Zusanli (ST36) acupoint injection for preventing postoperative ileus: A systematic review and meta-analysis of randomized clinical trials

Abstract

Summary Objective To evaluate the preventive effect of Zusanli (ST36) acupoint injections with various agents, for postoperative ileus (POI). Methods We searched electronic databases for randomized controlled trials from inception to 1st February 2015 evaluating ST36 acupoint injection for preventing POI. Revman 5.2.0 was used for data analysis with effect estimates presented as mean difference (MD) with 95% confidence interval (CI). Statistical heterogeneity was tested using I2 (defined as significant if I2 > 75%). We used a random effects model (REM) for pooling data with significant heterogeneity. Results Thirty trials involving 2967 participants were included. All trials were assessed as high risk of bias (poor methodological quality). For time to first flatus, meta-analysis favored ST36 acupoint injection of neostigmine (MD −20.70 h, 95% CI −25.53 to −15.87, 15 trials, I2 = 98%, REM), vitamin B1 (MD −11.22 h, 95% CI −17.01 to −5.43, 5 trials, I2 = 98%, REM), and metoclopramide (MD −15.65 h, 95% CI −24.77 to −6.53, 3 trials, I2 = 94%, REM) compared to usual care alone. Meta-analysis of vitamin B1 favored ST36 acupoint injection compared to intra-muscular injection (MD −17.21 h, 95% CI −21.05 to −13.36, 4 trials, I2 = 89%, REM). Similarly, for time to bowel sounds recovery and first defecation, ST36 acupoint injection also showed positive effects. Conclusions ST36 acupoint injections with various agents may have a preventive effect for POI. Safety is inconclusive as few of included trials reported adverse events. Due to the poor methodological quality and likely publication bias further robust clinical trials are required to arrive at a definitive conclusion.

Absorptive anti-adhesion barrier for the prevention of bowel obstruction after laparoscopic colorectal cancer surgery

“…Absorptive anti-adhesion barrier for the prevention of bowel obstruction after laparoscopic colorectal cancer surgery Shoichi Fujii 1) , Mitsuo Tsukamoto 2) , Ryu Shimada 2) , Koichi Okamoto 2) , Tamuro Hayama 2) , Takeshi Tsuchiya 2) , Keijiro Nozawa 2) , Keiji Matsuda 2) , Atsushi Ishibe 3) , Mitsuyoshi Ota 3)…”

“…Various products and postoperative management procedures have been used to prevent postoperative peritoneal adhesions [1][2][3][4][5][6][7][8] . The usefulness of the absorptive anti-adhesion barrier film Seprafilm [9][10][11][12][13][14] has been shown by many randomized control studies and meta-analysis, although studies with negative results do exist [15][16][17][18] .…”

Effect of Acupressure on Symptoms of Postoperative Ileus After Cesarean Section

“…2) [9,15]. Each session of acupressure lasted for 20 minutes (i.e., 10 minutes for each point), performed in a nonclockwise direction by moderate pressure of the pollex finger.…”

“…The presence of bowel sounds was investigated in time intervals of 2 hours in four quadrants, and to shrink the feasible error, the criterion was the presence of three bowel sounds in a minute [15]. The three other outcomes were measured as the interventions were implemented in acupressure group for both groups.…”

“…In contrast, some review studies were less conclusive regarding the effectiveness of acupuncture and acupressure for POI. Therefore, further valid and well-defined clinical studies are necessary to confirm the therapeutic effect of acupuncture and acupressure in POI treatment [10,15]. The purpose of this study was to find a noninvasive and costeffective treatment for POI.…”