Terapias complementares e alternativas no alívio da dor pós-cesariana: revisão sistemática da literatura e metanálise

• Autor(a) principal: Zimpel, Sandra Adriana [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5499518; http://repositorio.unifesp.br/handle/11600/50174
• topic: Complementary therapies; Alternative therapies; Pain; Caesarean; Obstetric analgesia; Terapias complementares; Terapias alternativas; Dor; Cesariana; Analgesia obstétrica

Objective: To evaluate the efficacy and safety of Complementary and Alternative Therapies (CAT) in the treatment of post-cesarean (CS) pain. Methods: Systematic review of randomized and quasi-randomized clinical trials. The search was conducted in seven electronic databases (CENTRAL, MEDLINE, EMBASE, LILACS, CINAHL, Pedro, CAMBASE) and complemented by checking the reference lists of included studies and through manual search of relevant journals, books and conferences abstracts. There were no language and date of publication restrictions. We included clinical trials that compared CAT alone or associated with analgesics versus no treatment, analgesics alone or placebo, in post-CS women. Primary outcomes were pain relief and adverse effects, and secondary outcomes included vital signs, need for additional analgesics and postpartum satisfaction. Two independent reviewers performed study selection, data extraction and risk of bias assessment for included studies, following the Cochrane Collaboration recommendations. We the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of the evidence. Where possible, we pooled data into metaanalyses. Results: We included 30 studies involving 2335 post-CS women, which tested seven different types of CAT. Most included studies used different methods and had poor data reporting, making quantitative analyses difficult. We classified 9 studies as having an unclear risk of bias, 16 as having a low risk and 5 as having a high risk of bias. Acupuncture associated with analgesics was more effective than placebo for pain up to 48 hours after CS and more effective than analgesics alone for pain at 24 hours post-CS. Aromatherapy was also better than placebo for pain, but data could not be analyzed quantitatively. Foot, or hand and foot, massages were more effective than analgesics alone for pain relief between 90 minutes and 24 hours after a CS. Music therapy was better than no treatment, but no better than analgesics, for pain relief. Reiki reduced pain between 24 and 48 hours post-CS, but not after 72 hours. The Benson relaxation technique, assessed in one study, reduced post-partum pain between 24 and 48 hours. One study reported that TENS was better than no treatment for pain up to one hour post-CS. Three other studies reported that TENS was better than placebo for pain between 12 and 24 hours post-CS. Only one study compared TENS plus analgesics versus analgesics alone and found no significant difference in pain relief. Conclusions: The results indicate that CAT may be effective in the relief of post-CS pain, but the quality of the evidence is low to very low. Among the interventions assessed, only music therapy did not show significant results. TENS was the intervention with the largest number of studies and aromatherapy was the intervention with the best quality of evidence (moderate). Acupuncture, aromatherapy, massage, music therapy and TENS were all interventions that reduced the need for additional analgesics.