• Anesthesia, Lymphedema, Operations, Postoperative Recovery
• Acupuncture/Acupressure, Bioflavonoids, Oxerutins and Other OPCs, Proteolytic Enzymes
• Arnica, Bee Propolis, Cayenne (Capsaicin), Ginger, Fish Oil, Horse Chestnut, Hypnotherapy, LavenderAromatherapy, Magnet Therapy, Multivitamin and Mineral Supplements, Music Therapy, Peppermint, Relaxation and Guided Imagery, Traditional Chinese Herbal Medicine
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 nondrug 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 have shown promise for problems encountered following surgery. However, keep in mind that many such substances have shown the potential to increase risk of bleeding during or after surgery. (See Herbs and Supplements to Use Only With Caution ). Furthermore, it is not at present possible to determine all the potential interactions between herbs and drugs used for anesthesia. For this reason, herbs and supplements should only be used for surgical support under the supervision of a physician.
According to most but not all studies, proteolytic enzymes may help reduce pain, bruising, and swelling after surgery.
A double-blind, placebo-controlled trial of 80 people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling. 1
Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in 80 individuals undergoing oral surgery. 2 The results showed reduced pain, inflammation, and swelling in the treated group as compared to the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery, 59 as well as in one study involving only bromelain . 3
Other double-blind, placebo-controlled studies have found bromelain helpful in nasal surgery, 6 cataract removal, 7 and foot surgery. 61 However, a study of 154 individuals undergoing facial plastic surgery found no benefit. 8
Note : Bromelain thins the blood and could increase 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 may be helpful as well.
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. Along 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 a total of more than 100 people have examined the effectiveness of oxerutins in lymphedema following breast cancer surgery, with generally good results. 9-11
For example, in a small, 6-month, double-blind study, oxerutins reduced swelling and improved comfort and mobility as compared to placebo. 11 Another study found benefit with a combination formula containing oxerutins, ginkgo , and the drug heptaminol. 82
The citrus bioflavonoids diosmin and hesperidin have also shown promise for lymphedema following breast cancer surgery, 16 as has a product containing hesperidin plus a bioflavonoid-rich extract of the herb butcher’s broom . 62Note : Do not use bioflavonoid combinations containing tangeretin if you are taking tamoxifen for breast cancer.
Oxerutins might also be helpful for the ordinary swelling that occurs after any type of surgery. In one double-blind trial, researchers gave oxerutins or placebo for 5 days to 40 people recovering from minor surgery or other minor injuries, and found oxerutins significantly helpful in reducing swelling and discomfort. 17
Oligomeric proanthocyanidins (OPCs), substances found in grape seed and pine bark, may be helpful for recovery from surgery as well. Like oxerutins, to which they are chemically related, OPCs are thought to work by reducing leakage from capillaries.
A double-blind, placebo-controlled study of 63 women with breast cancer found that 600 mg of OPCs daily for 6 months reduced postoperative symptoms of lymphedema. 22 Additionally, in a double-blind, placebo-controlled study of 32 people who were followed for 10 days after a face-lift, swelling disappeared much faster in the treated group. 23
For more information, including dosage and safety issues, see the full OPCs article.
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 2 inches above the wrist crease.
Many controlled studies involving more than 2,000 people have tested the potential benefits of stimulation at P6 in people undergoing surgery. 12,14,34-47,58,63-67,83,90,95,97,101 In most of these trials, treatment was carried out through the surgery itself, as well as afterwards. The results of these many trials, involving various types of surgery and diverse forms of acupuncture/acupressure, tend to contradict one another. On balance, however, it appears that acupuncture/acupressure may reduce nausea during and after surgery to at least some extent beyond that of the placebo effect.
Acupuncture has also been explored as a means of reducing pain after surgery with inconsistent results. 18,2948-50,63,68 In a 2008 review of 15 randomized controlled trial, 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. 93 An analysis of 5 trials found similar results.102 Patients who received ear acupuncture (auriculotherapy) did not use pain medication as much as those in the control group.
A small randomized trial of 70 patients found that acupuncture may decrease dry mouth and pain after removing lymph nodes in the neck for cancer treatment. 99
Contrary to popular belief, acupuncture does not appear to be helpful for providing or enhancing anesthesia itself. 19,96
For more information, see the full Acupuncture article.
