Perioperative Homeopathic Arnica and Bromelain: Current Results and Future Directions.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
pubmed:
5
12
2019
medline:
23
2
2021
entrez:
5
12
2019
Statut:
ppublish
Résumé
Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic practitioners. A significant barrier to utilization of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. The goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain with a focus on treatment regimen and outcomes. A triple database search was conducted with the keywords "arnica," "bromelain," and "surgery." References for each identified article were analyzed for additional articles. Articles were analyzed for methodology, outcomes, and conclusion. Articles were excluded if they did not involve human subjects, were published before 1990, and if they were not available in English. Level of evidence was determined based on methodology. A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively. There was marked heterogeneity with regard to surgical procedure, dosing regimen, outcomes measured, and results. Arnica seems to have a mitigating effect on ecchymosis, most notably following rhinoplasty and facelifts/facial procedures. Bromelain is well supported across numerous studies in reducing trismus, pain, and swelling following molar extractions. However, there was no effect demonstrated when evaluating topical arnica following blepharoplasty procedures. A systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results.
Identifiants
pubmed: 31800557
doi: 10.1097/SAP.0000000000002043
pii: 00000637-202003000-00018
doi:
Substances chimiques
Plant Extracts
0
Bromelains
9001-00-7
stem bromelain
EC 3.4.22.32
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e10-e15Références
Castro M. Homeopathy. A theoretical framework and clinical application. J Nurse Midwifery. 1999;44:280–290.
Norred CL, Zamudio S, Palmer SK. Use of complementary and alternative medicines by surgical patients. AANA J. 2000;68:13–18.
Seeley BM, Denton AB, Ahn MS, et al. Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial. Arch Facial Plast Surg. 2006;8:54–59.
Fitzhugh DJ, Shan S, Dewhirst MW, et al. Bromelain treatment decreases neutrophil migration to sites of inflammation. Clin Immunol. 2008;128:66–74.
Engwerda CR, Andrew D, Murphy M, et al. Bromelain activates murine macrophages and natural killer cells in vitro. Cell Immunol. 2001;210:5–10.
Taussig SJ, Yokoyama MM, Chinen A, et al. Bromelain: a proteolytic enzyme and its clinical application. A review. Hiroshima J Med Sci. 1975;24:185–193.
Devasagayam TP, Tilak JC, Boloor KK, et al. Free radicals and antioxidants in human health: current status and future prospects. J Assoc Physicians India. 2004;52:794–804.
Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action. J Nutr. 2004;134(suppl 12):3479S–3485S.
Boileau TW, Liao Z, Kim S, et al. Prostate carcinogenesis in N-methyl-N-nitrosourea (NMU)-testosterone-treated rats fed tomato powder, lycopene, or energy-restricted diets. J Natl Cancer Inst. 2003;95:1578–1586.
Karow JH, Abt HP, Fröhling M, et al. Efficacy of arnica montana d4 for healing of wounds after hallux valgus surgery compared to diclofenac. J Altern Complement Med. 2008;14:17–25.
Chaiet SR, Marcus BC. Perioperative Arnica montana for reduction of ecchymosis in rhinoplasty surgery. Ann Plast Surg. 2016;76:477–482.
Kotlus BS, Heringer DM, Dryden RM. Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study. Ophthalmic Plast Reconstr Surg. 2010;26395–397.
Kang JY, Tran KD, Seiff SR, et al. Assessing the effectiveness of Arnica montana and Rhododendron tomentosum (Ledum palustre) in the reduction of ecchymosis and edema after oculofacial surgery: preliminary results. Ophthalmic Plast Reconstr Surg 2017;33:47–52.
Totonchi A, Guyuron B. A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plast Reconstr Surg. 2007;120:271–274.
Simsek G, Sari E, Kilic R, et al. Topical application of arnica and mucopolysaccharide polysulfate attenuates periorbital edema and ecchymosis in open rhinoplasty: a randomized controlled clinical study. Plast Reconstr Surg. 2016;137:530e–535e.
Leu S, Havey J, White LE, et al. Accelerated resolution of laser-induced bruising with topical 20% arnica: a rater-blinded randomized controlled trial. Br J Dermatol. 2010;163:557–563.
van Exsel DC, Pool SM, van Uchelen JH, et al. Arnica ointment 10% does not improve upper blepharoplasty outcome: a randomized, placebo-controlled trial. Plast Reconstr Surg. 2016;138:66–73.
