Rédacteurs : Johan Nguyen, Henri Truong

Acupuncture Anesthesia

Anesthésie par acupuncture : évaluation

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Li 2014 ☆

  • Li Jin-Jin, Shao Xiao-Mei, Zhao Wen-Sheng, Shang Yue, Fang Jian-Qiao. [Acupuncture combined general anesthesia on dosage of anesthetic: a systematic review and meta-analysis]. Journal of Yunnan College of Traditional Chinese Medicine. 2014;37(5):61-65, 6. [187026].
  • Li Jin-Jin, Shao Xiao-Mei, Fang Jun-Fan, Fang Jian-Qiao. [Acupuncture-assisted general anesthesia: A systematic review and Meta-analysis]. China Journal of Traditional Chinese Medicine and Pharmacy. 2015;5:1473-148. [186915].
Objectives This paper presents a systematic review and meta-analysis of acupuncture combined general anesthesia.
Methods Systematic literature searches of 7 electronic databases were performed from inception to December 2013 by two investigators. We included randomized controlled trials that evaluated the effects of acupuncture compared with a control (routine procedure) or a sham intervention in patients undergoing general anesthesia. Two reviewers selected eligible studies and evaluated the risk of bias and the quality of the acupuncture intervention. Information on methods, participants, interventions, and outcomes was extracted. The total consumption of anesthetics during surgery was selected as the primary index. Meta-analysis of heart rate, mean arterial pressure and anesthetic recovery time was performed using random or fixed effects modeling.
Results Twelve trials that included 979 patients who received general anesthesia met the inclusion criteria. Results of pooled analyses indicated that compared with general anesthesia alone, acupuncture assistance significantly reduced the total dose of anesthetics needed (mean difference [95%CI], propofol (mg), -59. 29 [-91. 92, -26. 67], inhalational anesthetic (MAC)-2. 34 [-3. 60, -1. 09] and the anesthetic recovery time (min)-4. 31 [-4. 52, -4. 10], while no significant difference on heart rate and mean arterial pressure.
Conclusions Compared with routine general anesthesia alone, acupuncture assistance reduces the dose of anesthetics and shortens anesthetic recovery time, shows no effect on heart rate and mean arterial pressure.

1.1.2. Lee 2005 Ø

Lee H, Ernst E. Acupuncture analgesia during surgery: a systematic review. Pain. 2005;114(3):511-7. [140620]

Objective The aim of this systematic review is to assess the effectiveness of acupuncture as an adjunctive analgesic method to standard anaesthetic procedures for surgery and to determine whether acupuncture has any analgesic-sparing effect.
Method Electronic literature searches for randomised clinical trials (RCTs) of acupuncture during surgery were performed in seven electronic databases. No language restrictions were imposed. All included studies were rated according to their methodological quality and validity. As the studies were clinically heterogeneous, no meta-analyses were performed. The evidence was classified according to four levels: strong, moderate, limited, or inconclusive.
Results Nineteen RCTs were identified. Seven of them suggested that acupuncture is efficacious. Of nine high-quality RCTs, two studies had positive outcomes. There was no significant association between study quality and direction of outcome. One of eight high-validity trials reported a positive outcome and there was a significant relationship between validity and direction of outcome.
Conclusion The evidence that acupuncture is more effective than no acupuncture as an adjunct to standard anaesthetic procedures is therefore inconclusive. Strong evidence exists that real acupuncture is not significantly different from placebo acupuncture. For an analgesic-sparing effect of acupuncture, evidence remains inconclusive. In conclusion, this review does not support the use of acupuncture as an adjunct to standard anaesthetic procedures during surgery.

1.2. Special Acupuncture Techniques

1.2.1. Combined with Nerve Block

1.2.1.1. Cui 2018

Cui Bo, Tang Yidan, Zhou Jianxiong, Wu Junmei, Liu Jin, Gong Chunyu, Yang Lei, Yang Jing. [Effect of acupuncture combined nerve block on patients undergoing surgery: a meta-analysis]. Journal of Clinical Anesthesiology. 2018;2:159-162. [201796].

