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BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2019

Open Access 01-12-2019 | Acupuncture | Research article

Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice

Authors: Juan Zhu, Qian Xu, Rong Zou, Wenzhong Wu, Xiaoqiu Wang, Yanyi Wang, Fangbing Ji, Zhen Zheng, Man Zheng

Published in: BMC Complementary Medicine and Therapies | Issue 1/2019

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Abstract

Background

Acute postoperative pain remains a major clinical problem that affects patient recovery. Distal acupoint and peri-incisional stimulation are both used for relieving acute postoperative pain in hospital. Our objective was to assess and compare the effects of distal and peri-incisional stimulation on postoperative pain in open abdominal surgery.

Methods

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Chinese databases CNKI and Wanfangdata were searched to identify eligible randomized controlled trials. Intensity of postoperative pain, opioid consumption and related data were extracted and analyzed using a random effects model. Risk of bias was assessed. Subgroup analyses were conducted when data were enough.

Results

Thirty-five trials were included, in which 17 trials studied distal stimulation, another 17 trials studied peri-incisional stimulation and one studied the combination of the two approaches. No studies that directly compared the two approaches were identified. Subgroup analysis showed that both distal and peri-incisional stimulation significantly alleviated postoperative resting and movement pain from 4 h to 48 h after surgery by 6 to 25 mm on a 100 mm visual analogue scale. Peri-incisional stimulation showed a better reduction in postoperative opioid consumption. No studies compared the effects of the combined peri-incisional and distal stimulation with either mode alone. Overall the quality of evidence was moderate due to a lack of blinding in some studies, and unclear risk of allocation concealment.

