Are acupuncture and electroacupuncture effective in reducing pain after thyroid surgery?
Date of publication of the randomized controlled trial: December 2014
Design
Randomized controlled trial (RCT).
Participants
121 Caucasian patients underwent total thyroidectomy for benign disease (mean age: 49 years in acupuncture group, mean age: 56 years in control group, male %: 22.3%).
Intervention
Electroacupuncture was provided approximately 30 minutes before surgery and in the morning of postoperative day 1. Needles were stimulated using a dedicated electric stimulator. Each acupuncture session lasted for 30 minutes.
Comparator
Comparison 1: Electroacupuncture versus standard postoperative analgesic treatment (including acetaminophen <3000mg/day);
Comparison 2: Electroacupuncture versus manual acupuncture. In manual acupuncture patients, needles were stimulated manually at the insertion until de qi.
Major Outcomes
Outcome 1: Intraoperative pain as measured by remifentanil consumption during anesthesia (ug/kg/min);
Outcome 2: Postoperative pain as measured by Numeric Rating Scale (NRS) at postoperative day 2;
Outcome 3: Postoperative pain as measured by the McGill Pain Questionnaire at postoperative day 2;
Outcome 4: Postoperative pain as measured by analgesic (acetaminophen) consumption (mg/day) at postoperative day 2.
Settings
This trial was conducted in an inpatient setting in Italy.
Comparison    Electroacupuncture versus standard postoperative analgesic treatment
Main Results
Compared to standard postoperative analgesic treatment, patients in electroacupuncture group had a lesser remifentanil consumption, lower NRS score at postoperative day 2 and lower McGill score at postoperative day 2. Besides, patients in electroacupuncture group required less acetaminophen at postoperative day 2.
Comparison 1: Electroacupuncture versus standard postoperative analgesic treatment among patients underwent total thyroidectomy
Outcomes (unit) No. of studies (Total no. of participants) Median value/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (ug/kg/min) 1 (89) 0.138/ 27 0.167/ 62 Not applicable as there is only 1 study. Not reported 0.032 Moderate
2 (NA) 1 (89) 0/ 27 1/ 62 Not applicable as there is only 1 study. Not reported 0.054 Low
3 (NA) 1 (89) 0/ 27 4/ 62 Not applicable as there is only 1 study. Not reported 0.058 Low
4 (mg/day) 1 (89) 0/ 27 500/ 62 Not applicable as there is only 1 study. Not reported 0.004 Moderate
Keys: MD = mean difference, CI = confidence interval.
Comparison    Electroacupuncture versus manual acupuncture
Main Results
Compared to manual acupuncture, patients in electroacupuncture group had a lesser remifentanil consumption, lower NRS score at postoperative day 2 and lower McGill score at postoperative day 2.
Comparison 2: Electroacupuncture versus manual acupuncture among patients underwent total thyroidectomy
Outcomes (unit) No. of studies (Total no. of participants) Median value/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (mg/day) 1 (59) Not reported/ 27 Not reported/ 32 Not applicable as there is only 1 study. Not reported 0.025 Moderate
2 (NA) 1 (59) Not reported/ 27 Not reported/ 32 Not applicable as there is only 1 study. Not reported 0.008 Low
3 (NA) 1 (59) Not reported/ 27 Not reported/ 32 Not applicable as there is only 1 study. Not reported 0.003 Low
Keys: MD = mean difference, CI = confidence interval.
Comparison    Electroacupuncture versus standard postoperative analgesic treatment
Main Results
Compared to standard postoperative analgesic treatment, patients in electroacupuncture group had a lesser remifentanil consumption, lower NRS score at postoperative day 2 and lower McGill score at postoperative day 2. Besides, patients in electroacupuncture group required less acetaminophen at postoperative day 2.
Comparison 1: Electroacupuncture versus standard postoperative analgesic treatment among patients underwent total thyroidectomy
Outcomes (unit) 1 (ug/kg/min) 2 (NA) 3 (NA) 4 (mg/day)
No. of studies (Total no. of participants) 1 (89) 1 (89) 1 (89) 1 (89)
Median value/ No. of participants Intervention 0.138/ 27 0/ 27 0/ 27 0/ 27
Comparator 0.167/ 62 1/ 62 4/ 62 500/ 62
MD (95% CI) Not reported Not reported Not reported Not reported
p value 0.032 0.054 0.058 0.004
Overall quality of evidence* Moderate Low Low Moderate
Keys: MD = mean difference, CI = confidence interval.
Comparison    Electroacupuncture versus manual acupuncture
Main Results
Compared to manual acupuncture, patients in electroacupuncture group had a lesser remifentanil consumption, lower NRS score at postoperative day 2 and lower McGill score at postoperative day 2.
Comparison 2: Electroacupuncture versus manual acupuncture among patients underwent total thyroidectomy
Outcomes (unit) 1 (mg/day) 2 (NA) 3 (NA)
No. of studies (Total no. of participants) 1 (59) 1 (59) 1 (59)
Median value/ No. of participants Intervention Not reported/ 27 Not reported/ 27 Not reported/ 27
Comparator Not reported/ 32 Not reported/ 32 Not reported/ 32
MD (95% CI) Not reported Not reported Not reported
p value 0.025 0.008 0.003
Overall quality of evidence* Moderate Low Low
Keys: MD = mean difference, CI = confidence interval.
Conclusion
Benefits
Compared to standard postoperative analgesic treatment, patients in electroacupuncture group had a lesser remifentanil and acetaminophen consumption. Besides, patients in electroacupuncture group provided a lower NRS score and lower McGill score at postoperative day 2. In this comparison, for outcomes 1 and 4, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect; for outcomes 2 and 3, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect. Compared to manual acupuncture, patients in electroacupuncture group had a lesser remifentanil consumption, lower NRS score and lower McGill score at postoperative day 2. In this comparison, for outcome 1, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect; for outcomes 2 and 3, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in this trial.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25456960
The synopsis is based on the following article:
Iacobone M, Citton M, Zanella S, Scarpa M, Pagura G, Tropea S, et al. The effects of acupuncture after thyroid surgery: a randomized, controlled trial. Surgery. 2014 Dec 31;156(6):1605-13.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.