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Surgery Support

Related Terms

AnesthesiaLymphedemaOperationsPostoperative Recovery

Surgery causes major harm to the body. A deep cut results in swelling, pain, bruising, and bleeding. Anesthesia may cause an upset stomach and thinking problems, and make you feel dizzy or faint.

Bandages, salves, and keeping a wound clean will help it heal faster. It may also stop an infection. Many types of medicines ease symptoms such as pain. Opioids used to treat pain can cause even more problems. They can make you feel sick and can be habit forming.

Natural Therapies

To avoid medicines or unpleasant side effects, some people turn to natural therapies. These may include alternative treatments, such as acupuncture, or herbal and supplements. They may be helpful in treating postoperative pain, swelling, nausea, or bruising. Some may help wounds heal faster. Others treat anxiety and stress before and after surgery. The methods below may be combined or used with standard treatments.

Likely Effective

Alternative Therapies:

  • Acupoint stimulation is likely to ease nausea and vomiting and improve digestive function after some surgeries K1-K2
  • Acupuncture is likely to ease pain, nausea, digestive function, and reduce the need for opioids A1-A15
  • Chewing gum is likely to promote digestive function after some surgeries BB1-BB4
  • Electrotherapy is likely to reduce and delay the need for opioid pain relievers after total knee arthroplasty X1
  • Exercise-based interventions are likely to ease pain and improve function in people awaiting hip replacement surgery but not knee replacement surgery FF1
  • Music interventions are likely to ease postoperative pain, anxiety, and distress T1-T5

Herbs and Supplements:

  • Antioxidant supplements are likely to provide heart and kidney protection and reduce length of hospital stay Y1-Y3
  • Calcium alone or with vitamin D is likely to prevent low calcium levels after thyroid removal surgery N1, N2
  • Ginger is likely to ease postoperative nausea and vomiting Q1
  • Licorice is likely to ease postoperative sore throat R1
  • Motherwort is likely to reduce postpartum blood loss S1
  • Prebiotics, probiotics, and synbiotics are likely to reduce infection, length of stay, urinary tract infection, sepsis, and pneumonia P1-P7
  • Vitamin C is likely to reduce length of stay and some complications after surgery J1-J3

May Be Effective

Alternative Therapies:

  • Acupressure may ease pain, nausea, and vomiting M1-M3
  • Aromatherapy may ease nausea V1
  • Magnetic Therapy may ease pain, swelling, bruising, and nausea B1-B3
  • Massage may ease pain, anxiety, and scarring C1-C5
  • Psychological preparation may help with pain and reduce length of stay CC1
  • Relaxation therapies , such as guided imagery, breathing techniques, and music, may ease pain and anxiety D1-D4

Herbs and Supplements:

  • Arnica may ease pain, swelling, and bruising E1-E3
  • Coenzyme Q10 may prevent complications in people having heart surgery with cardiopulmonary bypass EE1
  • Honey may ease pain and promote wound healing after tonsillectomy in children Z1, Z2 Iron may ease infections L1
  • Magnesium may ease heart problems and pain in children having certain surgeries W1, W2
  • Melatonin may ease anxiety before surgery and improve sleep quality DD1, DD2
  • N-Acetylcysteine may reduce irregular heartbeat after cardiac surgery GG1
  • Omega-3 fatty acids may improve liver and heart function and reduce infection and length of hospital stay after certain surgeries O1-O8
  • Propolis may ease pain, bleeding, and promote wound healing F1
  • Topical green tea may ease pain and speed wound healing after episiotomy G1
  • Traditional Chinese herbal medicine may improve blood flow after breast surgery H1

Unlikely to Be Effective

Creatine is unlikely to improve strength or function after joint replacement surgery.I1

Not Enough Data to Assess

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or supplements you are taking. Some may interact with your treatment plan or health conditions. Some supplements discussed here have certain concerns.

Traditional Chinese herbal medicine should only be taken under a doctor’s care. Toxicities and side effects vary depending on the herb and amount used.

 

References

Acupuncture

A1. Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth. 2008;101(2):151-160.

A2. Sun BM, Luo M, Wu SB, Chen XX, Wu MC. Acupuncture versus metoclopramide in treatment of postoperative gastroparesis syndrome in abdominal surgical patients: a randomized controlled trial. Zhong Xi Yi Jie He Xue Bao. 2010;8(7):641-644.