Conclusion

Both distal and peri-incisional modes of stimulation were effective in reducing postoperative pain. Whether a combined peri-incisional stimulation and distal acupuncture has superior results requires further studies.
Literature
1.
Pfuntner A, Wier LM. Most Frequent Procedures Performed in U.S. Hospitals, 2011: Statistical brief #165[M]// healthcare cost and utilization project (HCUP) statistical briefs. PubMed, vol. 2013.
2.
Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth. 1989;63:189–95.CrossRef
3.
Ung JW, Lui JC. Postoperative pain management: Study of patients’ level of pain and satisfaction with health care providers’ responsiveness to their reports of pain. Nurs Health Sci. 2003;5:13–21.CrossRef
4.
American Society of Anesthesiologists (ASA) Committee on Standards and Practise Parameters. Practice guidelines for acute pain management in the perioperative setting. An updatereport by the American Society of Anesthesiologists task force on acute pain management. Anes. 2010;116:248–73.
5.
Hines R, Barash PG, Watrous G, O’Connor T. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg. 1992;74:503–9.CrossRef
6.
Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105–120.
7.
Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American PainSociety, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.CrossRef
8.
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444–53.CrossRef
9.
Derry CJ, Derry S, McQuay HJ, Moore RA. Systematic review of systematic reviews of acupuncture published 1996–2005. Clin Med. 2006;6:381–6.CrossRef
10.
11.
Naik PN, Kiran RA, Yalamanchal S, Kumar VA, Goli S, Vashist N. Acupuncture: An Alternative Therapy in Dentistry and Its Possible Applications. Med Acupunct. 2014;26(6):308–14 Review.CrossRef
12.
Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Brit J Anaesth. 2008;101(2):151–60.CrossRef
13.
Wong Lit Wan D, Wang Y, Xue CC, Wang LP, Liang FR, Zheng Z. Local and distant acupuncture points stimulation for chronic musculoskeletal pain: a systematicreview on the comparative effects. Eur J Pain. 2015;19(9):1232–47.CrossRef
14.
Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014;4(3):197–209.CrossRef
15.
Carroll D, Tramer M, McQuay H, Nye B, Moore A. Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain. Br J Anaesth. 1996;77:798–803.CrossRef
16.
Rakel B, Frantz R. Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement. J Pain. 2003;4:455–64.CrossRef
17.
Shuster JJ. Review: Cochrane handbook for systematic reviews for interventions, Version 5.1.0, published 3/2011. Julian P.T. Higgins and Sally Green, Editors[J]. Research Synthesis Methods. 2011;2(2):126–130.CrossRef
18.
Macintyre PE, Ready LB. Pharmacology of opioid. In: Acute Pain Management-A Practical Guide. 2nd ed. Philadelphia: W.B.Saunders; 2001. p. 15–49.
19.
MacPherson H, Altman DG, Hammerschlag R, Li Y, Wu T, et al. On behalf of the STRICTA revision group revised STandards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010;7(6):1–11.CrossRef
20.
Hui X, ShouZ S, LiX X. Effects of transcutaneous electric nerve stimulation on the postoperative analgesia with PCEA and recovery after surgery. Chinese J Clin Rehabilit. 2002;6(12):1784–5.
21.
Wu HC, Liu YC, Ou KL, Chang YH, Hsieh CL, Tsai Angela HC, Tsai HT, Chiu TH, Hung CJ, Lee CC, Lin JG. Effects of acupuncture on post-cesarean section pain. Chin Med J. 2009;122(15):1743–8.PubMed
22.
Li JZ, Li XZ, Wang MS, Li JP, Shi F, Yu HF. Effects of transcutaneous electrical stimulation of auricular Shenmen point on postoperative nausea and vomiting and patient-controlled epidural analgesia in cesarean section. Zhonghua Yi Xue Za Zhi. 2012;92(27):1892–5.PubMed
23.
Binder P, Gustafsson A, Uvnäs-Moberg K, Nissen E. Hi-TENS combined with PCA-morphine as post caesarean pain relief. Midwifery. 2011;7(4):547–52.CrossRef
24.
Kayman-Kose S, Arioz DT, Toktas H, Koken G, Kanat-Pektas M, Kose M, Yilmazer M. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014;27(15):1572–5.CrossRef
25.
Jaafarpour MK, Khani A, Javadifar N, Taghinejad H, Mahmoudi R, Saadipour KH. The analgesic effect of transcutaneous electrical nerve stimulation (TENS) on caesarean under spinal anaesthesia. J Clin Diagn Res. 2008;2(3):815–9.
26.
Sim CK, Xu PC, Pua HL, Zhang G, Lee TL. Effects of electroacupuncture on intraoperative and postoperative analgesic requirement. Acupunct Med. 2002;20(2–3):56–65.CrossRef
27.
Chen L, Tang J, White PF. The effect of location of transcutaneous electrical nerve stimulation on postoperative opioid analgesic requirement: acupoint versus nonacupoint stimulation. Anesth Analg. 1998;87(5):1129–34.PubMed
28.
Feng XM, Li J. Effect of electroacupuncture combined epidural anesthesia on plasma concentration of IL-1beta in patients undergoing gynecological surgery. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013;33(5):611–3.PubMed
29.
Feng XM, Li J, Wu Y. Effect of combined Electroacupuncture and epidural anesthesia in gynecological operation evaluated by bispectral index. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2010;30(2):150–2.PubMed
30.
Smith CM, Guralnick MS, Gelfand MM, Jeans ME. The effects of transcutaneous electrical nerve stimulation on post-cesarean pain. Pain. 1986;27(2):181–93.CrossRef
31.
Rakel B, Frantz R. Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain withmovement. J Pain. 2003;4(8):455–64.CrossRef
32.
