Abstract
Objective
To assess the efficacy and safety of acupuncture compound anesthesia (ACA) for traditional thyroidectomy.
Methods
Randomized controlled trials (RCTs) studying the use of ACA for traditional thyroidectomy were retrieved from PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP Database (CQVIP), Wanfang Academic Journal Full-text Database (Wanfang), and China Biology Medicine Disc (CBM) from inception to September 30, 2021. Two investigators independently extracted data and assessed the risk of bias and quality of the studies. Anesthesia effectiveness was the primary outcome, while the secondary outcomes included various pain scales, vital signs, analgesic consumption, and adverse events. Review Manager 5.3 was used for meta-analysis. Weighted mean difference (WMD), standardized mean difference (SMD), and confidence interval (CI) were used for statistical descriptions.
Results
A total of 16 papers were included, involving 1 228 patients. Meta-analysis showed that anesthesia effectiveness was significantly improved after adding acupuncture as an adjunct [SMD=0.62, 95%CI (0.40, 0.83), P<0.0001, I2=36%]. Besides, ACA can also moderate vital signs and reduce the feeling of pain [SMD=−1.61, 95%CI (−2.61, −0.61), P<0.00001, I2=95%], analgesic consumption, and adverse events. Subgroup analysis of the electroacupuncture (EA) group further revealed that the effectiveness of low-frequency EA [WMD=0.43, 95%CI (0.30, 0.55), P<0.00001, I2=15%] and the entire operative stimulation of EA [WMD=0.55, 95%CI (0.33, 0.77), P<0.00001, I2=0%] was significantly better than high-frequency EA and short-time stimulation of EA during the operation. Further, no significant difference existed between conventional analgesia and acupuncture analgesia.
Conclusion
ACA is beneficial to traditional thyroidectomy regarding efficacy and safety when acupuncture is applied as an adjunct. However, additional high-quality studies with larger sample sizes are needed to verify the findings.
摘要
目的
评估针刺复合麻醉(ACA)应用于传统甲状腺切除术的疗效和安全性。
方法
检索PubMed、EMBASE、Cochrane图书馆、科学网、中国知网(CNKI)、重庆维普数据库(CQVIP)、万方数据库(Wanfang)及中国生物医学文献数据库(CBM), 收集自建库至2021年9月30日期间ACA应用于传统甲状腺切除术的随机对照试验。两位研究者各自独立进行数据提取、偏倚风险评估及文献质量评价。本文采用麻醉效果作为主要结局指标, 次要结局指标包括各疼痛量表评分、生命体征、麻醉药物用量以及不良反应。采用Review Manager 5.3软件进行Meta分析。使用加权均数差(WMD)、标准化均数差(SMD)和可信区间(CI)进行统计描述。
结果
共纳入16篇研究, 计1 228位患者。Meta分析显示, 传统甲状腺切除术中联合针刺能够显著提高麻醉效果[SMD=0.62, 95%CI(0.40, 0.83), P<0.0001, I2=36%]; 此外, ACA也能稳定生命体征, 减轻疼痛[SMD=−1.61, 95%CI(−2.61, −0.61), P<0.00001, I2=95%]、减少麻醉药物用量及不良反应。针对电针组的亚组分析显示, 低频电刺激[WMD=0.43, 95%CI(0.30, 0.55), P<0.00001, I2=15%]和术中全程接受电刺激[WMD=0.55, 95%CI(0.33, 0.77), P<0.00001, I2=0%]的麻醉效果明显优于高频电刺激或术中短时间接受电刺激。此外,传统麻醉方法与单纯针刺麻醉之间未发现统计学差异。
结论
针刺联合传统麻醉时, ACA应用于传统甲状腺切除术疗效及安全性较好。然而, 该结论仍需要更多高质量、大样本的研究加以验证。
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
PATEL K N, YIP L, LUBITZ C C, GRUBBS E G, MILLER B S, SHEN W, ANGELOS P, CHEN H, DOHERTY G M, FAHEY T J3RD, KEBEBEW E, LIVOLSI V A, PERRIER N D, SIPOS J A, SOSA J A, STEWARD D, TUFANO R P, MCHENRY C R, CARTY S E. The American Association of Endocrine Surgeons Guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg, 2020, 271(3): e21–e93.
RUBIO G A, KORU-SENGUL T, VAGHAIWALLA T M, PARIKH P P, FARRA J C, LEW J I. Postoperative outcomes in Graves’ disease patients: results from the nationwide inpatient sample database. Thyroid, 2017, 27(6): 825–831.
