Table 2.
Characteristics of RCTs examining body acupoint stimulation included in the meta-analysis.
| First author, year, setting | Study design | Participants (n), age (years) | Surgery type | APS type | Intervention (acupoints, parameters) | Follow-up | Main outcomes | |
|---|---|---|---|---|---|---|---|---|
| Intervention group | Sham/control group | |||||||
| An, 2013, China [28] |
Double-blind RCT, three groups |
Randomized = 120 Completed = 120 EA: 40, 40.7 (12.1) TEAS: 40, 42.7 (10.9) Control: 40, 39.1 (10.9) |
Supratentorial tumor resection | EA | EA/TEAS groups: LI4/TE5, BL63/LV3, ST36/GB40 Duration: throughout operation |
Standard treatment | NR | VAS, recovery time, AE, PCA |
|
| ||||||||
| Yin, 2013, China [29] |
RCT | Randomized = 60 Completed = 60 Intervention: 30, 35.1 (8.6) Control: 30, 36.7 (10.3) |
Gynecological laparoscopic surgery | EA | ST36 and ST34 Duration: 30 min |
General anesthesia | NR | VAS, PONV, exhaust defecation |
|
| ||||||||
| Taghavi, 2013, Iran [3] |
Randomized, double-blind, placebo- controlled study |
Randomized = 90, 25 (5) Completed = 90 Intervention: 45 Placebo: 45 |
Inguinal surgeries | EA | LI4 and SD36 Duration: 20 min sessions 30 min preoperatively, 1 and 2 h postoperatively |
No electrical excitement through needles | NR | VAS, PCA, vital signs, side effects |
|
| ||||||||
| Zhang, 2013, China [30] |
RCT | Randomized = 80 Completed = 80 Intervention: 40 (19–64) Control: 40 (20–65) |
Hemorrhoidectomy | EA | BL30 Duration: 30 min, twice a day |
50 mg tramadol hydrochloride | NR | VAS, edema score, analgesics requirement, AE |
|
| ||||||||
| Lan, 2012, China [31] |
RCT | Randomized = 68 Completed = 60 Intervention: 30, 76 (6) Sham: 30, 75 (5) |
Total knee arthroplasty | EA | Bilateral P6, L14; ST36, and GB31 Duration: 30 min before incision; 2, 4, 20, and 44 h postoperatively |
Stimulation 30 min before incision at 0 mA | NR | Analgesics, VAS, RSS, AE |
|
| ||||||||
| Chen, 2012, China [32] |
RCT | Randomized = 70 Completed = 70 Intervention: 35, 67.4 (5.1) Control: 35, 65.6 (5.1) |
Total knee arthroplasty | EA | SP10, ST34, ST35, EX-LE4, GB34 Duration: 30 min daily for 1-2 postoperative weeks, twice a week in postoperative weeks 3–12 |
Routine rehabilitation therapy | 12 weeks post-op | HSS, ROM, VAS, MMT |
|
| ||||||||
| Coura, 2011, Brazil [33] |
Prospective, randomized, controlled study | Randomized = 22 Completed = 22 Intervention: 13, 56.2 (11.8) Control: 9, 62.5 (10.8) |
Cardiac surgery | EA | LI4–LI11, LR3–ST36, and PC6–TE5 acupoints Duration: 30 min |
LI4–LI11, LR3–ST36 acupoints; device turned off but connected, 30 min | NR | Analgesics/boluses required, VAS, hospitalization length |
|
| ||||||||
| Yeh, 2011, Taiwan [34] |
Single-blind, randomized, placebo- controlled trial |
Randomized = 90 Completed = 90 Intervention: 30, 60.7 (12.0) Sham: 30, 57.2 (15.7) Control: 30, 63.2 (14.0) |
Spinal surgery | EA | BL40, GB34, HT7, P6s Duration: 20 min, 3 and 4 h postoperatively |
Sham: same acupoints, not meridian acupoints Control: no AES intervention |
NR | VAS, BPI, opiate requirement |
|
| ||||||||
| Deng, 2010, China [35] |
RCT | Randomized = 60 Completed = 60 Intervention: 30, 50.2 (11.0) Control: 30, 50.1 (8.5) |
Gastrectomy, proctocolectomy | EA | LI4, PC8, ST25, and BL25 acupoints Duration: 30 min |
Simple general anesthesia | NR | VAS, satisfaction, somnus score, PCA, BP, HR, SpO2, PONV |
|
| ||||||||
| Sahmeddini, 2010, Iran [36] |
Randomized, double-blind study |
Randomized = 90 Completed = 90 Intervention: 45, 27 (11) Control: 45, 29 (10) |
Septoplasty | EA | LI4, LI11, HT7, HC6 acupoints Duration: 5 min prior to start of surgery |
EA system pasted over hand without needle and stimulation. | NR | VAS, pulse rate, arterial pressure, AE |
|
| ||||||||
| Colak, 2010, Turkey [37] |
