Surgery, even relatively minor surgery, is a significant trauma to the body. The surgical incision itself can cause swelling (edema), pain, and bruising; anesthesia frequently causes nausea and bloating. Certain surgeries that damage the body's lymphatic system, such as radical mastectomy, can cause a specific form of long-lasting swelling called lymphedema.

Modern surgery involves numerous sophisticated nondrug techniques to help wounds heal rapidly and completely. Various medications can be used to help offset the side effects of anesthesia.

A variety of herbs, supplements, and other alternative therapies have shown promise for problems encountered following surgery. However, keep in mind that many such substances have shown the potential to increase risk of bleeding during or after surgery. (See Herbs and Supplements to Use Only With Caution). Furthermore, it is not at present possible to determine all the potential interactions between herbs and drugs used for anesthesia. For this reason, herbs and supplements should only be used for surgical support under the supervision of a physician.

Proteolytic Enzymes

According to most but not all studies, proteolytic enzymes may help reduce pain, bruising, and swelling after surgery.

A double-blind, placebo-controlledtrial of 80 people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling.1

Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in 80 individuals undergoing oral surgery.2The results showed reduced pain, inflammation, and swelling in the treated group as compared to the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery,59 as well as in one study involving only bromelain.3

Other double-blind, placebo-controlled studies have found bromelain helpful in nasal surgery,6cataract removal,7and foot surgery.61However, a study of 154 individuals undergoing facial plastic surgery found no benefit.8

Note: Bromelain thins the blood and could increase risk of bleeding during or after surgery. For this reason, physician supervision is essential.

For more information, including dosage and safety issues, see the full articles on Bromelain and Proteolytic Enzymes.

Oxerutins and Other Bioflavonoids

Oxerutins have been widely used in Europe since the mid-1960s, primarily as a treatment for varicose veins. Derived from a naturally occurring bioflavonoid called rutin, oxerutins were specifically developed to treat varicose veins and related venous problems. However, they may also be helpful for treating swelling following surgery. Closely related bioflavonoids from citrus fruit may be helpful as well.

Women who have undergone surgery for breast cancer may experience a lasting and troublesome side effect: swelling in the arm caused by damage to the lymph system. Along with the veins, the lymphatic system is responsible for returning fluid to the heart. When this system is damaged by breast cancer surgery, fluid accumulates in the arm. Three, small, double-blind, placebo-controlled studies enrolling a total of more than 100 people have examined the effectiveness of oxerutins in lymphedema following breast cancer surgery, with generally good results.9-11

For example, in a small, 6-month, double-blind study, oxerutins reduced swelling and improved comfort and mobility as compared to placebo.11 Another study found benefit with a combination formula containing oxerutins, ginkgo, and the drug heptaminol.82

The citrus bioflavonoidsdiosmin and hesperidin have also shown promise for lymphedema following breast cancer surgery,16 as has a product containing hesperidin plus a bioflavonoid-rich extract of the herb butcher’s broom.62Note: Do not use bioflavonoid combinations containing tangeretin if you are taking tamoxifen for breast cancer.

Oxerutins might also be helpful for the ordinary swelling that occurs after any type of surgery. In one double-blind trial, researchers gave oxerutins or placebo for 5 days to 40 people recovering from minor surgery or other minor injuries, and found oxerutins significantly helpful in reducing swelling and discomfort.17

For more information, including dosage and safety issues, see the full articles on Oxerutins and Citrus Bioflavonoids.

Oligomeric Proanthocyanidins

Oligomeric proanthocyanidins (OPCs), substances found in grape seed and pine bark, may be helpful for recovery from surgery as well. Like oxerutins, to which they are chemically related, OPCs are thought to work by reducing leakage from capillaries.

A double-blind, placebo-controlled study of 63 women with breast cancer found that 600 mg of OPCs daily for 6 months reduced postoperative symptoms of lymphedema.22Additionally, in a double-blind, placebo-controlled study of 32 people who were followed for 10 days after a face-lift, swelling disappeared much faster in the treated group.23

For more information, including dosage and safety issues, see the full OPCs article.

Acupuncture/Acupressure

Acupuncture and acupressure are two related forms of treatment that involve stimulating certain locations on the body, known as acupuncture points. Numerous studies have evaluated treatment on a single acupuncture point—P6—for the relief of nausea following anesthesia. This point is located on the inside of the forearm, about 2 inches above the wrist crease.

Many controlled studies involving more than 2,000 people have tested the potential benefits of stimulation at P6 in people undergoing surgery.12,14,34-47,58,63-67,83,90,95,97,101,105 In most of these trials, treatment was carried out through the surgery itself, as well as afterwards. The results of these many trials, involving various types of surgery and diverse forms of acupuncture/acupressure, tend to contradict one another. On balance, however, it appears that acupuncture/acupressure may reduce nausea during and after surgery to at least some extent beyond that of the placebo effect.

Related to post-operative nausea is a condition called gastroparesis, a common complication of abdominal surgery where the stomach is unable to properly empty its contents after eating. In a controlled trial, 63 people who underwent abdominal surgery were randomized to receive acupuncture or a standard medication used to treat gastroparesis (metoclopramide given intravenously 3 times a day).104 According to the researchers, those in the acupuncture group experienced a higher cure rate.

Acupuncture has also been explored as a means of reducing pain after surgery with inconsistent results.18,29,48-50,63,68,103In a 2008 review of 15 randomized controlled trial, however, researchers determined that acupuncture is capable of reducing pain and the need for opioid medications (morphine and related agents) immediately following surgery compared with sham (fake) acupuncture.93An analysis of 5 trials found similar results.102 Patients who received ear acupuncture (auriculotherapy) did not use pain medication as much as those in the control group.

A small randomized trial of 70 patients found that acupuncture may decrease dry mouth and pain after removing lymph nodes in the neck for cancer treatment.99

A randomized trial of 80 women with post-hysterectomy urinary retention showed improvement in bladder function with acupuncture compared to acupoint injection of vitamin B12. Each group had daily treatment over the course of five consecutive days. Improvement was seen in 90% of the acupuncture group after two treatment courses compared to 72.5% in injection group.106

In a randomized trial of 80 patients having total knee arthroplasty, acupuncture was associated with greater reduction in pain and swelling, and quicker return to preoperative range of motion compared to range of motion exercises alone.107

Electric accupuncture was associated with significantly improved time to defectation in 165 patients with colorectal cancer who had laparoscopic surgery compared to sham electric acupuncture and no acupuncture. Electroaccupuncture was also associated with reduced pain, less pain medication, and improved time to walking.108

Contrary to popular belief, acupuncture does notappear to be helpful for providing or enhancing anesthesia itself.19,96

For more information, see the full Acupuncture article.