Top

Current Oncology Reports

Published in:

01-06-2021 | Acupuncture | Integrative Care (C Lammersfeld, Section Editor)

Integrative Approaches to Minimize Peri-operative Symptoms

Authors: Fahad Faruqi, Kathryn J. Ruddy, Shanda Blackmon

Published in: Current Oncology Reports | Issue 6/2021

Abstract

Purpose of Review

Cancer patients who require surgery often experience peri-operative symptoms, including nausea, anxiety, and pain, which can significantly impair quality of life. Here, we review the evidence for using integrative approaches to manage these peri-operative symptoms.

Recent Findings

Conventional peri-operative pharmacologic interventions, such as opiates for pain control, can lead to adverse effects such as respiratory depression, prolonged hospital course, and long-term dependence. Integrative medicine, also known as complementary and alternative medicine (CAM), has been explored as way to reduce peri-operative symptoms. Acupuncture, guided imagery, and loving-kindness meditation have all shown potential efficacy in reducing both peri-operative pain and anxiety in retrospective studies and small randomized controlled trials.

Summary

Integrative medicine techniques, such as acupuncture, are a promising approach to control peri-operative symptoms without the associated adverse effects of more conventional pharmacologic interventions.

Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA - J Am Med Assoc. 2016;315(15):1654–7.CrossRef

Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery. Anesth Analg. 2017;125:1733–40.PubMedPubMedCentralCrossRef

Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3:159–80.PubMedCrossRef

Bucx MJL, Krijtenburg P, Kox M. Preoperative use of anxiolytic-sedative agents: are we on the right track? J Clin Anesth. 2016;33:135–40.PubMedCrossRef

Integrative medicine [Internet]. Available from: https://www.mayoclinic.org/tests-procedures/complementary-alternative-medicine/about/pac-20393581. Accessed Jan 2020.

Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;Volume 10:2287–98.CrossRef

Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016;33:160–71.PubMedCrossRef

Mesbah A, Yeung J, Gao F. Pain after thoracotomy. BJA Educ. 2016;16:1–7.CrossRef

Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery after Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55:91–115.PubMedCrossRef

10.

Metin SK, Meydan B, Evman S, Dogruyol T, Baysungur V. The effect of pregabalin and methylcobalamin combination on the chronic postthoracotomy pain syndrome. Ann Thorac Surg : The Society of Thoracic Surgeons. 2017;103:1109–13. Available from. https://doi.org/10.1016/j.athoracsur.2016.09.031.CrossRef

11.

Qiu R, Perrino AC, Zurich H, Sukumar N, Dai F, Popescu W. Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study. Rom J Anaesth Intensive Care. 2018;25:43–8.PubMedPubMedCentral

12.

Bialka S, Copik M, Daszkiewicz A, Rivas E, Ruetzler K, Szarpak L, et al. Comparison of different methods of postoperative analgesia after thoracotomy—a randomized controlled trial. J Thorac Dis. 2018;10:4874–82.PubMedPubMedCentralCrossRef

13.

Fernandez MI, Martin-Ucar AE, Lee HD, West KJ, Wyatt R, Waller DA. Does a thoracic epidural confer any additional benefit following video-assisted thoracoscopic pleurectomy for primary spontaneous pneumothorax? Eur J Cardiothorac Surg. 2005;27(4):671–4.PubMedCrossRef

14.

Kim JA, Kim TH, Yang M, Gwak MS, Kim GS, Kim MJ, et al. Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy? J Korean Med Sci. 2009;24(5):930–5.PubMedPubMedCentralCrossRef

15.

Yoshioka M, Mori T, Kobayashi H, et al. The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study. Ann Thorac Cardiovasc Surg. 2006;12(5):313–8.PubMed

16.

Hill SE, Keller RA, Stafford-Smith M, et al. Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology. 2006;104(5):1047–53.PubMedCrossRef

17.

Vogt A, Stieger DS, Theurillat C, Curatolo M. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth. 2005;95:816–21.PubMedCrossRef

18.