RCT | Randomized = 30 Completed = 30 Intervention: 15, 52.3 (8.1) Control: 15, 51.5 (8.5) |
Coronary surgery | EA | LI4, LI11, ST36, PC6, LIV3 Duration: 20 min after a 24 h rest interval and then daily for the first 7 postoperative days |
Pharmacological analgesia | NR | VAS, analgesic intake, pulmonary function, postoperative complications |
|
| ||||||||
| Larson, 2010, USA [38] |
Single-blind RCT |
Randomized = 122 Completed = 122 Intervention: 61 Control: 61 |
Outpatient plastic surgery | EA | P6 Duration: NR |
Standardized pharmacological treatment | NR | Nausea, vomiting, pain, medications required, hospitalization length |
|
| ||||||||
| El-Rakshy, 2009, UK [39] |
Randomized, double-blind, comparative study |
Randomized = 107 Completed = 102 Intervention: 58 Control: 44 |
Abdominal hysterectomy, laparoscopic cholecystectomy | EA | Bilateral CV2, GV4, BL32, BL23, LI4, PC6; LR3, SP6, L14, PC6 Duration: during operation |
Morphine sulfate via PCA | NR | Morphine requirement, pain, nausea, vomiting |
|
| ||||||||
| He, 2007, China [40] |
RCT | Randomized = 60 Completed = 60 Intervention: 30, 57.65 (6.67) Control: 30, 58.07 (7.02) |
Radical surgery for intestinal cancer | EA | “E pang 3 line” and “Ding pang 1 line” acupoints Duration: from 20 min preoperatively to end of operation |
Epidural analgesia at end of operation | NR | VAS, BCS, gastrointestinal function |
|
| ||||||||
| Wong, 2006, Hong Kong [14] |
Randomized, double-blind, placebo- controlled trial |
Randomized = 27 Completed = 25 Intervention: 13, 64.6 (8.0) Sham: 12, 64.5 (8.5) |
Thoracotomy | EA | LI4, GB34, GB36, TE8 acupoints Duration: two 30 min sessions a day for the first 7 postoperative days |
Same acupoints, mimic prick sensation without piercing skin | NR | Peak flow rate, chest drain, VAS, PCA, complications |
|
| ||||||||
| Gilbertson, 2003, USA [41] |
RCT | Randomized = 40 Completed = 40 Intervention: 20, 43 (9.195) Sham: 20, 47.81 (6.765) |
Arthroscopic acromioplasty | EA | Acupoints chosen with primary expectation of localized benefit to the operated shoulder Duration: postoperative days 3–8 and then three times per week for 1 month (12 sessions) |
Similar to true acupoints and needles, connected but not functioning, blinking red light | 4 mos. | UCLA, VAS, analgesic use, SF-36, ROM |
|
| ||||||||
| Lin, 2002, Taiwan [42] |
RCT, four groups |
Randomized = 100 Completed = 100 M/F = 0/100 Control: 25, 39 (8) Sham: 25, 41 (12) LF EA: 25, 38 (7) HF EA: 25, 42 (13) |
Lower abdominal surgery | EA | ST36 acupoint Duration: 20 min before anesthesia induction |
Control group: no stimulation Sham group: needle insertion but no electrical stimulation |
NR | VAS, analgesic, PCA demand, HR, BP, SpO2, opioid-related AE |
|
| ||||||||
| Sim, 2002, Singapore [43] |
RCT, three groups |
Randomized = 90 Completed = 90 Control: 30, 47 (6) Preoperative EA: 30, 46 (5) Postoperative EA: 30, 45 (4) |
Gynecological lower abdominal surgery | EA | ST36 and PC6 acupoints Duration: 45 min |
Control group: 45 min placebo EA | NR | VAS, morphine requirement, AE, satisfaction |
|
| ||||||||
| Chen, 1998, USA [44] |
RCT | Randomized = 100 Completed = 100 Sham TENS: 25, 45 (12) No TENS: 25, 44 (13) Dermatomal TENS: 25, 44 (13) Acupoint TENS: 25, 43 (13) |
Total abdominal hysterectomy, myomectomy | EA | Dermatomal TENS: dermatomal levels corresponding to incision. Acupoint TENS: ST36 Duration: every 2-3 h while awake, at bedtime, on waking in morning |
Sham: no electrical stimulation No TENS: shoulder electrical stimulation (nonacupoint) |
NR | VAS, PCA demand, analgesic, recovery time, AE |
|
| ||||||||
| Wang, 1997, USA [45] |
Prospective, randomized, sham-controlled, single-blind study |
Randomized = 101 Completed = 101 PCA only: 26, 44 (10) Sham TAES: 25, 44 (9) LF TAES: 25, 45 (9) HF TAES: 25, 43 (8) |
