Preoperative anxiety management: acupuncture vs. pharmacological treatment - A prospective study.

OBJECTIVE: Acupuncture, both auricular and somatic, is a widely adopted and well-tolerated treatment for preoperative anxiety. The aim of our study was to compare the effectiveness of acupuncture with pharmacological treatment in reducing preoperative anxiety in patients undergoing cholecystectomy or TEP. MATERIALS AND METHODS: We randomized 120 patients in a control group PT (where patients underwent pharmacological treatment with Midazolam) and in an acupuncture group (here patients received somatic acupuncture SA and auricular acupuncture AA). Anxiety reduction was measured by intraoperative consumption of Propofol and Fentanyl and preoperatively by the Italian Version of the State-Trait Anxiety Inventory questionnaire (STAI). RESULTS: Propofol consumption in the somatic (SA) and auricular (AA) acupuncture groups was found to be lower compared to patients that did not receive any treatment. SA and AA patients required less Propofol than the PT group (p=0.0019 and p=0.0016 respectively) and patients that underwent SA treatment used less Fentanyl than the PT group (p=0.002). No difference was measured when comparing SA to AA (p=0.15) and AA to PT (p=0.16). CONCLUSIONS: Acupuncture is a safe and well-tolerated procedure that reduces preoperative anxiety. Both somatic and auricular acupuncture are more effective than pharmacological treatment in the intraoperative period. AA is easier to implement than SA.

L-PRP diminishes bone matrix formation around autogenous bone grafts associated with changes in osteocalcin and PPAR-γ immunoexpression.

Leucocyte- and platelet-rich plasma (L-PRP) is an autogenous platelet concentrate enriched with leukocytes that releases various growth factors responsible for the proliferation, regulation, and differentiation of mesenchymal cells during wound healing. Since the bone and medullary tissue are contiguous and share the same origin, this study evaluated the effect of L-PRP on the repair of calvaria bone using histomorphometric analysis of the newly formed bone, and compared the results in the presence of osteocalcin (OC) and peroxisome proliferator-activated receptor gamma (PPAR-γ) detected by immunohistochemistry. Artificial circular bone defects (5mm diameter) were produced in the calvaria of 42 rats. The defects were treated with autograft, autograft combined with L-PRP, or without grafting material (sham). The animals were euthanized at 15 or 40 days postsurgery (n=7 in each group). Data obtained were analyzed by Student-Newman-Keuls test for histomorphometric and immunohistochemical interpretation. The development of bone matrix was significantly less in the defects treated with L-PRP, while the medullary area composed of fatty cells was larger. This coincided with the minor expression of OC and expressive presence of PPAR-γ. These results suggest that L-PRP may impair osteoneogenesis and alter the ratio of differentiation between bone matrix and fatty cells, increasing the medullary tissue.