Fibla JJ, Molins L, Mier JM, Sierra A, Carranza D, Vidal G. The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial. Eur J Cardiothorac Surg. 2011;40(4):907–11.PubMed

19.

Kaya FN, Turker G, Basagan-Mogol E, Goren S, Bayram S, Gebitekin C. Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery. J Cardiothorac Vasc Anesth. 2006;20:639–43.PubMedCrossRef

20.

Kaplowitz J, Papadakos PJ. Acute pain management for video-assisted thoracoscopic surgery: an update. J Cardiothorac Vasc Anesth. 2012;26:312–21. Elsevier Inc.; Available from. https://doi.org/10.1053/j.jvca.2011.04.010.PubMedCrossRef

21.

Karmakar MK, Ho AMH. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004;14:345–52.PubMedCrossRef

22.

Hetmann F, Kongsgaard UE, Sandvik L, Schou-Bredal I. Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6- and 12-month follow-ups. J Pain Res. 2017;Volume 10:663–8.CrossRef

23.

Hirai K, Usuda J. Uniportal video-assisted thoracic surgery reduced the occurrence of post-thoracotomy pain syndrome after lobectomy for lung cancer. J Thorac Dis. 2019;11:3896–902.PubMedPubMedCentralCrossRef

24.

Reyad RM, Shaker EH, Ghobrial HZ, Abbas DN, Reyad EM, Abd Alrahman AAM, et al. The impact of ultrasound-guided continuous serratus anterior plane block versus intravenous patient-controlled analgesia on the incidence and severity of post-thoracotomy pain syndrome: a randomized, controlled study. Eur J Pain (United Kingdom). 2020;24:159–70.

25.

Yasin J, Thimmappa N, Kaifi JT, Avella DM, Davis R, Tewari SO, et al. CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis. Diagn Interv Radiol. 2020;26:53–7.PubMedCrossRef

26.

•• Nelson DB, Mehran RJ, Mitchell KG, Correa AM, Sepesi B, Antonoff MB, et al. Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non–small cell lung cancer. J Thorac Cardiovasc Surg. 2019;158:279–286.e1. https://doi.org/10.1016/j.jtcvs.2019.03.009 Elsevier Inc.; This was a prospective cohort study evaluating whether enhanced recovery after surgery (ERAS) protocols in lung cancer patients leads to higher rates of initiating adjuvant chemotherapy. The study found that only 40% of patients received adjuvant chemotherapy when ERAS protocols were not implemented compared to 62% of patients who received adjuvant treatment when ERAS protocols were in place.PubMedCrossRef

27.

Attias S, Schiff E, Matter I, Sroka G, Nae B, Arnon Z, et al. Complementary and alternative medicine interventions for perioperative symptoms: a comparative effectiveness study. Complement Ther Med. 2019;44:51–5. Elsevier; Available from. https://doi.org/10.1016/j.ctim.2019.03.003.PubMedCrossRef

28.

Carpenter JJ, Hines SH, Lan VM. Guided imagery for pain management in postoperative orthopedic patients: an integrative literature review. J Holist Nurs. 2017;35:342–51.PubMedCrossRef

29.

Wu MS, Chen KH, Chen IF, Huang SK, Tzeng PC, Yeh ML, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PLoS One. 2016;11:1–12.

30.

• Garland EL, Brintz CE, Hanley AW, Roseen EJ, Atchley RM, Gaylord SA, et al. Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis. JAMA Intern Med. 2020;180(1):91–105 This was a systematic review and meta-analysis evaluating the effectiveness of mind-body therapies such as meditation, guided imagery, relaxation, and hypnosis in reducing opiate-treated pain. The study found that mind–body therapies are associated with moderate reductions in pain with small reductions in opiate usage.PubMedCrossRef

31.

Wren AA, Shelby RA, Soo MS, Huysmans Z, Jarosz JA, Keefe FJ. Preliminary efficacy of a lovingkindness meditation intervention for patients undergoing biopsy and breast cancer surgery: a randomized controlled pilot study. Support Care Cancer. Support Care Cancer. 2019;27:3583–92.PubMedCrossRef

32.

