Surgery support

DEFINITION: Treatment to aid in postoperative healing.

• PRINCIPAL PROPOSED NATURAL TREATMENTS: Acupuncture-acupressure, bioflavonoids, oxerutins and other oligomeric proanthocyanidins, proteolytic enzymes
• OTHER PROPOSED NATURAL TREATMENTS: Arnica, bee propolis, cayenne (capsaicin), ginger, fish oil, horse chestnut, hypnotherapy, lavender aromatherapy, magnet therapy, multivitamin-multimineral supplements, music therapy, peppermint, relaxation, and guided imagery
• HERBS AND SUPPLEMENTS TO USE ONLY WITH CAUTION: Garlic, ginkgo, St. John’s wort, vitamin E

Introduction

Surgery, even relatively minor surgery, is a significant trauma to the body. The surgical incision itself can cause swelling (edema), pain, and bruising; anesthesia frequently causes nausea and bloating. Certain surgeries that damage the body’s lymphatic system, such as radical mastectomy, can cause a specific form of long-lasting swelling called lymphedema.

Modern surgery involves numerous sophisticated non-drug techniques to help wounds heal rapidly and completely. Various medications can be used to help offset the side effects of anesthesia.

Principal Proposed Natural Treatments

A variety of herbs, supplements, and other alternative therapies show promise in alleviating problems encountered following surgery. However, many such substances have shown the potential to increase the risk of bleeding during or after surgery. Furthermore, it is not possible to determine all the potential interactions between herbs and drugs used for anesthesia. For this reason, herbs and supplements should be used for surgical support only under the supervision of a physician.

Proteolytic enzymes. According to most studies, proteolytic enzymes may help reduce pain, bruising, and swelling after surgery. A double-blind, placebo-controlled trial of eighty people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved the rate of recovery, as measured by mobility and swelling.

Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in eighty persons undergoing oral surgery. The results showed reduced pain, inflammation, and swelling in the treated group compared with the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery and in one study involving only bromelain.

Other double-blind, placebo-controlled studies have found bromelain helpful in nasal surgery, cataract removal, and foot surgery. However, a study of 154 persons undergoing facial plastic surgery found no benefit.

Bromelain thins the blood and could increase the risk of bleeding during or after surgery. For this reason, physician supervision is essential.

Oxerutins and other bioflavonoids. Oxerutins have been widely used in Europe since the mid-1960s, primarily as a treatment for varicose veins. Derived from a naturally occurring bioflavonoid called rutin, oxerutins were specifically developed to treat varicose veins and related venous problems. However, they may also be helpful for treating swelling following surgery. Closely related bioflavonoids from citrus fruit also may be helpful.

Women who have undergone surgery for breast cancer may experience a lasting and troublesome side effect: swelling in the arm caused by damage to the lymph system. With the veins, the lymphatic system is responsible for returning fluid to the heart. When this system is damaged by breast cancer surgery, fluid accumulates in the arm. Three small, double-blind, placebo-controlled studies enrolling more than one hundred people have examined the effectiveness of oxerutins in lymphedema following breast cancer surgery, with generally good results.

In a small, six-month, double-blind study, oxerutins reduced swelling and improved comfort and mobility compared with placebo. Another study found benefit with a combination formula containing oxerutins, ginkgo, and the drug heptaminol. The citrus bioflavonoids diosmin and hesperidin have also shown promise for lymphedema following breast cancer surgery, as has a product containing hesperidin plus a bioflavonoid-rich extract of the herb butcher’s broom. One should not use bioflavonoid combinations containing tangeretin if also taking tamoxifen for breast cancer.

Oxerutins may be helpful for the ordinary swelling that occurs after any type of surgery. In one double-blind trial, researchers gave oxerutins or a placebo for five days to forty people recovering from minor surgery or other minor injuries and found oxerutins significantly helpful in reducing swelling and discomfort.

Oligomeric proanthocyanidins. Oligomeric proanthocyanidins (OPCs), substances found in grape seed and pine bark, may also be helpful for surgery recovery. Like oxerutins, which are chemically related, OPCs are thought to work by reducing leakage from capillaries. A double-blind, placebo-controlled study of sixty-three women with breast cancer found that 600 milligrams (mg) of OPCs daily for six months reduced postoperative symptoms of lymphedema. Additionally, in a double-blind, placebo-controlled study of thirty-two people who were followed for ten days after having a face-lift, swelling disappeared much faster in the treated group. OPCs have also shown promise in limiting the spread of cancer and relieving some symptoms associated with radiotherapy and chemotherapy.

Acupuncture and acupressure. Acupuncture and acupressure are two related forms of treatment that involve stimulating certain locations on the body known as acupuncture points. Numerous studies have evaluated treatment on a single acupuncture point, P6, for the relief of nausea following anesthesia. This point is located on the inside of the forearm, about two inches above the wrist crease.

Many controlled studies involving more than two thousand people have tested the potential benefits of stimulation at P6 in people undergoing surgery. In most of these trials, treatment was carried out through the surgery itself, as well as afterward. The results of these trials, involving various types of surgery and diverse forms of acupuncture and acupressure, tend to contradict one another. On balance, however, it appears that acupuncture and acupressure may reduce intraoperative (during surgery) and postoperative nausea to some extent beyond that of the placebo effect. Some research supports presurgery acupressure coupled with post-surgery acupuncture to reduce pain and limit anxiety in patients with ovarian and endometrial cancers.

