studies with a preponderance of benefit over harms. \\ Acupuncture may also be considered. An MA of 13 studies (682 patients) revealed that patients treated with acupuncture had less pain and used fewer opioids on postoperative day 1 as compared with those treated with control (<.001). |
+==== Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI, Germany) 2021 ⊕ ====
+Behandlung akuter perioperativer und posttraumatischer Schmerzen. [Treatment of acute perioperative and post-traumatic pain]. 2021.
+https://www.awmf.org/uploads/tx_szleitlinien/001-025l_S3_Behandlung-akuter-perioperativer-posttraumatischer-Schmerzen_2022-03.pdf
+| Acupuncture can be used as an adjuvant measure for certain indications.\\ //Tonsillectomy//: Acupuncture can also be used perioperatively |
+==== Australian and New Zealand College of Anaesthetists  (ANZA) 2020 ⊕ ====
+Acute Pain Management: Scientific Evidence Australian and New Zealand College of Anaesthetists  (ANZA). 2020:1317P.  {{:medias securises:acupuncture:evaluation:algologie-anesthesie par acupuncture:anza-205268.pdf|[205268]}} . [[https://www.anzca.edu.au/news/top-news/acute-pain-management-scientific-evidence-5th-edit|URL]].
+|Acupuncture by a variety of techniques may reduce postoperative pain and opioid consumption for a variety of surgical types (S) (Level I); specifically, the benefit may occur after lumbar spinal surgery (U) (Level I [PRISMA]), total knee arthroplasty (U) (Level I [PRISMA]), total hip arthroplasty (N) (Level I) and craniotomy (N) (Level I [PRISMA]).  |
 ==== European Society of Regional Anaesthesia and Pain Therapy  2020 ⊕ ====

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