Hamza MA, White PF, Ahmed HE, Ghoname EA. Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anesthesiology. 1999;91(5):1232–8.CrossRef
33.
Gary D, Kathleen AM. Transcutaneous electrical nerve stimulation (TENS) in the treatment of postoperative pain and prevention of paralytic ileus. Clin Rehabil. 1993;7(3):218–21.CrossRef
34.
Tsang HC, Lam CS, Chu PW, Yap J, Fung TY, Cheing GL. A randomized controlled trial of auricular transcutaneous electrical nerve stimulation for managing posthysterectomy pain. Evid-based Compl Alt. 2011;2011:276769.CrossRef
35.
Kim KS, Nam YM. The analgesic effects of capsicum plaster at the Zusanli point after abdominal hysterectomy. Anesth Analg. 2006;103(3):709–13.CrossRef
36.
Galloway DJ, Boyle P, Burns HJ, Davidson PM, George WD. A clinical assessment of electroanalgesia following abdominal operations. Surg Gynecol Obstet. 1984;159(5):453–6.PubMed
37.
Hershman MJ, Cheadle WG, Swift RI et al. Transcutaneous electrical nerve stimulation (TENS) as adjunctive analgesia in patients undergoing elective abdominal procedures. Surg Res Communications 1989; 7(1): 65–69.
38.
Dougal T. Effectiveness of transcutaneous electrical nerve stimulation following cholecystectomy. Physiotherapy. 1991;77(10):715–22.CrossRef
39.
Conn IG, Marshall AH, Yadav SN, Daly JC, Jaffer M. Transcutaneous electrical nerve stimulation following appendectomy: the placebo effect. Ann R Coll Surg Engl. 1986;68(4):191–2.PubMedPubMedCentral
40.
Adib-Hajbaghery M, Etri M. Effect of acupressure of ex-Le7 point on pain, nausea and vomiting after appendectomy: a randomized trial. J res med sci. 2013;18:482–6.PubMedPubMedCentral
41.
He BM, Li WS, Li WY. Effect of previous analgesia of scalp acupuncture on post-operative epidural morphine analgesia in the patient of intestinal cancer. Zhongguo Zhen Jiu. 2007;27(5):369–71.PubMed
42.
Hsiung WT, Chang YC, Yeh ML, Chang YH. Acupressure improves the postoperative comfort of gastric cancer patients: a randomised controlled trial. Complement Ther Med. 2015;23(3):339–46.CrossRef
43.
Bjersa K, Jildenstaal P, Jakobsson J, Egardt M, Fagevik OM. Adjunct high frequency transcutaneous electric stimulation (TENS) for postoperative pain management during weaning from epidural analgesia following Colon surgery: results from a controlled pilot study. Pain Manag Nurs. 2015;16(6):944–50.CrossRef
44.
Baoguo W, Tang J, White PF, Naruse R, Sloninsky A, Kariger R, Gold J, Wender RH. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement. Anesth Analg. 1997;85(2):406–13.
45.
Lin JG, Lo MW, Wen YR, Hsieh CL, Tsai SK, Sun WZ. The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery. Pain. 2002;99(3):509–14.CrossRef
46.
Ntritsou V, Mavrommatis C, Kostoglou C, Dimitriadis G, Tziris N, Zagka P, Vasilakos D. Effect of perioperative electroacupuncture as an adjunctive therapy on postoperative analgesia with tramadol and ketamine in prostatectomy: a randomized sham-controlled single-blind trial. Acupunct Med. 2014;32(3):215–22.CrossRef
47.
48.
Kotani N, Hashimoto H, Sato Y, et al. Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses. Anesthesiology. 2001;95(2):349–56.CrossRef
49.
Masatomo S, Muhammad IS, Nobutada M, Ozan A, Daniel IS. Minute sphere acupressure does not reduce postoperative pain or morphine consumption. Anesth Analg. 2003;96(2):493–7.CrossRef
50.
Bjerså K, Andersson T. High frequency TENS as a complement for pain relief in postoperative transition from epidural to general analgesia after pancreatic resection. Complement Ther Clin Pract. 2014;20(1):5–10.CrossRef
51.
Lim AT, Edis G, Kranz H, Mendelson G, Selwood T, Scott DF. Postoperative pain control: contribution of psychological factors and transcutaneous electrical stimulation. Pain. 1983;17(2):179–88.CrossRef
52.
Sodipo JO, Adedeji MBBS, Olumide O. Postoperative pain relief by transcutaneous electrical nerve stimulation (TENS). Am J Chin Med. 1980;8(1–2):190–4.CrossRef
53.
Hargreaves A, Lander J. Use of transcutaneous electrical nerve stimulation for postoperative pain. Nurs Res. 1989;38(3):159–61.CrossRef
54.
Cuschieri RJ, Morran CG, McArdle CS. Transcutaneous electrical stimulation for postoperative pain. Ann R Coll Surg Engl. 1985;67(2):127–9.PubMedPubMedCentral
55.
Lesley AS, Anna DO, Henry JM. Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. Pain. 2000;86:119–32.CrossRef
56.
Wu MS, Chen KH, Chen IF, Huang SK, et al. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS One. 2016;11(3):e0150367.CrossRef
57.
Modig J, Borg T, Karlstr G, Maripuu E, Sahlstedt B. Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg. 1983;62:174–80.CrossRef
58.
Tverskoy M, Oren M, Dashkovsky I, Kissin I. Alfentanil dose-response relationships for relief of postoperative pain. Anesth Analg. 1996;83:387–93.CrossRef
59.
Wu CL, Rowlingson AJ, Partin AW, et al. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med. 2005;30:516–22.CrossRef
60.
Adrian W, Simon H, Anna H, Edzard E. Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations. Acupunct in Med. 2001;19(2):84–92.CrossRef
61.
Hugh MP, Kate T, Stephen W, Mike F. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ. 2001;323:486–7.CrossRef
Metadata
Title
Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice
Authors
Juan Zhu
Qian Xu
Rong Zou
Wenzhong Wu
Xiaoqiu Wang
Yanyi Wang
Fangbing Ji
Zhen Zheng
Man Zheng
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2019
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-019-2583-8

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