Acupuncture in ambulatory anesthesia: a review

Figures & data

Figure 1 Flow diagram for article identification and selection.

Abbreviation: RCTs, randomized controlled trials.

Table 1 Randomized controlled trials on acupuncture for postoperative morbidities

Study	Patients/groups, n	Surgery/anesthesia maintenance	Blinding	Acupuncture point(s) and treatment plan	Control and/or comparator	Outcome(s)	Result(s)
Esmaeili et al^Citation56	227 adults/two groups	Elective surgery < 1.5 hours	Patients blinded	Bilateral PC6 during anesthesia for a minimum of 30 minutes	Standard care	Sore throat due to orolaryngeal intubation	Positive
Langenbach et al^Citation61	50 adults/three groups	Hemorrhoidopexy/intravenous	Patients blinded to acupuncture and sham, but not to standard care	GV2, GV20, BL30, BL57, Nei Ting, PC6 postoperatively for 20–30 minutes, and on first and second days after surgery	Sham Standard care	Pain Rescue analgesics Cardiovascular parameters	Partly positive Positive Negative
Lin et al^Citation58	60 children/two groups	Myringotomy/volatile	Patients blinded Assessor blinded	Bilateral LI4, HT7 during anesthesia for 10 minutes	Standard care	Pain Emergence agitation	Positive Positive
Liodden et al^Citation59	154 children/two groups	Tonsillectomy/intravenous	Open	Bilateral PC6 acupuncture during anesthesia Bilateral PC6 acupressure postoperatively for 24 hours	Standard care	Vomiting Discomfort Adverse events Acupuncture Wristbands	Positive Partly positive None Itching Tightness
Liodden et al^Citation37	282 children/two groups	Tonsillectomy/intravenous or volatile	All patients and people involved blinded except for acupuncturist	Bilateral PC6 during anesthesia for = 15 minutes	Standard care	Nausea and vomiting Pain Discomfort Adverse events	Negative Negative Negative Minor bleeding
Sertel et al^Citation57	123 adults/three groups	Tonsillectomy/intravenous	Patients in acupuncture and sham groups blinded; patients in control group not blinded. Assessor blinded	Bilateral S34, S44, PC5 1 hour after intake of analgesics for 20 minutes	Sham Standard care	Pain Adverse events	Positive None
Somri et al^Citation60	90 children/three groups	Dental restoration/volatile	All patients and people involved blinded except for acupuncturist	CV13 and bilateral PC6 during anesthesia for 15 minutes	Ondansetron Placebo NaCI	Nausea and vomiting Parent satisfaction	Positive Positive
Streitberger et al^Citation63	220 adults/four groups	Gynecological or breast surgery/volatile	All patients and people involved blinded except for acupuncturist	Bilateral PC6 before or after anesthesia induction for 20 minutes	Acupuncture or sham before induction Acupuncture or sham after induction	Nausea and vomiting Adverse events	Negative Hematomas

Table 2 RCTs on acupressure for postoperative morbidities

Study	Patients/groups, n	Surgery/anesthesia maintenance	Blinding	Acupuncture point(s) and timing	Control and/or comparator	Outcome(s)	Result(s)
Agarwal et al^Citation64	200 adults/two groups	Endoscopic urological/ volatile	All patients and people involved blinded except for acupuncturist	Bilateral PC6 30 minutes before anesthesia for 6 hours postoperatively	Sham	Nausea and vomiting Rescue medication	Negative Negative
Agarwal et al^Citation52	150 adults/three groups	Laparoscopic cholecystectomy/volatile	Patient blinded; others not stated	Bilateral PC6 30 minutes before anesthesia for 6 hours postoperatively	Ondansetron and sham Sham	Nausea and vomiting Rescue medication	Positive Positive
Alkaissi et al^Citation53	410 adults/three groups	Gynecological/general anesthesia, agent not specified	Patients blinded in treatment and sham groups, but not in control group Caregivers blinded	Bilateral PC6 before anesthesia for 24 hours postoperatively	Sham Standard care	Complete response Nausea and vomiting Treatment satisfaction Adverse events	Positive Positive Negative Redness Itching Headache
Duggal and Kochhar^Citation54	150 adults/three groups	Laparoscopic cholecystectomy/volatile	Patients and assessor blinded	PC6 after anesthesia induction, continuing postoperatively; lateral or bilateral not stated; pressure time not stated	Ondansetron NaCI	Nausea and vomiting	Positive
Majholm and Møller^Citation66	134 adults/two groups	Breast surgery/ intravenous	Patients and assessor blinded	Unilateral before anesthesia induction, for 24 hours	Sham	Nausea and vomiting Rescue medication	Negative Negative
Sam ad et al^Citation65	50 adults/two groups	Laparoscopic cholecystectomy/volatile	All patients and people involved blinded except for acupuncturist	Unilateral PC6 30 minutes before anesthesia for 6 hours	Sham	Nausea and vomiting	Negative
Ebrahim Soltani et al^Citation55	200 children and adults/ four groups	Strabismus surgery/ volatile	Patients and assessor blinded	Bilateral PC6 30 minutes before anesthesia for 6 hours	Ondansetron and sham Metoclopramide and sham Sham	Nausea and vomiting	Positive
White et al^Citation62	100 adults/two groups	Laparoscopic cholecystectomy or gastric binding/volatile and intravenous	Patients and assessor blinded	Bilateral PC6 30-60 minutes before anesthesia induction, for 72 hours postoperatively	Sham	Nausea Vomiting Rescue medication Treatment satisfaction Recovery time Resumption to normal activity	Negative Positive Negative Positive Negative Negative

Abbreviation: RCT, randomized controlled trials.