A3. 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.

A4. Yi WM, Pan AZ, Li JJ, Luo DF, Huang QH. Clinical observation on the acupuncture treatment in patients with urinary retention after radical hysterectomy. Chin J Integr Med. 2011;17(11):860-863.

A5. An LX, Chen X, Ren XJ, Wu HF. Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing a supratentorial craniotomy. Am J Chin Med. 2014;42(5):1099-1109.

A6. Liu Y, May BH, Zhang AL, et al. Acupuncture and related therapies for treatment of postoperative ileus in colorectal cancer: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2018;2018:3178472.

A7. Asmussen S, Maybauer DM, et al. Effects of Acupuncture in Anesthesia for Craniotomy: A Meta-Analysis. J Neurosurg Anesthesiol. 2017 Jul;29(3):219-227.

A8. Tedesco D, Gori D, et al. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. 2017 Oct 18;152(10):e172872.

A9. Kim KH, Kim DH, et al. Acupuncture for recovery after surgery in patients undergoing colorectal cancer resection: a systematic review and meta-analysis. Acupunct Med. 2016 Aug;34(4):248-256.

A10. Shin HC, Kim JS, et al. The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta-analysis and systematic review. Laryngoscope. 2016 Aug;126(8):1761-1767.

A11. Wu MS, Chen KH, et al. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS One. 2016 Mar 9;11(3):e0150367.

A12. Lee A, Chan SK, et al. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2015 Nov 2;(11):CD003281.

A13. Cho HK, Park IJ, et al. Can perioperative acupuncture reduce the pain and vomiting experienced after tonsillectomy? A meta-analysis. Laryngoscope. 2016 Mar;126(3):608-615.

A14. Cho YH, Kim CK, et al. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2015 Mar;15(3):279-291.

A15. Cheong KB, Zhang JP, et al. The effectiveness of acupuncture in prevention and treatment of postoperative nausea and vomiting--a systematic review and meta-analysis. PLoS One. 2013 Dec 13;8(12):e82474.

Magnetic Therapy

B1. Man D, Man B, Plosker H. The influence of permanent magnetic field therapy on wound healing in suction lipectomy patients: a double-blind study. Plast Reconstr Surg. 1999;104(7):2261-2266.

B2. Cepeda MS, Carr DB, Sarquis T, Miranda N, Garcia RJ, Zarate C. Static magnetic therapy does not decrease pain or opioid requirements: a randomized double-blind trial. Anesth Analg. 2007;104(2):290-294.

B3. Hedén P, Pilla AA. Effects of pulsed electromagnetic fields on postoperative pain: a double-blind randomized pilot study in breast augmentation patients. Aesthetic Plast Surg. 2008;32(4):660-666.

Massage

C1. Piotrowski MM, Paterson C, Mitchinson A, Kim HM, Kirsh M, Hinshaw DB. Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men. J Am Coll Surg. 2003;197(6):1037-1046.

C2. Dreyer NE, Cutshall SM, Huebner M, et al. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study. Complement Ther Clin Pract. 2015;21(3):154-159.

C3. Lee JS, Kim JP, Ryu JS, Woo SH. Effect of wound massage on neck discomfort and voice changes after thyroidectomy. Surgery. 2018. pii: S0039-6060(18)30278-2.

C4. Kukimoto Y, Ooe N, et al. The Effects of Massage Therapy on Pain and Anxiety after Surgery: A Systematic Review and Meta-Analysis. Pain Manag Nurs. 2017 Dec;18(6):378-390.

C5. Boitor M, Gélinas C, et al. The Effect of Massage on Acute Postoperative Pain in Critically and Acutely Ill Adults Post-thoracic Surgery: Systematic Review and Meta-analysis of Randomized Controlled Trials. Heart Lung. 2017 Sep - Oct;46(5):339-346.

Relaxation Therapies

D1. Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Res Nurs Health. 1988;11(4):235-244.

D2. Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. Int J Colorectal Dis. 2000;15(5-6):313-316.

D3. Broadbent E, Kahokehr A, Booth RJ, et al. A brief relaxation intervention reduces stress and improves surgical wound healing response: a randomised trial. Brain Behav Immun. 2012;26(2):212-217.

D4. Park E, Oh H, Kim T. The effects of relaxation breathing on procedural pain and anxiety during burn care. Burns. 2013;39(6):1101-1106.