Objective To evaluate the effect of acupuncture combined nerve block for surgery using meta-analysis.
Methods We searched the data of randomized controlled trial( RCT) in Pubmed, Cochrane library, Embase, CNKI,VIP and Wanfang from the construction of database to May 2017. All RCTs that met the standards of acupuncture combined nerve block for patients undergoing surgery were collected. The meta-analysis was performed by Review Manager 5. 3.
Results Five trials containing 382 patients were included in this meta-analysis. Compared with nerve block alone, the pooled data showed that acupuncture combined nerve block reduced the fluctuation of intraoperative blood pressure( MD =-13. 62,95% CI-15. 41–11. 84,P < 0. 001) and heart rate( MD =-6. 49,95% CI-8. 61–2. 36,P < 0. 001),and VAS scores 8 h( MD =-1. 07,95% CI-1. 38–0. 75,P < 0. 001),12 h( MD =-1. 11,95% CI-1. 30–0. 93,P < 0. 001) and 24 h( MD =-0. 15,95% CI-0. 25–0. 04,P = 0. 006) after operation in the experimental group.
Conclusion Acupuncture combined nerve block possibly improves the hemodynamic parameters and postoperative pain of patients undergoing surgery.

1.3. Specific Applications

1.3.1. Cardiac Surgery

1.3.1.1. Asmussen 2017 ☆☆

Asmussen S, Przkora R, Maybauer DM, Fraser JF, Sanfilippo F, Jennings K, Adamzik M, Maybauer MO. Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive Care. J Intensive Care Med. 2017;:0885066617708558. [192430].

Background Acupuncture treatment has been employed in China for over 2500 years and it is used worldwide as analgesia in acute and chronic pain. Acupuncture is also used in general anesthesia (GA). The aim of this systematic review and meta-analysis was to assess the efficacy of electroacupuncture (EA) in addition to GA in patients undergoing cardiac surgery.
Methods We searched 3 databases (Pubmed, Cochrane Library, and Web of Science-from 1965 until January 31, 2017) for randomized controlled trials (RCTs) including patients undergoing cardiac surgery and receiving GA alone or GA + EA. As primary outcomes, we investigated the association between GA + EA approach and the dosage of intraoperative anesthetic drugs administered, the duration of mechanical ventilation (MV), the postoperative dose of vasoactive drugs, the length of intensive care unit (ICU) and hospital stay, and the levels of troponin I and cytokines.
ResultsThe initial search yielded 477 citations, but only 7 prospective RCTs enrolling a total of 321 patients were included. The use of GA + EA reduced the dosage of intraoperative anesthetic drugs ( P < .05), leading to shorter MV time ( P < .01) and ICU stay ( P < .05) as well as reduced postoperative dose of vasoactive drugs ( P < .001). In addition, significantly lower levels of troponin I ( P < .01) and tumor necrosis factor α ( P < .01) were observed.
ConclusionThe complementary use of EA for open-heart surgery reduces the duration of MV and ICU stay, blunts the inflammatory response, and might have protective effects on the heart. Our findings stimulate future RCT to provide definitive recommendations.

1.3.2. Thyroid Surgery

1.3.2.1. Chen 2016 ☆

Chen Liang, Cao Yan-Jun, Li Tao, Wan Yu-Qian, Shen Wei-Dong. [Meta-analysis of the application of acupuncture combined cervical plexus anesthesia to thyroid surgery]. Shanghai Journal of Acupuncture and Moxibustion. 2016;35(2):235-40. [187056].

