Background
Thyroidectomy represents one of the most frequent procedures in endocrine surgery. Postoperative pain in patients undergoing thyroidectomy is the result of superficial incision, tissue dissection, and neck position during surgery. It needs appropriate control during the first days after the procedure. Administration of opioids and/or nonopioid drugs is often required, with frequent worsening of anesthetics-induced nausea and vomiting, and other side effects.
Alternative medicine may offer additional options for adequate management of postoperative pain. Acupuncture, a component of traditional Chinese medicine, is a well-known alternative and widely used treatment for pain, especially in Asian countries. In recent years, an increased use of acupuncture has been observed also in Western countries; the National Institutes of Health and the World Health Organization have recognized the safety and efficacy of the procedure for the treatment of neck pain. Thus, several clinical trials evaluating the efficacy of acupuncture as adjuvant method for postoperative analgesia have been published.
Conflicting results have been reported, and probably owing to the heterogeneity in acupuncture techniques that may consistently vary according to the site, timing and type of stimulation. In fact, electric, chemical, or physical stimulations have been also used in several studies to increase the effectiveness of the procedure.
This randomized, controlled trial evaluated the effectiveness of acupuncture in reducing pain in patients undergoing thyroid surgery.
Methods
We randomized 121 patients to a control group (undergoing only standard postoperative analgesic treatment with acetaminophen) and an acupuncture group, undergoing also either electroacupuncture (EA) or traditional acupuncture (TA). Pain was measured according to intraoperative remifentanil use, acetaminophen daily intake, Numeric Rating Scale (NRS), and McGill Pain Questionnaire on postoperative days (POD).
Results
Acupuncture group required less acetaminophen than controls at POD 2 (P = 0.01) and 3 (P = 0.016). EA patients required less remifentanil (P = 0.032) and acetaminophen than controls at POD 2 (P = 0.004) and 3 (P = 0.008). EA patients showed a trend toward better NRS and McGill scores from POD 1 to 3 compared with controls. EA patients had a lower remifentanil requirement and better NRS and McGill scores than TA patients. No differences occurred between TA patients and controls.
Conclusion
Acupuncture may be effective in reducing pain after thyroid surgery. EA is more useful; TA achieves no significant effects.
