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Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials
Liu N, Liu G, Chang X, Xu Y, Hou Y, Zhang D, Wang L, Chen S
Frontiers in Neurology 2024 Mar 18;15(1361037):Epub
systematic review

OBJECTIVE: This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context. METHODS: We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value. RESULTS: We conducted an analysis of 41 qualifying studies encompassing 3,003 patients, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS plus MA (SMD 0.67; 95% CI 0.01 to 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU plus MA (SMD 6.45; 95% CI 3.30 to 9.60), EA plus MA (SMD 4.89; 95% CI 1.46 to 8.32), and TEAS plus MA (SMD 5.31; 95% CI 0.85 to 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU plus MA was more efficacious than EA plus MA, TEAS plus MA, and AAT plus MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU plus MA (OR 4.98; 95% CI 1.01 to 24.42) was observed to be higher compared to that after AAT plus MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS plus MA (OR 0.36; 95% CI 0.18 to 0.70) and AAT plus MA (OR 0.20; 95% CI 0.08 to 0.50). The SUCRA ranking indicated that ACU plus MA, EA plus MA, TEAS plus MA, and AAT plus MA displayed superior SUCRA scores for each outcome index, respectively. CONCLUSIONS: For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA plus MA and TEAS plus MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU plus MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT plus MA is recommended for preventing postoperative adverse reactions. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/, identifier (CRD42023492859).

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