Name: acupoint needle-embedding combined with ironing therapy for postoperative pain after anal surgery
Uploaded: 2023-06-23T12:50:00
Description: Watch this Scientific Journal Video about Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery at JoVE.com

This research was supported by the Hospital Foundation of Hospital of Chengdu University of Traditional Chinese Medicine (Y2023016) and the Second Postgraduate Research Innovation Practice Project of the School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine (LCYJSKT2023-35)&#160;and Sichuan Provincial Administration of Traditional Chinese Medicine General Program (2023MS005).

A brief graphical flow of the protocol is shown in Figure 1. The protocol was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Hospital of Chengdu University of Traditional Chinese Medicine (code: 470000013, 4300000011). The data were obtained with the informed consent of the patients. The patients voluntarily signed informed consent prior to the study. The inclusion criteria were as follows: the ability to follow the doctor&#39;s advice; signing...

Surgical procedures for hemorrhoids have developed rapidly. In addition to the traditional M-M surgery, procedures such as rubber band ligation (RBL), the procedure for prolapse and hemorrhoids (PPH), tissue-selecting therapy stapler (TST), hemorrhoidal artery ligation, and infrared photocoagulation have also been widely used37,38,39. However, the advantages of M-M surgery, such as the high cure rate, low price, and simple opera...

Postoperative pain is one of the most common complications in anorectal surgery. Among these conditions, pain caused by hemorrhoid surgery is particularly prevalent1. Generally speaking, postoperative pain may be caused by anxiety after surgery2, improper surgical methods3, obstruction of blood and lymph flow4, surgical wound infection, and spasm of the internal anal sphincter5. In most cases, postoperative pain is a normal physiological response, but excessive or persistent pain causes discomfort to the patients, aggravates psychological pressure, and, thus, hinders recovery6.
For mild pain, non-steroid anti-inflammatory drugs (NSAIDs), calcium channel blockers, and surface anesthetics can fulfill the treatment requirements7,8. For severe pain, morphine and tramadol seem to be an appropriate selection9. However, analgesics are associated with poor pain relief effects in anorectal surgery, and the risks of gastrointestinal bleeding or gastric ulcers caused by NSAIDs make clinicians hesitant to prescribe them10,11. Furthermore, the addictiveness of opioids can have a huge impact on the patients&#39; living standards12. Optimizing the surgical procedure to prevent postoperative pain, such as by including lateral internal anal sphincterotomy, has been criticized due to its risk of anal incontinence13.
Acupoint needle embedding is a branch of acupuncture treatment, and its analgesic effect has been recognized for a long time. Ashi acupoint has a good analgesic effect, but its practice is limited because of the anus&#39; physiological function and anatomical structure, as directly stimulating the anus only increases the pain for the patients14. In recent years, stimulation on other acupoints to release pain has been reported15,16. Wang et al.17 achieved significant pain relief effects after hemorrhoid surgery by stimulating acupoints such as Changqiang (DU1), Chengshan (BL57), and Erbai (EX-UE2) with pestle needles. A more comprehensive study found that in the sham acupuncture group, pain relief was lower at 5 h, 7 h, and 8 h after treatment than in the acupuncture stimulation group18. Meanwhile, according to several meta-analyses, stimulation of acupoints can reduce postoperative pain with a better therapeutic effect than NSAIDs19,20. In TCM theory, stimulating acupoints can reduce the anxiety state of patients. In addition, it can promote local blood circulation to accelerate the resolution of inflammation and tissue repair17. A study has reported that acupuncture can also promote the release of endogenous analgesic substances, such as enkephalins and endorphins, to block the transmission of pain signals in nerve cells21. Acupuncture treatment is not only effective in relieving postoperative pain in hemorrhoids, but it has also been reported to be effective in relieving musculoskeletal pain22, back pain23, and primary dysmenorrhea24. Summarizing the previous clinical trials, we believe that acupuncture point stimulation is effective for pain relief after hemorrhoid surgery.
Ironing therapy is one of the most widely used treatment methods throughout human history. It involves using heat to penetrate the skin and accelerate blood flow, promote tissue metabolism, and regulate sensory nerves to reduce pain25. Furthermore, heat can also relieve the contraction of the muscles26. Massage techniques can be added to this treatment to increase the effect of pain relief. A previous clinical trial demonstrated that massage on the suprapubic and sacral regions could relieve pain in the perineal region27. It works by blocking pain signals from reaching the central nervous system while increasing sympathetic nerve activity and reducing the pain caused by negative emotions28,29.
The operating procedures included in the protocol increased the safety of the operation, shortened the hospitalization days, reduced the level of postoperative pain, and decreased the incidence of urinary retention and anal edema. Acupoint needle-embedding combined with ironing treatment is a characteristic traditional Chinese medical method for postoperative pain from hemorrhoids and is recommended for healthy adults with no contraindications. It is expected to become an important complementary treatment for patients with postoperative pain.

