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Perioperative Homeopathic Arnica and Bromelain: Current Results and Future Directions.

Annals of Plastic Surgery
Volume 84(3), March 2020, p e10-e15

Knackstedt, Rebecca MD, PhD*; Gatherwright, James MD+

From the *Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
+Division of Plastic Surgery, MetroHealth, Cleveland, Ohio.

Abstract

Introduction:
Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic practitioners. A significant barrier to utilization of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. The goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain with a focus on treatment regimen and outcomes.

Methods:
A triple database search was conducted with the keywords "arnica," "bromelain," and "surgery." References for each identified article were analyzed for additional articles. Articles were analyzed for methodology, outcomes, and conclusion. Articles were excluded if they did not involve human subjects, were published before 1990, and if they were not available in English. Level of evidence was determined based on methodology.
Results: A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively. There was marked heterogeneity with regard to surgical procedure, dosing regimen, outcomes measured, and results. Arnica seems to have a mitigating effect on ecchymosis, most notably following rhinoplasty and facelifts/facial procedures. Bromelain is well supported across numerous studies in reducing trismus, pain, and swelling following molar extractions. However, there was no effect demonstrated when evaluating topical arnica following blepharoplasty procedures.

Discussion:
A systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results.

https://journals.lww.com/annalsplasticsurgery/Abstract/2020/03000/Perioperative_Homeopathic_Arnica_and_Bromelain_.18.aspx

Excerpts:

"A significant barrier to use of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. Therefore, the goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain, with a focus on treatment regimen and outcomes. By highlighting the differences in dosing and objective postoperative measurements, we hope to emphasize the inconsistencies in homeopathic studies and encourage future studies to be performed with translatable dosing regimens and outcome measures."

"A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively."

[The table includes all kinds of doses - some of them homeopathic, some apparently containing actual amounts of the herb. Some treatments are oral, some topical. Some of the homeopathic remedies were of unknown dilution.]

[DISCUSSION]

"Therefore, based on these studies, one may assume a positive effect by incorporating them into their perioperative care. However, this is not commonly done. While this is likely multifactorial, a lack of knowledge regarding homeopathic remedies and their dosing is probably at the core. Homeopathic medications rely on ultradilute concentrations, represented by 'X' or 'C' with the goal of using the lowest possible dose to achieve the desired outcome. As this is not a commonly used dosing mechanism, regimens and outcomes can be misguided and misinterpreted.

"While herbal supplements hold promise for improving perioperative outcomes, there are several limitations and unanswered questions. Homeopathic medications are often toxic in nondiluted doses, making superdilution critical to avoid toxicity. However, the dilution schematic used in homeopathic medicine is not readily understood, making widespread translation difficult."

"In conclusion, a systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results."

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Comments:

While it might be useful to highlight the diversity of dosing of arnica and the fact that some practitioners might not understand the dilution schemes in homeopathic remedies, trying to draw conclusions on effectiveness and potential use from studies involving both real herbal materials and imaginary homeopathic materials (some given orally and some given topically) makes no sense.

As is frequently the case in papers on homeopathy, there is no discussion of the fact that homeopathy is absurd from a scientific standpoint, no discussion of the fact that 30C, 60C, and 50M dilutions of arnica contain no molecules of the original substances, not even any mention that homeopathy is controversial. This is what one might expect in a homeopathy journal, but not in a mainstream medical journal.

The introduction treats homeopathic arnica as if it were just another herbal remedy whose barrier to use by "allopathic" doctors is merely that "the preparations and dosing regimens are not widely known or understood," ignoring the fact that many doctors know very well what homeopathy is and reject it on scientific grounds.