Introduction: acupuncture surgical analgesia is a tool to take into account for medicine because it does not require very large financial expenses compared to conventional anesthesia, but its effectiveness must be verified, because it is an invasive non-pharmacological method that can have negative consequences if used inappropriately. Objectives: Describe how acupuncture surgical analgesia works and the effectiveness demonstrated in recent years. Method: A review of the literature found in the SCIELO and Cochrane database was carried out between the months of November and December 2023. 60 articles were consulted, of which 20 were chosen. Development: Acupuncture surgical analgesia prevents the patient from experience pain during the intervention; this has been proven mainly in inguinal hernia operations. . It is also important in recovery therapies where it has been shown to positively intervene in the quality of life of postoperative patients. Conclusions: It turns out to be effective during surgical interventions and in recovery therapies, although more studies are required to support this practice in other interventions; nor should we forget the possibility of causing a traumatic pneumothorax secondary to acupuncture with poor management of acupuncture surgical analgesia.
Effectiveness of acupuncture, Natural and traditional medicine, Physiology of acupuncture, Recovery therapies.
Natural and traditional Chinese medicine is an interesting subject that has been the subject of numerous studies. The Chinese medical system may be considered superstitious quackery by those unfamiliar with the subject, but this system, despite not being the oldest, is the longest-lasting and has served the world's largest population for millennia [1] .
The World Health Organization (WHO) recognizes the benefits of various treatments derived from traditional medicine in its various forms. Of all the modalities, acupuncture is the most widely used worldwide. It acts as an analgesic for various causes, including those of surgical origin [2] .
On the other hand, the way in which conventional medicine treats ailments due to surgical causes causes great dissatisfaction in patients, which is why many of them opt for acupuncture, which has demonstrated throughout history its importance as an analgesic during and after surgical interventions [1] .
The principle of acupuncture is the penetration of fine needles to relieve certain energy blockages along meridians by stimulating acupuncture points. Unblocking and promoting the continuous flow of energy blockages in the meridians is important for bodily functions [2] .
Acupuncture surgical analgesia (AQA) produces mechanical or electrical stimulation in various parts of the body, causing an increase in the pain threshold and, in turn, a decrease in intensity. This procedure helps the patient endure various types of surgical interventions and supports recovery in the case of postoperative patients [3] .
The AQA It emerged in 1958, when Chinese acupuncturists successfully used acupuncture as an anesthetic for tonsillectomy procedures, surprising the entire world. Most importantly, while the patients were anesthetized, they were conscious and fully able to cooperate with the surgeon. All their organs functioned well, their immune system improved, and their recovery rate increased [1], [2] .
AQA is also used in other countries; in Vietnam it was first used in 1969, when Professor Hoang Dinh Can performed the first thoracotomies. During the war it was used to perform numerous operations [2] .
In Cuba, two tonsillectomies were reported in Havana between 1976 and 1977. In 1982, several surgical interventions using AQA were performed by some well-known Vietnamese doctors in several hospitals in Havana. The subsequent visit of the director of the Institute of Traditional Medicine in Hanoi on September 1, 1984, during which a cholecystectomy with acupuncture was performed, marked a turning point in Cuban medicine, since the exchange of knowledge between Cuban doctors and such prestigious professors allowed for the maximum development of the analgesic use of needles [2] .
In 2019, Caveda Carrasco conducted a study in which he applied AQA in pediatric inguinal genital surgery and demonstrated the good response to treatment of patients with few complications [2] .
In 2021, Dr. Alemán Soria conducted research to describe the effect of acupuncture stimulation on the recovery from balanced general anesthesia in patients undergoing surgery for breast nodules and demonstrated that the application of acupuncture shortens the anesthetic recovery time in the patients studied [4] .
More studies have been conducted recently, which will be compiled and analyzed in this article.
AQA is a tool to be taken into account for medicine because it does not require very large economic expenses compared to conventional anesthesia, but its effectiveness must be verified, because it is a non- invasive pharmacological method that can have negative consequences if used inappropriately , which is why the objective To describe the effectiveness of acupuncture as anesthesia in surgical interventions and in recovery therapies in postoperative patients.
An exhaustive search was conducted using search engines such as Google Scholar and Dialnet; databases such as Scielo, Cochrane, and PubMed were also used. Information was retrieved only in Spanish and Portuguese. The selected articles are fully available from their respective databases and are free of charge.
Search strategies include terms such as: natural and traditional medicine, acupuncture, acupuncture in surgical interventions, acupuncture surgical analgesia, traditional Chinese medicine, and acupuncture recovery therapies.
The search period ran from November to December 2023. Sixty articles were reviewed, of which 20 were selected.
Acupuncture acts by releasing inflammatory cascades: following mechanical stimulation by the needle, proteins involved in inflammation are released. These cascades ultimately activate the nervous system in one way or another through mechanotransduction of its peripheral receptors [5] .