REDDI D, CURRAN N, STEPHENS R. An introduction to pain pathways and mechanisms. Br J Hosp Med (Lond), 2013, 74(Suppl 12): C188–C191.
KUZMINSKAITE V, SLAUZGALVYTE I, BUKELYTE G, BRUZYTE G, KONTRIMAVICIUTE E. Effects of sevoflurane and desflurane on early cognitive changes after thyroid surgery: interim results. Acta Med Litu, 2019, 26(1): 25–30.
BAKER D W. History of the joint commission’s pain standards: lessons for today’s prescription opioid epidemic. JAMA, 2017, 317(11): 1117–1118.
ZHANG R, LAO L, REN K, BERMAN B M. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 2014, 120(2): 482–503.
CHRISTENSEN P A, NORENG M, ANDERSEN P E, NIELSEN J W. Electroacupuncture and postoperative pain. Br J Anaesth, 1989, 62(3): 258–262.
TSENG C K, TAY A A, PACE N L, WESTENSKOW D R, WONG K C. Electro-acupuncture modification of halothane anaesthesia in the dog. Can Anaesth Soc J, 1981, 28(2): 125–128.
GLIEDT J A, DANIELS C J, WUOLLET A. Narrative review of perioperative acupuncture for clinicians. J Acupunct Meridian Stud, 2015, 8(5): 264–269.
YUAN W, WANG Q. Perioperative acupuncture medicine: a novel concept instead of acupuncture anesthesia. Chin Med J (Engl), 2019, 132(6): 707–715.
LIBERATI A, ALTMAN D G, TETZLAFF J, MULROW C, GØTZSCHE P C, IOANNIDIS J P, CLARKE M, DEVEREAUX P J, KLEIJNEN J, MOHER D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 2009, 339: b2700.
HIGGINS J P, ALTMAN D G, GØTZSCHE P C, JÜNI P, MOHER D, OXMAN A D, SAVOVIC J, SCHULZ K F, WEEKS L, STERNE J A; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
MA W H, LI Y H, GAO X Q, LUO Y X, CHEN S, WANG X T, WEN K H. Effects of electroacupuncture anesthesia of different frequencies on stress reaction in thyroid surgery. Zhongguo Zhen Jiu, 2010, 30(10): 849–852.
GAO X Q, MA W H, LI Y H, WANG X T, CHEN S. The clinical study of acupuncture-assisted anesthesia with different frequencies continuous waves on thyroid surgery. Zhongguo Linchuang Shiyong Yixue, 2009, 3(4): 51–53.
ZHENG Y, YE X Q, LU H. Effect of electrical acupuncture combined with ultrasound-guided cervical plexus nerve block in patients undergoing thyroidectomy. Baiqiuen Yixue Zazhi, 2019, 17(5): 430–433.
LIU Y Y, LI Y L, CAI M X, ZOU P, LAI Y, HU D H. Effect of electroacupuncture on bispectral index of electroencephalography in patients undergoing subtotal thyroidectomy. Zhongguo Zhongxiyi Jiehe Zazhi, 2006, 25(12): 1070–1073.
YU M J, HONG J L, HU K K. Discussion on the effects of acupuncture anesthesia combined with cervical plexus block anesthesia in patients undergoing thyroid surgery. Dangdai Yiyao Luncong, 2019, 17(20): 82–83.
FU Z H, PENG F S. Clinical research on the application of acupuncture combined with block anesthesia of the cervical plexus in thyroid surgery. Henan Zhongyi, 2017, 37(1): 157–159.
WU Y J, YUAN J. Effect of cervical plexus block anesthesia combined with needles for thyroid surgery. Disi Junyi Daxue Xuebao, 2007, 28(5): 468.
ZHANG X Y. Application of superficial cervical plexus block combined with acupuncture anesthesia in thyroid surgery for enhanced recovery after surgery. Xuzhou Yike Daxue Xuebao. 2018, 38(5): 293–296.
BAI D. Study on the effect of acupuncture at Hegu and Neiguan in patients undergoing thyroidectomy on analgesia and postoperative pain. Liaoning Zhongyiyao Daxue Xuebao, 2019, 21(6): 135–138.
XIE C J, HE X J. Clinical observation on acupuncture and compound cervical plexus anaesthesia applied in thyroid operation. Zhongyiyao Daobao, 2007, 13(2): 50–52.