Objectives To assess the effectiveness and safety of applying acupuncture combined cervical plexus anesthesia versus cervical plexus anesthesia alone to thyroid surgery.
Methods A Cochrane systematic review was conducted of randomized controlled trials of acupuncture combined cervical plexus anesthesia. China Knowledge Resource Integrated Database (CNKI), VIP, Chinese Biomedical Literature Database (CBM), Wanfang Database, Pubmed, Ebsco and Medline were electronically searched for the literature published before May 31 st, 2014. Randomized controlled trials of acupuncture combined cervical plexus anesthesia meeting the inclusion criteria were selected after excluding repeated, unrelated and nonrandomized controlled trials. The randomized controlled trials meeting the inclusion criteria were qualitatively assessed using the PEDro scale and a systematic analysis was made using Rev Man 5. 2 software.
Results A total of 12 pieces of literature with 754 patients were included in this study. An analysis of effectiveness showed good homogeneity. OR (combined effect size) =4. 49, 95%CI (2. 82, 7. 14). Z (test for overall effect) =6. 33, P<0. 00001. There was a statistically significant difference, suggesting that acupuncture combined cervical plexus anesthesia was better than in the control group. It can be considered that acupuncture combined cervical plexus anesthesia can improve the effect of the anesthesia. An analysis of intraoperative heart rate showed large heterogeneity [WMD=﹣11. 16, 95%Cl (﹣16. 54, ﹣5. 78)], suggesting that the heart rate was lower than in the control group during surgery under acupuncture combined cervical plexus anesthesia. An analysis of adverse reactions showed good homogeneity. OR (combined effect size) =0. 20, 95%CI (0. 11, 0. 35). Z (test for overall effect) =5. 56, P<0. 00001. There was a statistically significant difference, suggesting that adverse reactions to acupuncture combined cervical plexus anesthesia were fewer than in the control group.
Conclusions In comparison with cervical plexus anesthesia alone, acupuncture combined cervical plexus anesthesia can improve the effect of the anesthesia, decrease intraoperative heart rate and reduce the occurrence of adverse reactions.

1.3.3. GI Endoscopy

1.3.4. Oocytes Retrieval

1.3.5. Neurosurgery

1.3.5.1. Asmussen 2017 ☆☆

Asmussen S, Maybauer DM, Chen JD, Fraser JF, Toon MH, Przkora R, Jennings K, Maybauer MO. Effects of Acupuncture in Anesthesia for Craniotomy: A Meta-Analysis. J Neurosurg Anesthesiol. 2017;29(3):219-227. [109151].

BackgroundAcupuncture treatment has been used in China for >2500 years, and at present it is used worldwide as a form of analgesia in patients with acute and chronic pain. Furthermore, acupuncture is regularly used not only as a single anesthetic technique but also as a supplement or in addition to general anesthesia (GA).
ObjectivesThe aim of this systematic review and meta-analysis was to assess the level of evidence for the clinical use of acupuncture in addition to GA in patients undergoing craniotomy. DESIGN: This is a systematic review of randomized controlled trials with meta-analyses. DATA SOURCES: The literature search (PubMed, Cochrane Library, and Web of Science) yielded 56 citations, published between 1972 and March 01, 2015. No systematic review or meta-analyses on this topic matched our search criteria. Each article of any language was assessed and rated for the methodological quality of the studies, using the recommendation of the Oxford Centre for Evidence Based Medicine. Ten prospective randomized controlled clinical trials with a total of 700 patients were included. ELIGIBILITY CRITERIA: Included in the meta-analysis were studies that involved any craniotomy under GA compared with a combination of GA and acupuncture. Exclusion criteria were no acupuncture during surgery, no GA during surgery, only postoperative data available, animal studies, and low grade of evidence.
ResultsThe use of acupuncture significantly reduced the amount of volatile anesthetics during surgery (P<0.001) and led to faster extubation time (P=0.001) and postoperative patient recovery (P=0.003). In addition, significantly reduced blood levels of the brain tissue injury marker S100β 48 hours after operation (P=0.001) and occurrence of postoperative nausea and vomiting (P=0.017) were observed. No patient studied suffered from awareness.
Conclusions The analysis suggests that the complementary use of acupuncture for craniotomy has additional analgesic effects, reduces the needed amount of volatile anesthetic, reduces the onset of postoperative nausea and vomiting, and might have protective effects on brain tissue. Our findings may stimulate future randomized controlled trials to provide definitive recommendations.

1.3.6. shockwave Lithotripsy