Williams JB, Alexander KP, Morin JF, Langlois Y, Noiseux N, Perrault LP, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. Am J Cardiol. 2013;111:137–42.PubMedPubMedCentralCrossRef

33.

Palmer JB, Lane D, Mayo D, Schluchter M, Leeming R. Effects of music therapy on anesthesia requirements and anxiety in women undergoing ambulatory breast surgery for cancer diagnosis and treatment: a randomized controlled trial. J Clin Oncol. 2015;33:3162–8.PubMedCrossRef

34.

Attias S, Keinan Boker L, Arnon Z, Ben-Arye E, Bar’Am A, Sroka G, et al. Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety. J Clin Anesth [Internet]. Elsevier Inc.; 2016;29:54–64. Available from: https://doi.org/10.1016/j.jclinane.2015.10.017

35.

Chen J, Tu Q, Miao S, Zhou Z, Hu S. Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: a meta-analysis of randomized controlled trials. Int J Surg. 2020;73:57–64.PubMedCrossRef

36.

Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. J Surg Res. 2015;198:441–9.PubMedCrossRef

37.

Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338–50.PubMedCrossRef

38.

39.

Zhang R, Lee SM, Wigfield C, Vigneswaran WT, Ferguson MK. Lung function predicts pulmonary complications regardless of the surgical approach. Ann Thorac Surg. 2015;99:1761–7.PubMedCrossRef

40.

Brunelli A, Pompili C, Salati M, Refai M, Berardi R, Mazzanti P, et al. Preoperative maximum oxygen consumption is associated with prognosis after pulmonary resection in stage i non-small cell lung cancer. Ann Thorac Surg [Internet]. Elsevier Inc; 2014;98:238–42. Available from: https://doi.org/10.1016/j.athoracsur.2014.04.029

41.

Hamada K, Irie M, Fujino Y, Hyodo M, Hanagiri T. Prognostic value of preoperative exercise capacity in patients undergoing thoracoscopic lobectomy for non-small cell lung cancer. Lung Cancer [Internet]. Elsevier; 2019;128:47–52. Available from: https://doi.org/10.1016/j.lungcan.2018.12.013

42.

Saito H, Hatakeyama K, Konno H, Matsunaga T, Shimada Y, Minamiya Y. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease. Thorac Cancer. 2017;8:451–60.PubMedPubMedCentralCrossRef

43.

Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer ( Review ) Summary of findings for the main comparison. 2017

44.

Maeda K, Higashimoto Y, Honda N, Shiraishi M, Hirohata T, Minami K, et al. Effect of a postoperative outpatient pulmonary rehabilitation program on physical activity in patients who underwent pulmonary resection for lung cancer. Geriatr Gerontol Int. 2016;16(5):550–5.PubMedCrossRef

45.

• Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937–47 This study was a parallel-arm single-blind randomized controlled trial comparing pre-operative moderate aerobic and resistance exercises (prehabilitation) to the same exercise intervening post-operatively (rehabilitation). The prehabilitation group had a higher increase in functional walking capacity, and a higher proportion of patients recovered to baseline exercise capacity 8 weeks after surgery.PubMedCrossRef

46.

Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg [Internet]. Springer International Publishing; 2019;43:659–95. Available from: https://doi.org/10.1007/s00268-018-4844-y

Title: Integrative Approaches to Minimize Peri-operative Symptoms
Authors: Fahad Faruqi
Kathryn J. Ruddy
Shanda Blackmon
Publication date: 01-06-2021
Publisher: Springer US
Keywords: Acupuncture
Opioids
Opioids
Pain Syndromes
Thoracotomy
Anxiety
Published in: Current Oncology Reports / Issue 6/2021
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI: https://doi.org/10.1007/s11912-021-01051-9

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 6/2021

Update on Osteosarcoma

Role of Machine Learning and Artificial Intelligence in Interventional Oncology

Correction to: Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis

Erythroleukemia: an Update

Tumor Biomarkers and Interventional Oncology: Impact on Local Outcomes for Liver and Lung Malignancy

Immunotherapy in Cervical Cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer