Acupuncture and related techniques for postoperative pain after hemorrhoidectomy: A systematic review and network meta-analysis

Introduction: Several acupuncture related techniques are used in clinical practice for postoperative pain after hemorrhoidectomy. As the comparative effectiveness between these treatments was unclear, a systematic review and network meta-analysis was conducted. Methods: MEDLINE, Embase, the Cochrane Library Chinese biomedical database (CBM), and China journal full-text database (CNKI) were searched from January 1st, 1996 to February 1st, 2020, for randomized controlled trials (RCTs) assessing the effectiveness of acupuncture and related techniques. The Cochrane risk of bias tool and GRADE were used to assess the quality of the included RCTs. The effect sizes were pooled by using random-effects model and data presented as standardized mean difference (SMD) or relative ratio (RR). Results: We included 107 RCTs (n = 10,972) for network meta-analysis assessing the relative effectiveness of 40 treatments and 48 RCTs (n = 5226) to analyse responder rate. Auricular acupressure plus acupuncture (RR, 1.44 [95 %CI, 1.15-1.81], P-score = 0.923), acupuncture (RR, 1.23, [95 %CI, 1.04-1.45], P-score = 0.723), other acupuncture techniques (RR, 1.22, [95 %CI, 1.04-1.44], P-score = 0.727) and auricular acupressure (RR, 1.22, [95 %CI, 1.09-1.36], P-score = 0.720) were significantly superior over usual care, and auricular acupressure plus acupuncture ranked the most effective. 72 RCTs (n = 7220) were analysed for pain intensity. Providing eight treatments was significantly superior compared with usual care. Auricular acupressure plus acupuncture (SMD, -1.82 [95 %CI, -3.33 to -0.31], P-score = 0.799) ranked the most effective. Conclusion: Auricular acupressure plus acupuncture provided the best outcomes but findings were limited by the quality of the evidence.