Hart O, Mullee MA, Lewith G, et al. Double-blind, placebo-controlled, randomized clinical trial of homoeopathic arnica C30 for pain and infection after total abdominal hysterectomy. J R Soc Med. 1997;90:73–78.
Stevinson C, Devaraj VS, Fountain-Barber A, et al. Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery. J R Soc Med. 2003;96:60–65.
Robertson A, Suryanarayanan R, Banerjee A. Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial. Homeopathy. 2007;96:17–21.
Ramelet AA, Buchheim G, Lorenz P, et al. Homeopathic arnica in postoperative haematomas: a double-blind study. Dermatology. 2000;201:347–348.
Jeffrey SL, Belcher HJ. Use of Arnica to relieve pain after carpal-tunnel release surgery. Altern Ther Health Med. 2002;8:66–68.
Paris A, Gonnet N, Chaussard C, et al. Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study. Br J Clin Pharmacol 2008;65:180–187.
Brinkhaus B, Wilkens JM, Lüdtke R, et al. Homeopathic arnica therapy in patients receiving knee surgery: results of three randomised double-blind trials. Complement Ther Med. 2006;14:237–246.
Lokken P, Straumsheim PA, Tveiten D, et al. Effect of homoeopathy on pain and other events after acute trauma: placebo controlled trial with bilateral oral surgery. BMJ. 1995;310:1439–1442.
Alonso D, Lazarus MC, Baumann L. Effects of topical arnica gel on post-laser treatment bruises. Dermatol Surg. 2002;28:686–688.
Cornu C, Joseph P, Gaillard S, et al. No effect of a homoeopathic combination of Arnica montana and Bryonia alba on bleeding, inflammation, and ischaemia after aortic valve surgery. Br J Clin Pharmacol. 2009;69:136–142.
Macedo SB, Calvalho JCT, Ferreira LR, et al. Effect of Arnica montana 6 cH on edema, mouth opening and pain in patients submitted to extraction of impacted third molars. Ärztezeitschrift für Naturheilverfahren 2005;46:381–387.
Cornu C, Joseph P, Gaillard S, et al. No effect of a homoeopathic combination of Arnica montana and Bryonia alba on bleeding, inflammation, and ischaemia after aortic valve surgery. Br J Clin Pharmacol. 2010;69:136–142.
Shetty V, Mohan A. A prospective, randomized, double-blind, placebo-controlled clinical trial comparing the efficacy of systemic enzyme therapy for edema control in orthognathic surgery using ultrasound scan to measure facial swelling. J Oral Maxillofac Surg. 2013;71:1261–1267.
Inchingolo F, Tatullo M, Marrelli M, et al. Clinical trial with bromelain in third molar exodontia. Eur Rev Med Pharmacol Sci. 2010;14:771–774.
Ghensi P, Cucchi A, Creminelli L, et al. Effect of oral administration of bromelain on postoperative discomfort after third molar surgery. J Craniofac Surg. 2017;28:e191–e197.
Singh T, More V, Fatima U, et al. Effect of proteolytic enzyme bromelain on pain and swelling after removal of third molars. J Int Soc Prev Community Dent. 2016;6(suppl 3):S197–S204.
Isola G, Matarese M, Ramaglia L, et al. Efficacy of a drug composed of herbal extracts on postoperative discomfort after surgical removal of impacted mandibular third molar: a randomized, triple-blind, controlled clinical trial. Clin Oral Investig. 2019;23:2443–2453.
Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014;72:1043–1048.
Bormann KH, Weber K, Kloppenburg H, et al. Perioperative bromelain therapy after wisdom teeth extraction—a randomized, placebo-controlled, double-blinded, three-armed, cross-over dose-finding study. Phytother Res. 2016;30:2012–2019.
de la Barrera-Nunez MC, Yáñez-Vico RM, Batista-Cruzado A, et al. Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period. Med Oral Patol Oral Cir Bucal. 2014;19:e157–e162.
Ordesi P, Pisoni L, Nannei P, et al. Therapeutic efficacy of bromelain in impacted third molar surgery: a randomized controlled clinical study. Quintessence Int. 2014;45:679–684.
Weber CR, Griffin JM. Evaluation of dexamethasone for reducing postoperative edema and inflammatory response after orthognathic surgery. J Oral Maxillofac Surg. 1994;52:35–39.
Aiyegbusi AI, Olabiyi OO, Duru FI, et al. A comparative study of the effects of bromelain and fresh pineapple juice on the early phase of healing in acute crush achilles tendon injury. J Med Food. 2011;14:348–352.