Arnica

E1. Kaziro GS. Metronidazole (Flagyl) and Arnica Montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial. Br J Oral Maxillofac Surg. 1984;22(1):42-49.

E2. Jeffrey SL, Belcher HJ. Use of Arnica to relieve pain after carpal-tunnel release surgery. Altern Ther Health Med. 2002;8(2):66-68.

E3. Kang JY, Tran KD, Seiff SR, Mack WP, Lee WW. 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(1):47-52.

Propolis

F1. Moon JH, Lee MY, Chung YJ, Rhee CK, Lee SJ. Effect of topical propolis on wound healing process after tonsillectomy: randomized controlled study. Clin Exp Otorhinolaryngol. 2018;11(2):146-150.

Topical Green Tea

G1. Shahrahmani H, Kariman N, Jannesari S, et al. The effect of green tea ointment on episiotomy pain and wound healing in primiparous women: A randomized, double-blind, placebo-controlled clinical trial. Phytother Res. 2018;32(3):522-530.

Traditional Chinese Herbal Medicine (TCHM)

H1. Chen J, Lv Q, Yu M, Zhang X, Gou J. Randomized clinical trial of Chinese herbal medications to reduce wound complications after mastectomy for breast carcinoma. Br J Surg. 2010;97(12):1798-1804.

Creatine

I1. Tyler TF, Nicholas SJ, Hershman EB, Glace BW, Mullaney MJ, McHugh MP. 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(2):383-388.

I2. Roy BD1, de Beer J, Harvey D, Tarnopolsky MA. Creatine monohydrate supplementation does not improve functional recovery after total knee arthroplasty. Arch Phys Med Rehabil. 2005;86(7):1293-1298.

Vitamin C

J1. Chen S, Roffey DM, et al. Effect of Perioperative Vitamin C Supplementation on Postoperative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-Analysis. Clin J Pain. 2016 Feb;32(2):179-185.

J2. Shi R, Li ZH, et al. Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. Clin Cardiol. 2018 Jun;41(6):871-878.

J3. Hemilä H, Chalker E. Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients. 2019 Mar 27;11(4). pii: E708.

Acupoint Stimulation

K1. Wang M, Gao YH, et al. Zusanli (ST36) acupoint injection for preventing postoperative ileus: A systematic review and meta-analysis of randomized clinical trials. Complement Ther Med. 2015 Jun;23(3):469-483.

K2. Sun R, Dai W, et al. Non-needle acupoint stimulation for prevention of nausea and vomiting after breast surgery: A meta-analysis. Medicine (Baltimore). 2019 Mar;98(10):e14713.

Iron

L1. Schack A, Berkfors AA, et al. The Effect of Perioperative Iron Therapy in Acute Major Non-cardiac Surgery on Allogenic Blood Transfusion and Postoperative Haemoglobin Levels: A Systematic Review and Meta-analysis. World J Surg. 2019 Jul;43(7):1677-1691.

Acupressure

M1. Liu Y, Tang WPY, et al. A Systematic Review and Meta-Analysis of Acupressure for Postoperative Gastrointestinal Symptoms among Abdominal Surgery Patients. Am J Chin Med. 2017;45(6):1127-1145.

M2. Zhong Q, Wang D, et al. Effectiveness of Auricular Acupressure for Acute Postoperative Pain after Surgery: A Systematic Review and Meta-Analysis. Chin J Integr Med. 2019 Mar;25(3):225-232.

M3. Klaiman P, Sternfeld M, Deeb Z, et al. Magnetic acupressure for management of postoperative nausea and vomiting: a preliminary study. Minerva Anestesiol. 2008;74(11):635-642.

Calcium

N1. Alhefdhi A, Mazeh H, et al. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist. 2013;18(5):533-542.

N2. Xing T, Hu Y, et al. Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia: A meta-analysis. Medicine (Baltimore). 2019 Feb;98(8):e14455.

Omega 3 Polyunsaturated Fatty Acids

O1. Zhang B, Zhen Y, et al. Polyunsaturated fatty acids for the prevention of atrial fibrillation after cardiac surgery: an updated meta-analysis of randomized controlled trials. J Cardiol. 2014 Jan;63(1):53-59.