Other Proposed Natural Treatments
The herb ginger is thought to have anti-nausea effects. In studies, ginger has been given prior to surgery in order to prevent the nausea that many people experience when they awaken from anesthesia. However, despite some early positive results, the preponderance of evidence indicates that ginger is not helpful for this purpose. 24-27,69,84
Warning : Do not use ginger either before or immediately after surgery, or labor and delivery, without a physician's approval. Not only is it important to have an empty stomach before undergoing anesthesia, there are theoretical concerns that ginger may affect bleeding.
Preliminary evidence suggests that peppermint oil may be helpful for postoperative flatulence and nausea. 53,85
One small double-blind, placebo-controlled study found that magnet therapy patches of the "unipolar" variety reduced pain and swelling after suction lipectomy. 52 However, a study of 165 people undergoing various forms of surgery failed to find that use of static magnets over the surgical incision reduced postsurgical pain. 30 Furthermore, the positioning of static magnets at the acupuncture /acupressure point P6 in patients undergoing ear, nose, and throat (ENT) or gynaecological surgeries reduced nausea and vomiting no better than placebo in a randomized trial. 98 Interestingly, a small, pilot study involving 80 women undergoing breast augmentation procedures found that daily pulsed electromagnetic field therapy reduced postoperative discomfort significantly more than placebo therapy within 3 days of surgery. 91
In a double-blind, placebo-controlled study of 37 people undergoing surgery for carpal tunnel syndrome , an ointment made from the herb arnica (combined with homeopathic arnica tablets) appeared to slightly reduce post-surgical pain. 70
Horse chestnut has effects similar to OPCs (discussed above ) and has also shown promise for reducing postoperative swelling. 54 A preliminary study suggests that topically administered capsaicin provides short-term pain relief immediately following hernia repair surgery. 94
Good nutrition is essential to recovery from any physical trauma. For this reason, use of a multivitamin and mineral supplement in the weeks leading up to surgery, and for some time afterwards, might be advisable.
A placebo-controlled study failed to find that onion extract can help reduce skin scarring following surgery. 21
A randomized trial involving 90 women who had undergone a mastectomy found that the Chinese herbSalvia miltiorrhiza did help to reduce wound complications.100 In this same study, the Chinese herb anisodamine was also helpful, but there were more adverse effects related to this treatment.
Treatment via inhalation of essential oils is called aromatherapy . One controlled trial found that that lavender oil, administered through the oxygen face mask, reduced need for pain medications following gastric banding surgery. 32
At least 20 controlled studies, enrolling a total of more than 1,500 people, have evaluated the potential benefit of hypnosis for people undergoing surgery. 71 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. Unfortunately, many of these studies were of very poor quality.
Relaxation therapy techniques, such as meditation, guided imagery, and self-hypnosis, have also shown promise for relieving some of the discomforts of surgery. 72-80,92 One study found minimal benefits with music therapy. 28
For a discussion of homeopathic approaches to surgery support, see the Homeopathy database.
Numerous herbs and supplements have the potential to cause problems during or after surgery, including some of those discussed in this article. For this reason, we strongly suggest that you do not use any herb or supplement in the week leading up to surgery, except under 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. 55-57 For this reason, it is probably advisable to avoid garlic supplements prior to surgery and not to restart it after surgery until all risk of bleeding is past. However, raw garlic consumed in food may not present the same risk. A placebo-controlled study found that one-time consumption of actual raw garlic consumed in food at the fairly high dose of 4.2 mg did not impair platelet function. In addition, volunteers who continued to consume the dietary garlic for a week did no show any change in their normal platelet function. 33
- Devil's claw
- Dong quai
- Fish oil
- Horse chestnut
- Red clover
- Vitamin A
- White willow
1. Rahn H-D. Efficacy of hydrolytic enzymes in surgery. Presented at: Symposium on Enzyme Therapy in Sports Injuries: XXIV FIMS World Congress of Sport Medicine; May 29 1990; Amsterdam, The Netherlands.
6. Seltzer AP. Minimizing post-operative edema and ecchymoses by the use of an oral enzyme preparation (bromelain): a controlled study of 53 rhinoplasty cases . Eye Ear Nose Throat Mon . 1962;41:813-817.
8. Gylling U, Rintala A, Taipale S, et al. The effect of a proteolytic enzyme combinate (bromelain) on the postoperative oedema by oral application. A clinical and experimental study. Acta Chir Scand. 1966;131:193-196.
10. Mortimer PS, Badger C, Clarke I, et al. A double-blind, randomized, parallel-group, placebo-controlled trial of O-(beta-hydroxyethyl)-rutosides in chronic arm oedema resulting from breast cancer treatment. Phlebology . 1995;10:51-55.
