The effectiveness of acupuncture point stimulation for the prevention of postoperative sore throat: A meta-analysis

Abstract

Background: Enhanced recovery pathways can be further improved for postoperative sore throat (POST) that occurs after surgery under general anesthesia. Medications have shown some effectiveness in preventing POST, but acupuncture or related techniques with better safety and lower cost can be used as an alternative or adjuvant therapy to treat perioperative symptoms by stimulating acupuncture point (acupoint). Therefore, we aimed to conduct a meta-analysis to assess whether acupoint stimulation helps patients prevent POST in adults undergoing tracheal intubation for general anesthesia.

Methods: Publications in PubMed, the Cochrane Central Register, ScienceDirect, and ClinicalTrial.gov were surveyed from January 2000 through August 2020. Studies that compared interventions between true acupoint stimulation and no or sham acupoint stimulation were included. The primary outcomes were the incidence and severity of POST at 24h.

Results: Four randomized control trials and 1 comparative study involving 1478 participants were included. Compared with the no or sham acupoint stimulation, the true acupoint stimulation was associated with a reduced incidence (risk ratio, 0.32; 95% confidence interval (CI), 0.18-0.55; P < .001) and decreased severity (standardized mean difference, -2.79; 95% CI, -4.59 to - 0.99; P = .002) of POST. There were no significant adverse events related to acupoint stimulation. The finding for POST was assured by subgroup, sensitivity, and trial sequential analyses.

Conclusions: Acupoint stimulation may reduce the occurrence of POST. It can be considered as one of nonpharmacological methods to prevent POST in enhanced recovery pathways. Further rigorous studies are needed to determine the effectiveness of acupoint stimulation.

Figure 1.

PRISMA flow diagram for searching and identification of included studies.

Figure 2.

Risk of bias for included studies. (A) 4 RCT with RoB 2.0; (B) 1 QES with ROBINS-I. RCT: randomized controlled trial; QES: quasi-experimental study.

Figure 3.

Forest plot for the incidence of POST at 24h. The plot shows the reduced incidence in patients treated with acupoint stimulation compared with control. The control involves a treatment with no or sham acupoint stimulation. The I² value for heterogeneity was zero.

Figure 4.

Forest plot for the severity of POST at 24h. The plot shows the decreased severity in patients treated with acupoint stimulation compared with control. The control involves a treatment with no or sham acupoint stimulation. The I² value for heterogeneity was zero.

Figure 5.

The trial sequential analysis with median control event proportion of 18.7% from 4 included RCTs. The cumulative z curve (blue line) crosses the conventional boundary for benefit (horizontal brown line) and the trial sequential monitoring boundary for benefit (red line), showing a positive effect.