LAN L. Clinical research on acupuncture and compound cervical plexus anaesthesia applied in thyroid operation. Shantou Daxue Yixueyuan Xuebao, 2014, 27(4): 226, 229.
JIA Z Y. Research on acupuncture and compound cervical plexus anaesthesia applied in thyroid operation. Zhongguo Shiyong Yikan, 2018, 45(11): 96–98.
CHENG S Q, HUANG L H. Protective effects of acupuncture anesthesia in thyroid surgery. Hubei Zhongyi Zazhi, 2010, 32(8): 65–66.
LIU L M, WANG A, WAN Q, ZHANG M, ZHAO W M, HUANG H B. Clinical observation on acupuncture and compound cervical plexus anaesthesia applied in unilateral thyroid surgery. Zhongguo Zhongyiyao Keji, 2019, 26(6): 952–953.
GAO H P, NIU C F, WANG B H. Clinical observation on acupuncture and compound cervical plexus anaesthesia applied in thyroid surgery. Changchun Zhongyi Xueyuan Xuebao, 1999, 15(4): 29.
HUANG L H. The Clinic Study of Combined Acupuncture Medication Anesthesia Used in Thyroid Surgery. Wuhan: Master Thesis of Hubei University of Chinese Medicine, 2012.
THONG I S K, JENSEN M P, MIRÓ J, TAN G. The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure?. Scand J Pain, 2018, 18(1): 99–107.
SACCÒ M, MESCHI M, REGOLISTI G, DETRENIS S, BIANCHI L, BERTORELLI M, PIOLI S, MAGNANO A, SPAGNOLI F, GIURI P G, FIACCADORI E, CAIAZZA A. The relationship between blood pressure and pain. J Clin Hypertens (Greenwich), 2013, 15(8): 600–605.
LORD B, WOOLLARD M. The reliability of vital signs in estimating pain severity among adult patients treated by paramedics. Emerg Med J, 2011, 28(2): 147–150.
Chinese Society of Anesthesiology Task Force on Perioperative Application of Acupoint Stimulation. Consensus on perioperative application of acupoint stimulation. Zhonghua Mazuixue Zazhi, 2017, 37(10): 1153–1158.
ZHENG X Z, WEI K. Research progress of acupuncture therapy for preventing and treating postoperative nausea and vomiting. Xiandai Yiyao Weisheng, 2021, 37(3): 407–410.
ACAR H V. Acupuncture and related techniques during perioperative period: a literature review. Complement Ther Med, 2016, 29: 48–55.
CHEN L, CAO Y J, LI T, WAN Y Q, SHEN W D. Meta analysis of the application of acupuncture combined cervical plexus anesthesia to thyroid surgery. Shanghai Zhenjiu Zazhi, 2016, 35(2): 235–240.
WANG Y, NIE S Q, ZHUANG Y R, LUO L J, MA W H. Meta analysis of the efficacy of acupuncture combined cervical plexus anesthesia to thyroid surgery//2015 Congress of Chinese Society of Integrative Anesthesiology. Proceedings of the Annual Meeting of Chinese Society of Integrative Anesthesiology (CSIA), the Second National Symposium on Integrative Anesthesiology, and the Founding Congress of the Professional Committee of Jiangsu Association of Integrative Anesthesiology. Yangzhou: Chinese Society of Integrative Anesthesiology, 2015: 595–597.
Acknowledgments
The authors received no financial support for the research, authorship, and/or publication of this article. The registration number of this study in the International Prospective Register of Systematic Reviews (PROSPERO) is CRD42021287948.
Author information
Authors and Affiliations
Contributions
The study was designed by WANG Dongcai and SHU Jicheng. YE Zhe performed the study. YE Zhe, WU Haibin, and LIN Jiwei analyzed the data and drafted the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Additional information
First Author: YE Zhe, M.M., resident physician
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provided a link to the Creative Commons license, and indicate if changes were made.
About this article
Cite this article
Ye, Z., Wang, D., Wu, H. et al. Acupuncture compound anesthesia for traditional thyroidectomy: a systematic review and meta-analysis. J. Acupunct. Tuina. Sci. 21, 500–511 (2023). https://doi.org/10.1007/s11726-023-1410-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11726-023-1410-4
Keywords
- Acupuncture Therapy
- Electroacupuncture
- Acupuncture Analgesia
- Thyroidectomy
- Randomized Controlled Trials
- Systematic Review
- Meta-analysis