Conditions:
Surgery Support
Related Terms
•
Anesthesia, Lymphedema, Operations, Postoperative Recovery
Principal Proposed Treatments
•
Proteolytic Enzymes, Oxerutins, Citrus Bioflavonoids, OPCs, Ginger, Acupuncture/Acupressure
Other Proposed Treatments
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Bee Propolis, Magnet Therapy, Peppermint, Horse Chestnut, Multivitamin and Mineral Supplements
Herbs and Supplements to Avoid
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Garlic, Ginkgo, Vitamin E, Others
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 Treatments for Surgery Support
A variety of herbs, supplements, and other alternative therapies have been tried for problems encountered following surgery. However, keep in mind that many such substances can interact with anesthetic drugs, and in some cases might increase risk of bleeding. For this reason, herbs and supplements should only be used for surgical support under the supervision of a physician.
Proteolytic Enzymes: May Be Helpful for Recovery from Surgery
Proteolytic enzymes may help reduce pain, bruising, and swelling after surgery, although the evidence from studies is somewhat contradictory.
Proteolytic enzymes help you digest the proteins in food. Your pancreas produces the proteolytic enzymes trypsin and chymotrypsin. Others, such as papain and bromelain, are found in foods. The primary use of proteolytic enzymes is as a digestive aid for people who have trouble digesting proteins. However, for reasons that are not clear, these enzymes also appear to help recovery from injuries such as surgery.
What Is the Scientific Evidence for Proteolytic Enzymes?
Numerous studies have evaluated various proteolytic enzymes as an aid to recovery from surgery, but the results have been mixed.
A double-blind placebo-controlled trial of 80 individuals 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
A double-blind placebo-controlled study of 204 women receiving episiotomies after childbirth found evidence that a mixed proteolytic enzyme product can reduce inflammation.60 Bromelain was also found effective for reducing inflammation following episiotomy in one double-blind placebo-controlled trial of 160 women,4 but a very similar study found no benefit.5
Other double-blind placebo-controlled studies have found bromelain effective 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.
For more information, including dosage and safety issues, see the full articles on bromelain and proteolytic enzymes.
Oxerutins and Other Bioflavonoids: May Be Helpful for Lymphedema and Ordinary Post-Surgical Swelling
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 lymphedema and ordinary post-surgical edema. Oxerutins appear to work by strengthening the capillaries.
Bioflavonoids from citrus fruit may be helpful as well.
What Is the Scientific Evidence for Oxerutins?
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 double-blind placebo-controlled studies enrolling a total of over 100 people have examined the effectiveness of oxerutins in lymphedema following breast cancer surgery.9,10,11
In a 6-month double-blind placebo-controlled study, oxerutins worked significantly better than placebo in reducing swelling, aiding comfort and mobility, and in other measures of lymphedema.12
Two smaller studies also found oxerutins to be more effective than placebo,13,14 but the researchers were not sure that the improvement was large enough to make a real difference. Other researchers who have investigated oxerutins for lymphedema say that this treatment "convert[s] a slowly worsening condition into a slowly improving one."15
The citrus bioflavonoids diosmin and hesperidin might also be helpful for lymphedema following breast cancer surgery.16Note: 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
For more information, including dosage and safety issues, see the full articles on oxerutins and citrus bioflavonoids.
OPCs: May Also Be Helpful for Lymphedema and Ordinary Post-Surgical Edema
OPCs (oligomeric proanthocyanidins), 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.
Ginger: May Be Helpful for Post-Surgical Nausea
European physicians sometimes give their patients ginger before and just after surgery to prevent the nausea that many people experience when they awaken from anesthesia. However, this treatment should be attempted only with a physician's approval.
What Is the Scientific Evidence for Ginger?
Studies evaluating ginger as a treatment for post-surgical nausea have returned conflicting results.
A double-blind British study compared the effects of ginger, placebo, and the drug metoclopramide in the treatment of nausea following gynecological surgery.24 The results in 60 women showed that both treatments produced similar benefits compared to placebo.
A similar British study followed 120 women receiving gynecological surgery.25 Whereas nausea and vomiting developed in 41% of participants given placebo, these symptoms developed in only 21% of the group treated with ginger and 27% of the groups treated with metoclopramide (Reglan).
However, a double-blind study of 108 people undergoing similar surgery showed no benefit with ginger as compared to placebo.26 Negative results were also seen in another study.27
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.
For more information, including dosage and safety issues, see the full ginger article.
