Acupuncture compound anesthesia for traditional thyroidectomy: a systematic review and meta-analysis

Objective To assess the efficacy and safety of acupuncture compound anesthesia (ACA) for traditional thyroidectomy. Methods Randomized controlled trials (RCTs) studying the use of ACA for traditional thyroidectomy were retrieved from PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP Database (CQVIP), Wanfang Academic Journal Full-text Database (Wanfang), and China Biology Medicine Disc (CBM) from inception to September 30, 2021. Two investigators independently extracted data and assessed the risk of bias and quality of the studies. Anesthesia effectiveness was the primary outcome, while the secondary outcomes included various pain scales, vital signs, analgesic consumption, and adverse events. Review Manager 5.3 was used for meta-analysis. Weighted mean difference (WMD), standardized mean difference (SMD), and confidence interval (CI) were used for statistical descriptions. Results A total of 16 papers were included, involving 1 228 patients. Meta-analysis showed that anesthesia effectiveness was significantly improved after adding acupuncture as an adjunct [SMD=0.62, 95%CI (0.40, 0.83), P <0.0001, I 2 =36%]. Besides, ACA can also moderate vital signs and reduce the feeling of pain [SMD=−1.61, 95%CI (−2.61, −0.61), P <0.00001, I 2 =95%], analgesic consumption, and adverse events. Subgroup analysis of the electroacupuncture (EA) group further revealed that the effectiveness of low-frequency EA [WMD=0.43, 95%CI (0.30, 0.55), P <0.00001, I 2 =15%] and the entire operative stimulation of EA [WMD=0.55, 95%CI (0.33, 0.77), P <0.00001, I 2 =0%] was significantly better than high-frequency EA and short-time stimulation of EA during the operation. Further, no significant difference existed between conventional analgesia and acupuncture analgesia. Conclusion ACA is beneficial to traditional thyroidectomy regarding efficacy and safety when acupuncture is applied as an adjunct. However, additional high-quality studies with larger sample sizes are needed to verify the findings.