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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:soins peri-operatoires:04. douleur post-operatoire [22 Jan 2025 18:02] Nguyen Johan [1.3.10. Knee Surgery] |
acupuncture:evaluation:soins peri-operatoires:04. douleur post-operatoire [25 May 2025 10:48] (Version actuelle) Nguyen Johan [1.3.7. Anorectal Surgery] |
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| === Auricular Acupuncture === | === Auricular Acupuncture === | ||
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| + | == Zhou 2025 == | ||
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| + | 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 ☆== | == Usichenko 2008 ☆== | ||
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| ^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.| | ^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 === | ||
| - | == Pediatric Laparoscopic Appendectomy == | + | |
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| + | == Yıldız 2024 == | ||
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| + | 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.| | ||
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| + | === Pediatric Laparoscopic Appendectomy === | ||
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| ^ 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). | | ^ 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. | | ^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. | | ||
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| + | === Abdominal Surgeries === | ||
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| + | == Staff 2025 == | ||
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| + | 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 === | === Anorectal Surgery === | ||
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| + | == Huang 2024 == | ||
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| + | 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 2022 == | ||
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| + | === surgical herniorrhaphy === | ||
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| + | == Shekouhi 2023 == | ||
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| + | 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.| | ||
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| === Knee Surgery === | === Knee Surgery === | ||
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| + | == Jin 2025 == | ||
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| + | 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.| | ||
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| + | == Li 2025 == | ||
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| + | 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.| | ||
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| + | == Chu 2024 (function) == | ||
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| + | 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 2024 (network meta-analysis) == | ||
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| ^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.| | ^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.| | ^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.| | ||
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| + | == Xin 2024 == | ||
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| + | 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).| | ||
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| == Chen 2021 (Total Knee Arthroplasty) == | == Chen 2021 (Total Knee Arthroplasty) == | ||