Activation of nociceptors causes excitation of wide dynamic range neurons, which are involved in coding the intensity of the nociceptive stimulus [5] .
Aδ and C fibers send input to many types of nociceptive neurons [5] .
Descending inhibitory mechanisms, supraspinal areas and networks with the release of different transmitters and the involvement of non-specific mechanisms such as placebo effects, are essential in the mechanisms of action of acupuncture [5] .
Surgical anesthetic acupuncture includes needle manipulation, electroacupuncture, and bioenergetic techniques to achieve analgesia during surgical procedures [6] .
In the case of needle manipulation, there are different studies that use different techniques, for example:
In 2020, Guadalupe Zaragoza reported having used needles in the pericapsular nerve group (PENG) block for hip surgery, and it was concluded that the PENG block, being exclusively sensitive and more selective, does not affect the patient's hemodynamic stability, due to sympathetic blockade. For this and other reasons, the authors consider it a good option [6] .
Another investigation carried out in 2020 by Hidalgo Hernández, uses electroacupuncture on post-surgical pain from inguinal hernioplasty and seroma complications. For this, stainless steel needles were used with the KWB 808 I electrostimulator, direct current at 2 Hz unilaterally for 30 min, puncturing V 17 Geshu (cathode), V 22 Sanjiaoshu (anode), E 36 Zusanli (anode) and E 35 Dubi (cathode). After this, the surgical lesion had a recovery close to 100%. It should be noted that therapeutic laser was also used in this study [7] .
The AQA has demonstrated great effectiveness in several studies using it as a study object or as an alternative therapy:
Acupuncture and acupressure at Neiguan point, also known as P6, located on the inner side of the arms near the wrist, are mentioned in several studies as alternative therapy and are reported to reduce nausea but not vomiting, and have been postulated as prophylaxis for postoperative nausea and vomiting in the pre-induction period [8], [9], [10] .
Studies such as that of Capote Hernández in 2020 demonstrate the effectiveness of acupuncture surgical analgesia in type I and II inguinal hernia operations [11] .
In a research conducted by Huerta López and others in 2020, acupuncture was used in the symptoms of carpal tunnel syndrome. Its authors conclude that the management of these patients could benefit if acupuncture were adopted within comprehensive care programs, because it would be a safe, effective and affordable form of treatment [12] .
In 2021, in a study on the effects of acupuncture on postoperative ileus in patients undergoing colorectal cancer surgery conducted by Viviana Gómez Betancur and other authors, it was concluded that acupuncture shows a great positive effect without showing an adverse side or complications associated with its use [13] .
Another study in 2021 by Nunes Nacimiento on the impact of acupuncture in the postoperative treatment of the anterior cruciate ligament in soccer players, concludes that acupuncture greatly helps in post-surgical treatment, mainly in pain control and with much better effects when associated with physiotherapy; it can accelerate the return of athletes to their sports activities, although they point out that more studies are required on this topic [14] .
In 2022, an intervention carried out by Ponce Orellana and another study carried out by Siguencia Yamasqui , agree that acupuncture appears to be effective in reducing preoperative anxiety and postoperative pain in women undergoing breast cancer surgery [15], [16] .
In 2023, a study conducted by Fuentes Ayala also corroborates the effectiveness of acupuncture as a complementary non-pharmacological treatment in recovery therapies for post-operative patients [17] .
In the same year, a study conducted by Barragán Zurita concluded that acupuncture surgical analgesia is important in hernias because it represents an effective and safe alternative to conventional pharmacological analgesia, and reduces the risk of side effects and complications related to the use of medications. Furthermore, it highlights the positive impact it can have on postoperative recovery and the quality of life of patients [18] .
Despite the numerous references that support the effectiveness of AQA, in 2022, a study carried out by Chávez Marin reveals that in some clinics such as the Vázquez aesthetic clinic, acupuncture is rarely used, nurses preferring to use analgesic pharmacological treatments [19] .
Finally, it is worth mentioning a letter to the editor written by Pérez Castro in which he mentions traumatic pneumothorax associated with acupuncture, which represents a danger to the well-being of the postoperative patient [20] .
AQA has proven effective during surgical procedures and in recovery therapies. Evaluating the efficacy of this practice in certain diseases constitutes a further contribution to the knowledge of anesthesiology specialists , as it involves minimal costs compared to other analgesic methods. However, further studies are needed to support its use in other procedures, primarily due to the possibility of secondary traumatic pneumothorax associated with acupuncture due to poor AQA management.
WERA: Conceptualization, data curation, research, methodology, project administration, resources, supervision, validation, writing of the original draft and manuscript.
SRSJ: Conceptualization, Research, Supervision, Validation, writing of the original draft and manuscript.
The authors declare that there are no conflicts of interest.
The authors did not receive funding for the development of this article.
Copyright 2024 Wilfredo Enrique Romero Aguirre et al.
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