Effect of Invasive Acupuncture on Awakening Quality After General Anesthesia: Systematic Review and Meta-analysis

Overview

Journal Front Med (Lausanne)

Date 2025 Jan 28

PMID 39871839

Authors

Fan-Dong Bu

Shang-Kun Si

Dong-Bin Zhang

Yong-Liang Chi

Affiliations

Soon will be listed here.

Abstract

Background: The process of waking up from general anesthesia is still not well understood, and recovery issues such as delayed awakening, agitation, postoperative cognitive dysfunction, continue to be a challenge for anesthesiologists. Currently, the treatment of these complications is mainly achieved through the antagonistic action of specific drugs, but sometimes the antagonistic drugs are not as effective as they should be and can add to the financial burden of the patient. Acupuncture, a common treatment in Traditional Chinese Medicine, is widely used around surgery. However, there is no enough evidence to show it improves recovery after anesthesia. To explore this, we reviewed relevant randomized trials and conducted a meta-analysis.

Objective: This systematic review was conducted to explore the effect of perioperative application of invasive acupuncture on the quality of postoperative awakening after general anesthesia.

Methods: By searching PubMed, Embase, Cochrane Clinical Trials Center, China Knowledge Network (CNKI), China Biomedical Database (CBM), Wanfang Medical Database, Weipu Database, to include randomized controlled trials of invasive acupuncture applied perioperatively. Search is limited from the build-up of the database to March 2022. The statistical analysis was conducted using RevMan 5.3. Quality assessment of the included research literature using Cochrane-recommended risk of bias assessment tool.

Results: 18 randomized controlled trials were included with 1,127 patients. 565 patients in invasive acupuncture intervention group, 562 patients in control group. Results showed that invasive acupuncture group had a shorter eye opening time than control group (MD = -6.42, 95% CI [-8.17, -4.66],  < 0.001), shorter extubation times (MD = -5.84, 95% CI [-8.12, -3.56],  < 0.001), lower MAP at extubation (MD = -18.54, 95% CI [-22.69, -14.39],  < 0.001), lower HR at extubation (MD = -14.85, 95% CI [-23.90, -5.81],  < 0.001). No statistical difference in the occurrence of POCD (OR = 0.56, 95% CI [0.28, 1.11],  = 0.10) and postoperative agitation (OR = 0.42, 95% CI [0.11, 1.65],  = 0.21).

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42023410260.

References

Yan X, Han X, Xing Q, Li Y, Dong X, Wu Y . [Comparative study between electroacupuncture at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery]. Zhongguo Zhen Jiu. 2021; 41(1):59-64. DOI: 10.13703/j.0255-2930.20200121-k0001. View

Yang Q, Ma W, Li Y . [Comparison of effects of acupuncture-assisted anesthesia with different acupoint combination in gynecologic laparoscopy operation]. Zhongguo Zhen Jiu. 2012; 32(1):59-64. View

An L, Ji Y, Wang L . [The application of electro-acupuncture combined with sevoflurane anesthesia in neurosurgery]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011; 31(9):1181-6. View

Seo I, Seong C, Jung G, Park S, Kim S, Kim M . The effect of sub-Tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery. Eur J Anaesthesiol. 2011; 28(5):334-9. DOI: 10.1097/EJA.0b013e3283426ed6. View

Abe D, Hanaoka Y, Kobayashi K, Kiuchi T, Watanabe T, Kobayashi S . ＜Editors' Choice＞ Surgical removal of an intracranially migrated acupuncture needle: a case report and literature review. Nagoya J Med Sci. 2022; 84(4):890-899. PMC: 9748321. DOI: 10.18999/nagjms.84.4.890. View

Liao H, Satyanarayanan S, Lin Y, Su K . Clinical efficacy and immune effects of acupuncture in patients with comorbid chronic pain and major depression disorder: A double-blinded, randomized controlled crossover study. Brain Behav Immun. 2023; 110:339-347. DOI: 10.1016/j.bbi.2023.03.016. View

Kim H, Markert R, Burtson K . Battlefield acupuncture appears to be an effective therapy for pain management. Acupunct Med. 2021; 40(1):43-49. DOI: 10.1177/09645284211050648. View

Chen T, Zhang W, Chu Y, Wang Y . Acupuncture for Pain Management: Molecular Mechanisms of Action. Am J Chin Med. 2020; 48(4):793-811. DOI: 10.1142/S0192415X20500408. View

Hinman R, McCrory P, Pirotta M, Relf I, Forbes A, Crossley K . Acupuncture for chronic knee pain: a randomized clinical trial. JAMA. 2014; 312(13):1313-22. DOI: 10.1001/jama.2014.12660. View

10.

Garland S, Xie S, DuHamel K, Bao T, Li Q, Barg F . Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. J Natl Cancer Inst. 2019; 111(12):1323-1331. PMC: 6910189. DOI: 10.1093/jnci/djz050. View

11.

Yan J, Lin C, Zhang C, Ou J, Luo F, Zhang S . [Effects of assisted-electroacupuncture on recovery of fast tracking anesthesia in mPCNL]. Zhongguo Zhen Jiu. 2014; 34(4):385-8. View

12.

Yang N, Yang J, Ye Y, Huang J, Wang L, Wang Y . Electroacupuncture ameliorates intestinal inflammation by activating α7nAChR-mediated JAK2/STAT3 signaling pathway in postoperative ileus. Theranostics. 2021; 11(9):4078-4089. PMC: 7977469. DOI: 10.7150/thno.52574. View

13.

Harbell M, Barendrick L, Mi L, Quillen J, Millstine D . Patient Attitudes Toward Acupuncture in the Perioperative Setting. J Integr Complement Med. 2022; 28(4):349-354. DOI: 10.1089/jicm.2021.0311. View

14.

Tolly B, Waly A, Peterson G, Erbes C, Prielipp R, Apostolidou I . Adult Emergence Agitation: A Veteran-Focused Narrative Review. Anesth Analg. 2020; 132(2):353-364. DOI: 10.1213/ANE.0000000000005211. View

15.

Gemma M, Bricchi M, Giannini A, Coffano B, Grandi L, Quirico P . Acupuncture accelerates recovery from general anaesthesia. Can J Anaesth. 1993; 40(12):1224-5. DOI: 10.1007/BF03009621. View

16.

An L, He Y, Ren X, Li S, Han R, Wang B . [Effect of electroacupuncture on Sevoflurane anesthesia in patients undergoing resection of supratentorial tumor]. Zhongguo Zhen Jiu. 2010; 30(8):669-73. View

17.

Gemma M, Nicelli E, Gioia L, Moizo E, Beretta L, Calvi M . Acupuncture accelerates recovery after general anesthesia: a prospective randomized controlled trial. J Integr Med. 2015; 13(2):99-104. DOI: 10.1016/S2095-4964(15)60159-5. View

18.

Zhang N, Daly D, Terblanche M, Joshi S, Tacey M, Vesty G . Doctors' and Nurses' Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey. Pain Manag Nurs. 2022; 23(6):800-810. DOI: 10.1016/j.pmn.2022.08.008. View

19.

Thng F, Rao K, Huang P . Case series: acupuncture-related pneumothorax. Int J Emerg Med. 2022; 15(1):48. PMC: 9465868. DOI: 10.1186/s12245-022-00455-z. View

20.

Fabregas N, Bruder N . Recovery and neurological evaluation. Best Pract Res Clin Anaesthesiol. 2008; 21(4):431-47. DOI: 10.1016/j.bpa.2007.06.006. View