Acupuncture for chronic rhinosinusitis and related postoperative pain: A systematic review and network meta-analysis

Background: The network meta-analysis system was used to evaluate the efficacy of various acupuncture and moxibustion techniques for chronic rhinosinusitis (CRS) and related postoperative pain. Methods: An electronic search of PubMed, Embase, Web of Science, Cochrane Library, OVID(the Offshore Vessel Inspection Database), CNKI, Wanfang, VIP, and CBM databases was conducted to identify ran-domised controlled trials on acupuncture and moxibustion for CRS and related postoperative pain from database inception to February 2021.The study included randomised controlled trials (RCTs) published in China and other countries in languages limited to Chinese and English. Primary studies included treated individuals without limitations on age, gender, or nationality and diagnosed as CRS. The total effective rate, visual analogue scale (VAS) score, and symptom and sign score were the primary outcomes. Evi-dence quality and risk-of-bias were determined. Network meta-analysis was performed. Results: Nineteen articles were included, involving 11 types of intervention measures. The pairwise com-parisons showed that both acupuncture therapy combined with drugs (ATD) and sphenopalatine ganglion acupuncture combined with drugs (SGAD) were superior to western medicine (WM) in improving the to-tal effective rate, and ATD was superior to manual acupuncture therapy (MAT), WM, and placebo (PL). In reducing the VAS score, both ATD and SGAD were superior to WM. Point-through-point acupuncture com-bined with pricking blood therapy (PABT) was superior to MAT. In reducing symptom and sign score, ATD was superior to WM and PL. PABT was superior to MAT. The results of network meta-analysis showed that ATD was superior to MAT, Traditional Chinese medicine (TCM), and WM in improving the total effective rate. In reducing the symptom and sign score, ATD was superior to PL, WM, MAT, and sham acupuncture (SA). PL was superior to MAT, WM, and SA. and PABT was superior to MAT and SA, MAT was superior to WM. There was no significant difference between the intervention measures in reducing the VAS score. The surface under the cumulative ranking curve showed that ATD had the best effect in improving the total effective rate and reducing the VAS and symptom and sign score. Conclusion: ATD was the best method for improving the total effective rate and reducing the VAS and symptom and sign score in the treatment of CRS and related postoperative pain. However, considering the current study quantity and quality, multicentre and high-quality clinical studies with larger sample sizes are needed to verify our findings. Trial registration: International Prospective Register of Systematic Reviews(CRD42021246103).(c) 2022 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.