Acupuncture/Acupressure: May Also Be Helpful for the Nausea of Surgery
Numerous studies have evaluated treatment on a single acupuncture point for reducing surgical nausea. This point, traditionally thought to be effective for relief of nausea and vomiting, is located on the inside of the forearm, about 2 inches above the wrist crease. Most studies have investigated pressure on this point (acupressure) rather than needling. The most common means of applying pressure involves a band placed around the forearm. The band contains a pearl-sized bead that applies stimulation to P6 when pressed by the wearer. Direct massage may also be used.
Studies that evaluated the use of P6 stimulation for reducing nausea in women undergoing gynecological surgery have found generally good results. However, acupressure studies in other forms of surgery have found about as many negative as positive results.
In a double-blind trial, acupressure at P6 using band and bead stimulation was compared to sham acupressure in 104 patients undergoing laparoscopy (telescopic examination of the abdomen) as part of infertility treatment.34 The results showed significant improvements in nausea and vomiting in the treated group as compared to the placebo group.
A similar double-blind placebo-controlled study of 94 women tested P6 stimulation for prevention of nausea and vomiting during and after cesarean section with spinal anesthesia.35 Again, acupressure treatment helped significantly. Benefits were also seen in other studies: one double-blind study of 60 women receiving minor gynecological surgery,36 a double-blind placebo-controlled trial of 60 women receiving epidural morphine for relief of C-section pain,37 and a single-blind placebo-controlled trial of 125 women undergoing minor gynecological surgery.38 Another double-blind study compared acupuncture to the drug metoclopramide in 75 individuals receiving spinal anesthesia for C-section, and found them equally effective.39 The only negative results discovered during a literature search were from a single-blind trial of 47 women undergoing gynecological surgery, which found no benefit with acupressure.40
However, studies of P6 stimulation in other forms of surgery have produced almost equally balanced mixed results. A double-blind placebo-controlled trial of 200 individuals undergoing various types of surgery reported positive results, but in fact these results fell just shy of the usual cut-off for statistical significance and should properly be considered inconclusive.41 Another large double-blind placebo-controlled trial followed 200 patients undergoing urological surgery and found evidence that P6 stimulation was not effective.42A double-blind study of 66 children undergoing eye surgery also found no benefit,43 as did a double-blind placebo-controlled trial of 84 children undergoing inguinal surgery.44 On the other hand, three double-blind placebo-controlled trials found benefit against anesthesia-induced nausea for children undergoing eye surgery. One trial used Korean hand acupuncture and enrolled 50 children,45 and another used laser acupuncture and enrolled 40 children.46 A third study was unique in that it tested the effectiveness of acupressure at points other than P6, and it also found benefits.58 In addition, band and bead acupressure was found effective in a single-blind placebo-controlled trial of 152 general surgical patients.47
The bottom line: The efficacy of acupuncture for surgery related nausea is still unclear.
Acupuncture has also been explored as a means of reducing pain after surgery. However, the two best-designed studies found no benefit.48,49,50
Other Proposed Treatments for Surgery Support
A preliminary controlled study found that the honeybee product propolis mouthwash following oral surgery significantly speeded healing time as compared to placebo.51
One small double-blind placebo-controlled study suggests that magnet therapy patches of the "unipolar" variety can help reduce pain and swelling after surgery.52
Preliminary studies suggest peppermint oil may be helpful for post-operative nausea.53
Just like OPCs, extracts of horse chestnut are sometimes recommended to help reduce swelling after sprains, other athletic injuries, and surgery. This use is based on the known effects of horse chestnut on blood vessels, and there is some evidence that it may be effective.54 However, horse chestnut may also increase bleeding and should only be used under a doctor's supervision.
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.
In addition, numerous herbs and supplements might help wounds heal better. (For more information, see the full article on minor wounds.) However, these treatments should not be used for surgical wounds except on the advice of a physician.
Herbs and Supplements to Avoid
The herb garlic "thins" the blood. Case reports suggest that garlic can increase bleeding during or after surgery.55,56,57 For this reason, it is probably advisable to avoid garlic supplements for a week prior to surgery, and not to restart it after surgery until all risk of bleeding is past.
Many of the herbs suggested for surgery support in this article also carry a risk of increasing bleeding.
Many other herbs and supplements might increase risk of bleeding as well, including chamomile, devil's claw, dong quai, feverfew, fish oil, ginkgo, ipriflavone, mesoglycan, papaya, PC-SPES, phosphatidylserine, policosanol, red clover, reishi, vitamin A, high-dose vitamin E, and white willow.
Before undergoing any surgical procedure, you should inform your physician of all herbs or supplements you might be taking.
View References
Last reviewed March 2002 by Medical Review Board
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