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			<td>diclofenac sodium enteric-coated capsules</td>
			<td>Temmler Ireland Co., Ltd., Kerry, Ireland</td>
			<td>H20170098</td>
			<td></td>
		</tr>
		<tr>
			<td>fructus aurantii</td>
			<td>Traditional Chinese Medicine Co., Ltd., Sichuan, China</td>
			<td>220209</td>
			<td></td>
		</tr>
		<tr>
			<td>fructus foeniculi</td>
			<td>Traditional Chinese Medicine Co., Ltd., Sichuan, China</td>
			<td>220210</td>
			<td></td>
		</tr>
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			<td>gauze bag</td>
			<td>Anhui Meijianan Household Products Co., Ltd, Anhui, China</td>
			<td>M921</td>
			<td></td>
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			<td>hand sanitizer</td>
			<td>Suolang Medical Disinfectants Co., Ltd., Zhejiang, China</td>
			<td>200561121Q</td>
			<td></td>
		</tr>
		<tr>
			<td>iodophor cotton swabs</td>
			<td>Jiabeier Medical Technology Co., Ltd., Zhejiang, China</td>
			<td>20162140536</td>
			<td></td>
		</tr>
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			<td>microwave oven</td>
			<td>Galanz Group Co., Ltd., Guangdong, China</td>
			<td>P70D20L-ED(W0)</td>
			<td></td>
		</tr>
		<tr>
			<td>press needle</td>
			<td>Suzhou Acupuncture Supplies Co., Ltd. Zhejiang, China</td>
			<td>20162200591</td>
			<td></td>
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			<td>pulverizer</td>
			<td>Zhaofenger Industry and Trade Co., Ltd., Hunan, China</td>
			<td>J80031</td>
			<td></td>
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		<tr>
			<td>radix paeoniae alba</td>
			<td>Guoqiang Pharmaceutical Co., Ltd., Sichuan, China</td>
			<td>220601</td>
			<td></td>
		</tr>
		<tr>
			<td>rhizoma chuanxiong</td>
			<td>Yuankang Pharmaceutical Co., Ltd., Sichuan, China</td>
			<td>220603</td>
			<td></td>
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			<td>rhizoma corydalis</td>
			<td>Xinhehua Pharmaceutical Co., Ltd., Sichuan, China</td>
			<td>2206071</td>
			<td></td>
		</tr>
		<tr>
			<td>rhizoma curcumae longae</td>
			<td>Traditional Chinese Medicine Co., Ltd., Sichuan, China</td>
			<td>220216</td>
			<td></td>
		</tr>
		<tr>
			<td>sterile cotton swabs</td>
			<td>Zhongxin Sanitary Materials Co., Ltd., Sichuan, China</td>
			<td>20180021</td>
			<td></td>
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		<tr>
			<td>sterile tweezers</td>
			<td>Weigao Grope Medical Polymer Co., Ltd., Shandong, China</td>
			<td>20182640148</td>
			<td></td>
		</tr>
		<tr>
			<td>thermometer</td>
			<td>Beierkang Medical Devices Co., Ltd., Guangdong, China</td>
			<td>20162200505</td>
			<td></td>
		</tr>
		<tr>
			<td>treatment towel</td>
			<td>Sichuan Hualikang Medical Technology Co., Ltd, Sichuan, China</td>
			<td>2111901</td>
			<td></td>
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acupoint needle-embedding combined with ironing therapy for postoperative pain after anal surgery

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is guided by traditional Chinese medicine (TCM) syndrome differentiation theory and employs acupoint stimulation and heat to alleviate pain. Although prior research has shown that these are dependable methods for pain relief, the combined effect of the two techniques has not been described. In our research, we found that compared to using diclofenac sodium enteric-coated capsules alone, adding acupoint needle-embedding combined with ironing therapy was more effective for reducing pain levels at different stages after hemorrhoid surgery. Although this technique is efficient and commonly used in clinics, due to its invasive practice, acupoint needle embedding still carries risks relating to hospital-acquired infections and broken needles. Ironing therapy, on the other hand, can result in burns and connective tissue injuries. Therefore, there is an urgent need to develop a standardized protocol for medical staff. Our protocol refines the traditional techniques and provides detailed instructions on patient preparation, operation techniques, and postoperative care to ensure the therapy is carried out safely and efficiently. By standardizing this therapy, this technique is expected to become an important complementary therapy for postoperative pain relief&#160;in hemorrhoids, which will significantly improve patients &#39;life quality after anal surgery.