O2. Ma YJ, Liu L, et al. Perioperative ω-3 Polyunsaturated Fatty Acid Nutritional Support in Gastrointestinal Cancer Surgical Patients: A Systematic Evaluation. Nutr Cancer. 2016 May-Jun;68(4):568-76.

O3. Langlois PL, Hardy G, et al. Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis. Clin Nutr. 2017 Jun;36(3):737-746.

O4. Wang H, Chen J, et al. N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review. J Interv Card Electrophysiol. 2018 Mar;51(2):105-115.

O5. Zhang C, Lin J, et al. Effect of ω-3 polyunsaturated fatty acids on liver function and inflammatory reaction in patients undergoing hepatectomy: a systematic review and meta-analysis of randomized control trials. Expert Rev Gastroenterol Hepatol. 2019 Apr;13(4):375-384.

O6. Yu J, Liu L, et al. Effects of omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy: a systematic review and meta-analysis. BMC Cancer. 2017 Apr 14;17(1):271.

O7. Guo XY, Yan XL, et al. Omega-3 fatty acids for postoperative atrial fibrillation: alone or in combination with antioxidant vitamins? Heart Lung Circ. 2014 Aug;23(8):743-750.

O8. Xin W, Wei W, et al. Fish oil and atrial fibrillation after cardiac surgery: a meta-analysis of randomized controlled trials. PLoS One. 2013 Sep 10;8(9):e72913.

Probiotics

P1. Sawas T, Al Halabi S, et al. Patients Receiving Prebiotics and Probiotics Before Liver Transplantation Develop Fewer Infections Than Controls: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2015 Sep;13(9):1567-74.e3; quiz e143-144.

P2. Lytvyn L, Quach K, et al. Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect. 2016 Feb;92(2):130-139.

P3. Arumugam S, Lau CS, et al. Probiotics and Synbiotics Decrease Postoperative Sepsis in Elective Gastrointestinal Surgical Patients: a Meta-Analysis. J Gastrointest Surg. 2016 Jun;20(6):1123-1131.

P4. Kasatpibal N, Whitney JD, et al. Effectiveness of Probiotic, Prebiotic, and Synbiotic Therapies in Reducing Postoperative Complications: A Systematic Review and Network Meta-analysis. Clin Infect Dis. 2017 May 15;64(suppl_2):S153-S160.

P5. Yang Z, Wu Q, et al. Effect of Perioperative Probiotics and Synbiotics on Postoperative Infections After Gastrointestinal Surgery: A Systematic Review With Meta-Analysis. JPEN J Parenter Enteral Nutr. 2017 Aug;41(6):1051-1062.

P6. Ouyang X, Li Q, et al. Probiotics for preventing postoperative infection in colorectal cancer patients: a systematic review and meta-analysis. Int J Colorectal Dis. 2019 Mar;34(3):459-469.

P7. He D, Wang HY, et al. Use of pro-/synbiotics as prophylaxis in patients undergoing colorectal resection for cancer: a meta-analysis of randomized controlled trials. Clin Res Hepatol Gastroenterol. 2013 Sep;37(4):406-415.

Ginger

Q1. Tóth B, Lantos T, et al. Ginger (Zingiber officinale): An alternative for the prevention of postoperative nausea and vomiting. A meta-analysis. Phytomedicine. 2018 Nov 15;50:8-18.

Licorice

R1. Kuriyama A, Maeda H. Topical application of licorice for prevention of postoperative sore throat in adults: A systematic review and meta-analysis. J Clin Anesth. 2019 May;54:25-32.

Motherwort

S1. Chen W, Yu J, et al. Motherwort injection for preventing postpartum hemorrhage in pregnant women with cesarean section: A systematic review and meta-analysis. J Evid Based Med. 2018 Nov;11(4):252-260.

Music Interventions

T1. Hole J, Hirsch M, et al. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet. 2015 Oct 24;386(10004):1659-1671.

T2. van der Heijden MJ, Oliai Araghi S, et al. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One. 2015 Aug 6;10(8):e0133608.

T3. Bradt J, Dileo C, et al. Music interventions for preoperative anxiety. Cochrane Database Syst Rev. 2013 Jun 6;(6):CD006908.

T4. Kühlmann AYR, de Rooij A, et al. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg. 2018 Jun;105(7):773-783.

T5. Vetter D, Barth J, et al. Effects of Art on Surgical Patients: A Systematic Review and Meta-analysis. Ann Surg. 2015 Nov;262(5):704-713.

