Post-Surgical Patients

Moegi Tanaka et al. (2021) · PloS one

This randomized controlled trial with 77 analyzed women explored whether Yokukansan, a traditional Japanese Kampo herbal formula, can reduce anxiety around breast cancer surgery. Kampo is the Japanese adaptation of traditional herbal medicine, and Yokukansan combines seven herbal extracts that are traditionally prescribed for irritability, restlessness, and insomnia. Perioperative anxiety (anxiety in the period around an operation) matters because the authors link it to faster heart rate, higher blood pressure, longer postoperative pain, and a higher risk of postoperative delirium. Common anxiety medicines such as benzodiazepines can cause sedation, which is why a short-course herbal option was tested. Women aged 20 to 60 undergoing partial or total mastectomy at two Niigata hospitals in Japan were randomly assigned to a Yokukansan group or a control group. The Yokukansan group took two 2.5 g doses of a standardized extract granule, one at bedtime the night before surgery and one 2 hours before anesthesia; the control group received water. Anxiety was measured objectively with salivary alpha-amylase (an enzyme that rises with stress) and subjectively with two questionnaires, the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory. Pain was rated on a 100-mm scale the day after surgery. Salivary alpha-amylase just before surgery was lower in the Yokukansan group than in controls (0.88 versus 1.14 on a log scale, p = 0.03), meaning a smaller physiological stress signal at that moment. HADS-Anxiety scores dropped by 2.77 points with Yokukansan and 1.43 points in controls (both significant, though the difference between groups did not reach significance, p = 0.083), and the authors suggest part of the drop may reflect reassurance once surgery was complete. Trait anxiety on the STAI fell by 4.23 points with Yokukansan and did not change in controls (p = 0.92), with a significant group-by-time interaction (p = 0.009). On both questionnaires higher scores mean more anxiety, so falling scores indicate improvement. Pain scores were nearly identical (1.4 versus 1.36, p = 0.70), and no adverse events were observed. The authors suggest two preoperative doses may reduce perioperative anxiety and that further research is justified. Several limitations apply. Patients knew which group they were in because no matching placebo exists for Kampo medicines, so reassurance may explain some of the effect. Salivary alpha-amylase measures stress generally, and the analyzed groups fell short of the planned size, leaving statistical power at 0.708. Pain was low in both groups, so any pain effect remains untested. Larger double-blind, placebo-controlled trials, including more invasive surgeries, are called for.

Massimo Chiaretti et al. (2020) · Scientific reports

This randomized clinical trial with 199 adults at an Italian university proctology clinic compared two plant-based venotonic products, called phlebotonics, with routine care for hemorrhoidal disease (swollen anal cushions that cause bleeding, itching or irritation, and pain) and for recovery after hemorrhoid surgery. One product was a flavonoid preparation containing rutin, borage, horse chestnut and witch hazel. The other was a Centella asiatica (gotu kola) preparation containing triterpenic acids, asiaticoside, arnica and aloe. Flavonoids are plant antioxidants reported to improve venous tone and reduce inflammation, while Centella is reported to stimulate collagen and repair connective tissue. Participants aged 18 to 85 were randomized to three groups. Group A (73 people) took 300 mg flavonoid tablets twice daily for 15 days and applied a 3 g ointment inside the anus once daily. Group B (66 people) took 60 mg Centella tablets twice daily for 15 days and used a 3 g Centella-based ointment. Group C (60 people) received routine care only. Everyone followed a water- and vegetable-rich diet and used a medicated soap for 42 days. Time until bleeding stopped was tracked, and irritation or pain was rated on a visual analogue scale. Among 130 people with hemorrhoidal disease, bleeding stopped after a median of 2 weeks with flavonoids and 3 weeks with Centella or routine care (flavonoids versus routine care p < 0.001, meaning a clear difference; Centella versus routine care p = 0.152, meaning no significant difference). Irritation scores were lower than routine care for both products (flavonoids p = 0.007; Centella p = 0.041), and the two products did not differ (p = 0.782). After hemorrhoidectomy (31 people), bleeding time did not differ significantly between groups, and pain differed only for flavonoids versus routine care (p = 0.045). In 34 people with thrombosed hemorrhoids, pain fell faster with either product (all p < 0.001). Tissue examination linked flavonoids to fibrosis, a fibrous tissue change in the excised piles (p = 0.008). No adverse reactions were reported except burning from the Centella ointment in one person, which led to suspension of that ointment. The authors interpret the results as favouring flavonoids for bleeding and irritation, with Centella comparable on irritation. Limitations are stated plainly: a single centre, only 42 days of follow-up, small surgical and thrombosis subgroups added after the original protocol, no described blinding of participants, and multi-ingredient products that prevent attributing effects to individual plants. A medicated soap containing Centella was also given to every group. The authors suggest longer trials to test whether the benefits last.