11. Piller NB, Morgan RG, Casley-Smith JR. A double-blind, cross-over trial of O-(beta-hydroxyethyl)-rutosides (benzo-pyrones) in the treatment of lymphoedema of the arms and legs. Br J Plast Surg . 1988;41:20-27.
12. Habib AS, Itchon-Ramos N, Phillips-Bute BG, et al. Transcutaneous Acupoint Electrical Stimulation with the ReliefBand® for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia. Anesth Analg . 2006;102:581-584.
22. Pecking A, Desprez-Curely JP, Megret G. Oligomeric grape flavanols (Endotelon®) in the treatment of secondary upper limb lymphedemas [translated from French]. Paris, France: Association de Lymphologie de Lange Francaise Hopital Saint-Louis. 1989; 69-73.
24. Bone ME, Wilkinson DJ, Young JR, et al. Ginger root—a new anti-emetic. The effect of ginger root on postoperative nausea and vomiting after major gynecological surgery. Anaesthesia. 1990;45:669-671.
27. Visalyaputra S, Petchpaisit N, Somcharoen K, et al. The efficacy of ginger root in the prevention of postoperative nausea and vomiting after outpatient gynaecological laparoscopy. Anaesthesia . 1998;53:506-510.
31. Wichmann MW, Thul P, Czarnetzki HD, et al. Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): Data from a prospective, randomized, multicenter trial. Crit Care Med . 2007 Jan 25. [Epub ahead of print]
32. Kim JT, Ren CJ, Fielding GA, et al. Treatment with lavender aromatherapy in the post-anesthesia care unit reduces opioid requirements of morbidly obese patients undergoing laparoscopic adjustable gastric banding. Obes Surg. 2007;17:920-925.
37. Ho CM, Hseu SS, Tsai SK, et al. Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief. Acta Anaesthesiol Scand. 1996;40:372-375.
51. Magro Filho O, de Carvalho AC. Topical effect of propolis in the repair of sulcoplasties by the modified Kazanjian technique. Cytological and clinical evaluation. J Nihon Univ Sch Dent . 1994;36:102-111.
58. Chu YC, Lin SM, Hsieh YC, et al. Effect of BL-10 (tianzhu), BL-11 (dazhu) and GB-34 (yanglinquan) acuplaster for prevention of vomiting after strabismus surgery in children. Acta Anaesthesiol Sin. 1998;36:11-16.
59. Cameron IW. An investigation into some of the factors concerned in the surgical removal of the impacted lower wisdom tooth, including a double blind trial of chymoral. Br J Oral Surg. 1980;18:112-124.
63. Kotani N, Hashimoto H, Sato Y, et al. Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses. Anesthesiology . 2001;95:349-356.
72. Gaston-Johansson F, Fall-Dickson JM, Nanda J, et al. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nurs . 2000;23:277-285.
86. Tyler TF, Nicholas SJ, Hershman EB, et al. The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: a randomized, placebo-controlled, double-blind trial. Am J Sports Med . 2004;32:383-388.
90. Agarwal A, Dhiraaj S, Tandon M, et al. Evaluation of capsaicin ointment at the Korean hand acupressure point K-D2 for prevention of postoperative nausea and vomiting. Anaesthesia . 2005;60:1185-1188.
92. Lang EV, Berbaum KS, Pauker SG, et al. Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice. J Vasc Interv Radiol. 2008;19:897-905.
94. Aasvang EK, Hansen JB, Malmstrom J, et al. The effect of wound instillation of a novel purified capsaicin formulation on postherniotomy pain: a double-blind, randomized, placebo-controlled study. Anesth Analg. 2008;107:282-291.
95. Liu YY, Duan SE, Cai MX, et al. Evaluation of transcutaneous electroacupoint stimulation with the train-of-four mode for preventing nausea and vomiting after laparoscopic cholecystectomy. Chin J Integr Med. 2008;14:94-97.
97. Allen TK, Habib AS. P6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: a systematic review of randomized controlled trials. Anesth Analg. 2008;107:1308-1312.
101. Kim YH, Kim KS, Lee HJ, Shim JC, Yoon SW. The efficacy of several neuromuscular monitoring modes at the p6 acupuncture point in preventing postoperative nausea and vomiting. Anesth Analg. 2011;112(4):819-823.
102. Asher GN, Jonas DE, Coeytaux RR, et al. Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials. J Altern Complement Med. 2010;16(10):1097-1108.
Last reviewed June 2011 by EBSCO CAM Review Board
Last updated Updated: 6/27/2011
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