Figure 2 The degree of optimal acupuncture stimulation in accordance with traditional Chinese medicine can be expressed by the Optimal Acupuncture Continuum Indicator Summary (OACIS) wheel. In this figure, the acupuncture relevance of acupuncture-related techniques is compared with skin-penetrating acupuncture needles and acupressure stimulation. The lines from the hub (O) represent the modality continuum of optimal acupuncture–suboptimal acupuncture, illustrated as spokes in a wheel. A suboptimal acupuncture moves outward to the rim, while optimal acupuncture is found nearer to the hub.

Note: Preproduced from: Journal of Clinical Epidemiology, May 2009: Vol:10, Thorpe KE, Zwarenstein M, Oxman AD, et al. A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. 2009;180(10):E47–E57. © 2009, with permission from Elsevier.

Esmaeili S, Alizadeh R, Shoar S, Naderan M, Shoar N. Acupuncture in preventing postoperative anaesthesia-related sore throat: a comparison with no acupuncture. Acupunct Med. 2013;31(3):272–275.

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Langenbach MR, Aydemir-Dogruyol K, Issel R, Sauerland S. Randomized sham-controlled trial of acupuncture for postoperative pain control after stapled haemorrhoidopexy. Colorectal Dis. 2012;14(8):e486–e491.

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Lin YC, Tassone RF, Jahng S, et al. Acupuncture management of pain and emergence agitation in children after bilateral myringotomy and tympanostomy tube insertion. Paediatr Anaesth. 2009;19(11):1096–1101.

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Liodden I, Howley M, Grimsgaard AS, et al. Perioperative acupuncture and postoperative acupressure can prevent postoperative vomiting following paediatric tonsillectomy or adenoidectomy: a pragmatic randomised controlled trial. Acupunct Med. 2011;29(1):9–15.

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Liodden I, Sandvik L, Valeberg BT, Borud E, Norheim AJ. Acupuncture versus usual care for postoperative nausea and vomiting in children after tonsillectomy/adenoidectomy: a pragmatic, multicentre, double-blinded, randomised trial. Acupunct Med. 2015;33(3):196–203.

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Sertel S, Herrmann S, Greten HJ, et al. Additional use of acupuncture to NSAID effectively reduces post-tonsillectomy pain. Eur Arch Otorhinolaryngol. 2009;266(6):919–925.

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Somri M, Vaida SJ, Sabo E, Yassain G, Gankin I, Gaitini LA. Acupuncture versus ondansetron in the prevention of postoperative vomiting. A study of children undergoing dental surgery. Anaesthesia. 2001; 56(10):927–932.

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Streitberger K, Diefenbacher M, Bauer A, et al. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: a randomised placebo-controlled patient and observer blind trial. Anaesthesia. 2004;59(2):142–149.

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Agarwal A, Pathak A, Gaur A. Acupressure wristbands do not prevent postoperative nausea and vomiting after urological endoscopic surgery. Can J Anaesth. 2000;47(4):319–324.

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Agarwal A, Bose N, Gaur A, Singh U, Gupta MK, Singh D. Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 2002;49(6):554–560.

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Alkaissi A, Evertsson K, Johnsson VA, Ofenbartl L, Kalman S. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women. Can J Anaesth. 2002;49(10):1034–1039.

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Duggal G, Kochhar S. Comparative study of ondansetron and acupressure for postoperative nausea and vomiting after laparoscopic cholecystectomy. Journal of Advance Researches in Biological Sciences. 2012;4(4):330–336.

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Majholm B, Møller AM. Acupressure at acupoint P6 for prevention of postoperative nausea and vomiting: a randomised clinical trial. Eur J Anaesthesiol. 2011;28(6):412–419.

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Samad K, Afshan G, Kamal R. Effect of acupressure on postoperative nausea and vomiting in laparoscopic cholecystectomy. J Pak Med Assoc. 2003;53(2):68–72.

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Ebrahim Soltani A, Mohammadinasab H, Goudarzi M, et al. Acupressure using ondansetron versus metoclopramide on reduction of postoperative nausea and vomiting after strabismus surgery. Arch Iran Med. 2010;13(4):288–293.

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White PF, Zhao M, Tang J, et al. Use of a disposable acupressure device as part of a multimodal antiemetic strategy for reducing postoperative nausea and vomiting. Anesth Analg. 2012;115(1):31–37.

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