Daikenchuto

U1. Hoshino N, Takada T, et al. Daikenchuto for reducing postoperative ileus in patients undergoing elective abdominal surgery. Cochrane Database Syst Rev. 2018 Apr 5;4:CD012271.

Aromatherapy

V1. Hines S, Steels E, et al. Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database Syst Rev. 2018 Mar 10;3:CD007598.

Magnesium

W1. Cho HK, Park IJ, et al. Efficacy of Adjuvant Magnesium for Posttonsillectomy Morbidity in Children: A Meta-analysis. Otolaryngol Head Neck Surg. 2018 Jan;158(1):27-35.

W2. Lee HY, Ghimire S, et al. Magnesium supplementation reduces postoperative arrhythmias after cardiopulmonary bypass in pediatrics: a metaanalysis of randomized controlled trials. Pediatr Cardiol. 2013 Aug;34(6):1396-1403.

Electrotherapy

X1. Tedesco D, Gori D, et al. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. 2017 Oct 18;152(10):e172872.

Antioxidant Supplements

Y1. Geng J, Qian J, et al. The clinical benefits of perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery: a meta-analysis. Interact Cardiovasc Thorac Surg. 2017 Dec 1;25(6):966-974.

Y2. Ali- Hasan- Al- Saegh S, Mirhosseini SJ, et al. Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: an updated and comprehensive meta-analysis and systematic review. Cardiovasc Ther. 2016 Oct;34(5):360-370.

Y3. Ali-Hassan-Sayegh S, Mirhosseini SJ, et al. Antioxidant supplementations for prevention of atrial fibrillation after cardiac surgery: an updated comprehensive systematic review and meta-analysis of 23 randomized controlled trials. Interact Cardiovasc Thorac Surg. 2014 May;18(5):646-654.

Honey

Z1. Lal A, Chohan K, et al. Role of honey after tonsillectomy: a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol. 2017 Jun;42(3):651-660.

Z2. Hwang SH, Song JN, et al. The efficacy of honey for ameliorating pain after tonsillectomy: a meta-analysis. Eur Arch Otorhinolaryngol. 2016 Apr;273(4):811-818.

Physical Therapy

AA1. Chesham RA, Shanmugam S. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review. Physiother Theory Pract. 2017 Jan;33(1):9-30.

AA2. Hulzebos EH, Smit Y, et al. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. 2012 Nov 14;11:CD010118.

Chewing Gum

BB1. Song GM, Deng YH, et al. Meta-analysis comparing chewing gum versus standard postoperative care after colorectal resection. Oncotarget. 2016 Oct 25;7(43):70066-70079.

BB2. Short V, Herbert G, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015 Feb 20;(2):CD006506.

BB3. Hochner H, Tenfelde SM, et al. Gum chewing and gastrointestinal function following caesarean delivery: a systematic review and meta-analysis. J Clin Nurs. 2015 Jul;24(13-14):1795-1804.

BB4. Su'a BU, Pollock TT, et al. Chewing gum and postoperative ileus in adults: a systematic literature review and meta-analysis. Int J Surg. 2015 Feb;14:49-55.

Psychological Preparation

CC1. Powell R, Scott NW, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016 May 26;(5):CD008646.

Melatonin

DD1. Hansen MV, Halladin NL, et al. Melatonin for pre- and postoperative anxiety in adults. Cochrane Database Syst Rev. 2015 Apr 9;(4):CD009861.

DD2. Andersen LP, Werner MU, et al. A systematic review of peri-operative melatonin. Anaesthesia. 2014 Oct;69(10):1163-1171.

Coenzyme Q10

EE1. de Frutos F, Gea A, et al. Prophylactic treatment with coenzyme Q10 in patients undergoing cardiac surgery: could an antioxidant reduce complications? A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):254-259.

Exercise-Based Interventions

FF1. Gill SD, McBurney H. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2013 Jan;94(1):164-176.

N Acetylcysteine

GG1. Gu WJ, Wu ZJ, et al. N Acetylcysteine supplementation for the prevention of atrial fibrillation after cardiac surgery: a meta-analysis of eight randomized controlled trials. BMC Cardiovasc Disord. 2012 Feb 24;12:10.

Last reviewed February 2020 by EBSCO NAT Review Board Eric Hurwitz, DC  Last Updated: 11/10/2020