Beyza Nur Erayata et al. (2025) · PloS one

This single-blind randomized controlled trial with 24 adults recovering from anterior cruciate ligament (ACL) reconstruction explored whether percussion massage therapy (PMT) — handheld devices that deliver rapid, rhythmic vibration pulses to muscle, sometimes called massage guns — adds benefit when combined with a structured post-surgical exercise program. ACL reconstruction requires months of rehabilitation focused on restoring knee range of motion, strength, and proprioception (the body's sense of joint position, tested here as joint position sense), while managing pain that can otherwise limit progress. PMT has mostly been studied in healthy athletes; this trial asked whether it also helps people recovering from surgery. Twenty-four participants aged 18-40, all within eight weeks of hamstring-autograft ACL reconstruction, were randomly split into two equal groups of 12. Both groups followed the same progressive, three-phase neuromuscular exercise program, five days a week for six weeks (30 sessions total). The PMT group also received five minutes of percussion massage per muscle group (quadriceps, hamstrings) with a Hypervolt device at 40 Hz before each session. Researchers measured pain (Visual Analog Scale), knee function (WOMAC), balance (Berg Balance Scale), quality of life (SF-36), range of motion, joint position sense, and muscle thickness by ultrasound, before and after the six weeks. Both groups improved significantly across every outcome after six weeks (p<0.001), confirming that structured exercise alone works well after ACL reconstruction. But adding PMT produced significantly larger gains in several key areas: resting pain dropped further (5.75 versus 4.17 points on a 0-10 scale, p=0.004), activity pain dropped further (6.92 versus 5.50 points, p=0.003), knee function scores improved more (71.7 versus 46.1 points on WOMAC, p=0.002 — a large effect, Cohen's d=1.41), balance improved more (24.7 versus 15.5 points on the Berg scale, p=0.040), and knee-bending range of motion gained more (43.1 versus 30.2 degrees, p=0.048). Joint position sense at 60 degrees also improved more with PMT (p=0.023), though at 30 degrees the two groups were statistically similar. Muscle thickness gains and most quality-of-life measures were comparable between groups, suggesting PMT's edge lies mainly in pain relief, function, balance, and motion rather than muscle bulk. For people recovering from ACL surgery, these results suggest a few minutes of percussion massage before each exercise session may meaningfully speed up pain relief, functional recovery, and balance, with no adverse events reported. The trial is small (12 people per group) and single-site, the groups started with somewhat different baseline pain and muscle measurements, and there was no long-term follow-up, so the durability of these gains beyond six weeks is unknown. Larger trials testing different PMT frequencies and durations are needed before this becomes a standard rehabilitation recommendation.

Katarzyna Janda et al. (2020) · Nutrients

This systematic review pooled nine randomised clinical trials to ask whether passionflower (Passiflora incarnata) helps with anxiety, sleep and related neuropsychiatric symptoms. Passionflower is a perennial climbing vine whose aerial parts, flowers and fruit are used medicinally, and whose activity is attributed to flavonoids such as apigenin and luteolin and to flavonoid glycosides including vitexin and isovitexin. The European Medicines Agency recognised it as a medicinal product in a 2014 herbal monograph. The review frames the problem as stress — the body's response to physical and psychological stressors, which becomes pathological when prolonged and can impair concentration and memory. The authors searched PubMed, Embase and ClinicalTrials.gov to October 2019 and screened 417 records down to nine trials run between 2017 and 2019, five of them in Iran. Participants were all adults, between 16 and 128 per trial, and eight of the nine trials enrolled healthy volunteers rather than diagnosed patients. Preparations varied widely — drops, tablets, syrup, a standardised extract and herbal tea — over periods from a single day to 30 days. Anxiety was measured with instruments including the State-Trait Anxiety Inventory and the Corah Dental Anxiety Scale, sedation with the Ramsey scale, and sleep with polysomnography. Most trials found reduced anxiety, though the benefit was smaller in people whose anxiety was mild to begin with. In generalised anxiety disorder, 45 drops daily for 28 days matched oxazepam without impairing work performance. Before surgery, 500 mg tablets lowered anxiety more than oxazepam, and a 700 mg per 5 mL syrup given 30 minutes before spinal anaesthesia reduced anxiety with haemodynamics unchanged. Compared with midazolam before wisdom-tooth extraction, 260 mg gave similar calming with markedly less somnolence (50% versus 82.5%) and no amnesia at all, against 20% on midazolam — although more participants would still choose midazolam again (52% versus 27.5%), which the authors attribute to that same amnesia preventing negative memories. Herbal tea drunk nightly for a week improved self-reported sleep quality by 5.2% over placebo. No adverse effects, memory loss or collapse of psychometric function were reported anywhere in the review. The practical reading is that passionflower performs comparably to two established sedatives for procedural anxiety, with a different side-effect profile — less somnolence, no amnesia — which may matter where alertness is wanted afterwards. The evidence is genuinely limited, though: nine small trials, too heterogeneous to pool statistically, three of them rated low quality, and most never recorded which part of the plant was used. Its anxiolytic action is thought to work through the GABA system. Larger trials across more varied populations are needed before firm dosing guidance is possible.