Statistical analysis 
Collect and analyze the data using SPSS 22.0. In this work, normally distributed continuous variables were expressed as mean &#177; standard (SD), and comparisons between two groups were made using the Student&#39;s t-test. Continuous variables with skewed distributions were described using the median and 25% and 75% interquartile range, M (QL, QU), and comparisons between groups were performed using the Mann-Whitney U-test. Dichotomous variables were tested using the Chi-squar...

Watch this Scientific Journal Video about Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery at JoVE.com

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery

The high incidence of pain after anal surgery is due to the physiological structure and pathological status of the anus. At present, the use of painkillers cannot provide satisfactory pain relief, which makes complementary therapy important. This paper proposes acupoint needle-embedding combined with ironing therapy to relieve postoperative pain.

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is ...

Acupoint needle-embedding combined with ironing therapy is commonly used in clinics, but this operation process is not standardized, and may carry risks relating to this procedure. This technique effectively reduces pain levels at different stages after the hemorrhoid surgery. This technique reduces postoperative pain of hemorrhoid patients, and improves the patient's life quality after surgery.Begin with the patient assessment, evaluating their skin condition. After inspecting all equipment, ensuring the validity of consumables, and that the press needles are not damaged, perform operator disinfection with hand sanitizer using the seven step hand washing method. Disinfect the acupoint needle embedding site using a iodophor four cotton swab, spiraling outwards from the center, allowing the disinfectant to remain for about one minute.Ensure the disinfected area is larger than three centimeters in diameter. To embed the needles, begin by selecting three acupoints including EX-UE2, BL-57 and SP-6. Using sterilized tweezers, grip the press needle's edge.Position the needle over a chosen acupoint, and firmly press its tail with the right thumb within one second. Once the needle is inserted, gently rotate it 20 to 25 times clockwise at 40 to 50 times per minute, followed by counterclockwise rotations at the same speed. Secure the needle at the acupoint with tape.Apply up and down floating pressure on the needle tail. To remove the needles, carefully remove the tape after disinfecting hands. Then gently separate the needle base from the skin using tweezers.Once detached, gently pull out the needle using the tweezers. Upon completion, disinfect the affected skin with an iodophor cotton swab. Apply pressure with a sterile cotton swab if bleeding occurs.Following the procedure, execute the seven step hand washing method for disinfection. If the needle's broken end is flat or slightly depressed, squeeze the skin downward with the left thumb and index finger to expose the needle, then remove it using tweezers. To begin ironing, start by disinfecting the operation site.Focus on the CV-29, ST-25, and DU-1 operation sites. Now crush the drug at room temperature and humidity of 40 to 70%using a pulverizer. After pulverization, pack 130 grams of the drug into a gauze bag, and soak it in water until fully saturated.Heat the gauze bag for two minutes in a microwave oven at 90 to 110 degrees Celsius, then cool it to 40 to 45 degrees Celsius before wrapping the medicated gauze bag securely with a treatment towel. Place both hands on the sides of the gauze bag, then straighten your elbows, leaning forward to apply gentle pressure. When the abdomen sinks by three to five centimeters, hold for five seconds, allowing heat to penetrate the skin, then slowly release.Next, massage with the medicine bag, circling clockwise 60 times and counterclockwise 60 times, each rotation lasting one to two seconds. After the operation, cover the treated area, keeping it warm. Reuse the medicinal bag up to four times.To manage burns limited below a deep partial degree, promptly rinse the affected area with flowing cold water for 30 minutes. Disinfect the damaged spot with iodophor swabs. Cover it with gauze, and secure it with medical tape.Apply antibiotic ointment if the area is large. Patients treated with acupoint needle embedding combined with ironing had relatively lower VAS scores after the first defecation. Patients treated with traditional Chinese medicine were in less pain on the fifth day post-surgery and on the discharge day compared to the control group.The treatment group showed greater decrease in VAS scores between the first to fifth day post-surgery. A rigorous procedure ensures the effectiveness of the treatment while eliminating most complications. When the treatment is ineffective, or central allergesic can be applied.Our goal is to relieve the patient's medical pain after the anal surgery. This protocol lies the foundation for the scientific study of the traditional ethnomedicine. It provides a standardized operation technique for the subsequent in-depth research.

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