Acupuncture has also been explored as a means of reducing pain after surgery with inconsistent results. In a review of fifteen randomized, controlled trials, however, researchers determined that acupuncture is capable of reducing pain and the need for opioid medications (morphine and related agents) immediately following surgery, compared with sham (fake) acupuncture. A small randomized trial of seventy persons found that acupuncture may decrease dry mouth and pain after the removal of lymph nodes in the neck for cancer treatment. Contrary to popular belief, acupuncture does not appear to be helpful for providing or enhancing anesthesia itself, but it continues to be widely utilized.

Other Proposed Natural Treatments

The herb ginger is thought to have antinausea effects. In studies, ginger has been given before surgery to prevent the nausea that many people experience when they awaken from anesthesia. However, evidence confirming this use is mixed, and ginger can interact poorly with some medications or contribute to bleeding in some people. One should not use ginger either before or immediately after surgery or labor and delivery without a physician’s approval.

One small, double-blind, placebo-controlled study found that magnet therapy patches of the “unipolar” variety reduced pain and swelling after suction lipectomy. However, a study of 165 people undergoing various forms of surgery failed to find that the use of static magnets over the surgical incision reduced postsurgical pain. Furthermore, the positioning of static magnets at the acupuncture-acupressure point P6 in persons undergoing ear, nose, and throat or gynecological surgeries reduced nausea and vomiting no better than placebo in a randomized trial. A small pilot study involving eighty women undergoing breast augmentation procedures found that daily pulsed electromagnetic field therapy reduced postoperative discomfort significantly more than placebo therapy within three days of surgery.

A double-blind, placebo-controlled study examined thirty-seven people undergoing surgery for carpal tunnel syndrome. The use by these persons of an ointment made from the herb Arnica (combined with homeopathic Arnica tablets) appeared to slightly reduce postsurgical pain.

Horse chestnut has effects similar to OPCs and has also shown promise for reducing postoperative swelling. A preliminary study suggests that topically administered capsaicin provides short-term pain relief immediately following hernia repair surgery. In two studies, the sports supplement creatine has been tried as an aid to strengthen recovery after knee surgery, but no benefits were seen.

A placebo-controlled study failed to find that onion extract could help reduce skin scarring following surgery. The use of a fish oil product as part of a total parenteral nutrition regimen (intravenous feeding) may help speed recovery after major abdominal surgery.

Treatment via inhalation of essential oils is called aromatherapy. One controlled trial found that lavender oil, administered through an oxygen face mask, reduced the need for pain medications following gastric banding surgery. Some evidence suggests that peppermint oil may be helpful for postoperative flatulence and nausea. Peppermint oil inhalers have been successfully used for some cardiac patients following surgery with few side effects.

Many controlled studies of more than 20,000 people have evaluated the potential benefit of hypnosis for people undergoing surgery. Their combined results suggest that hypnosis may provide benefits both during and after surgery, including reducing anxiety, pain, and nausea; normalizing blood pressure and heart rate; minimizing blood loss; and speeding recovery and shortening hospitalization. Many of these studies were of very poor quality, however.

Relaxation therapy techniques, such as meditation, guided imagery, and self-hypnosis, have also shown promise for relieving some of the discomforts of surgery. However, one study found minimal benefits with music therapy.

Good nutrition is essential to recovery from any physical trauma. For this reason, the use of a multivitamin-multimineral supplement in the weeks before surgery and for some time afterward might be advisable.

Herbs and Supplements to Use with Caution

Numerous herbs and supplements have the potential to cause problems during or after surgery, including some of those discussed here. For this reason, one should not use any herb or supplement in the week before surgery except under a physician’s supervision.

For example, the herb garlic significantly thins the blood, and case reports suggest that garlic can increase bleeding during or after surgery. It is probably advisable to avoid garlic supplements before surgery and not to restart the supplements after surgery until there is no longer any risk of bleeding. However, raw garlic consumed in food may not present the same risk. A placebo-controlled study found that one-time consumption of raw garlic consumed in food at a fairly high dose of 4.2 mg did not impair platelet function. Also, volunteers who continued to consume the dietary garlic for one week did not show any change in their normal platelet function.

The use of the herb ginkgo has also been associated with serious bleeding complications related to surgery. Many other herbs and supplements have also shown potential for increasing the risk of bleeding. Most prominent among these are high-dose vitamin E and policosanol. Others include bromelain, chamomile, devil’s claw, dong quai, feverfew, fish oil, ginger, horse chestnut, ipriflavone, mesoglycan, papaya, phosphatidylserine, red clover, reishi, vitamin A, and white willow. In addition, one report suggests that the use of St. John’s wort may interact with anesthetic drugs.

Bibliography

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Scharbert, G., et al. “Garlic at Dietary Doses Does Not Impair Platelet Function.” Anesthesia and Analgesia, vol. 105, 2007, pp. 1214-18.

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