Lower abdominal surgery | EA | LI4 acupoint Duration: every 2 h for 30 min while awake |
PCA only Sham TAES |
NR | Hospitalization length, VAS, analgesia required, PCA need, AE, recovery time |
|
| ||||||||
| Masuda, 1986, Japan [46] |
Controlled study | Randomized = 24 Completed = 24 Intervention: 11, 48 (13) Control: 13, 49 (10) |
Eye surgery | EA | “Gohkoku” (Hoku) and “Shikoh” (Chikkou) acupoints Duration: from 30 min before surgery until end of operation |
Usual neuroleptanesthesia without acupuncture | NR | Pain, anesthetics required, swelling circulatory, |
|
| ||||||||
| Kim, 2009, Korea [23] |
Double-blind, placebo- and sham-controlled study | Randomized = 84 Completed = 84 Intervention: 28, 27.7 (9.1) Sham: 28, 28.6 (8.1) Control: 28, 29.2 (9.3) |
Orthognathic surgery | Plaster therapy | Bilateral LI4 acupoints Duration: 30 min before anesthesia induction in first operation, 8 h/day for 3 postoperative days |
Sham: inactive tape Control: inactive tape at bilateral LI4 points and deltoid regions |
NR | VAS, PCA, AE, PONV, satisfaction score |
|
| ||||||||
| Kim, 2006, Korea [47] |
Double-blind, placebo- and sham-controlled study | Randomized = 90 Completed = 90 Intervention: 30, 41.5 (9.7) Sham: 30, 43.2 (10.7) Control: 30, 42.0 (9.2) |
Abdominal hysterectomy | Plaster therapy | ST36 acupoint Duration: 30 min preoperatively, 8 h/day for 3 postoperative days |
Sham: plaster on sham acupoints Control: inactive tape without plaster |
NR | PCA, VAS, PONV, urinary retention, AE, satisfaction |
|
| ||||||||
| Park, 2004, Korea [49] |
Randomized, double-blind, sham-controlled study | Randomized = 150 Completed = 150 Intervention: 50, 43.8 (32–39) Sham: 50, 44.9 (33–61) Control: 50, 42.6 (32–47) |
Total abdominal hysterectomy | Plaster therapy | K-A20 acupoint Duration: 8 h beginning 30 min before anesthesia induction |
Sham: placebo tape at K-A20; PAS placed on the lateral thighs as in Group K Placebo: placebo tape placed at K-A20 and on lateral thighs as in Group K. |
NR | Sore throat, PONV, fentanyl dose, AE |
|
| ||||||||
| Adib-Hajbaghery, 2013, Iran [51] |
Single-blind RCT |
Randomized = 70 Completed = 70 Intervention: 35, 26.89 (9.59) Control: 35, 31.17 (14.79) |
Appendectomy | Acupressure | LE7 acupoint Duration: 7 h |
Sham point opposite LE7 | NR | VAS, nausea, vomiting |
|
| ||||||||
| Chen, 2005, Taiwan [48] |
RCT | Randomized = 104 Completed = 104 Intervention: 52, 32.69 (4.09) Control: 52, 32.27 (4.74) |
Cesarean section (CS) | Acupressure | P6 acupoint Duration: 20 min per arm before and within 24 h after CS |
Postoperative nursing | NR | DDQ, RINV, VASA, STAI, VAS |
|
| ||||||||
| Sakurai, 2003, Austria [20] |
RCT | Randomized = 53 Completed = 53 Intervention: 23, 43 (16) Control: 30, 49 (14) |
Abdominal surgery | Acupressure | Nei guan, Zusanli, Sanyinjiao, and Gongsun acupoints Duration: NR |
Standard anesthesia monitoring | NR | VAS, PONV, side effects, antiemetic requirement |
|
| ||||||||
| Felhendler, 1996, Sweden [50] |
RCT | Randomized = 40 Completed = 40 Intervention: 20, 32 (22–44) Control: 20, 35 (29–45) |
Knee arthroscopy | Acupressure | ST1, ST45, SP1, SP21, SP4, BL1, BL67, KI1, KI27, KI4, GB1, GB44, LR1, LR14, LR5 Duration: 30 min after waking from anesthesia |
15 nonacupoints, no active stimulation | NR | VAS, cardiovascular measurements |
|
| ||||||||
| Maimer, 2013, Germany [52] |
Prospective, randomized, controlled, observer-blinded clinical trial | Randomized = 100 Completed = 100 Control acupuncture: 33, 65 (10) Classic Chinese acupuncture: 34, 68 (11) Control: 33, 66 (10) |
Heart surgery | Manual acupuncture | Control acupuncture: LI4, SI6, BL60, EX1, GV20, GB8, ST8 Classic acupuncture: P6, ST34, SP10, ST44, K3R, LIV2 Duration: needle stimulation by rotation for ~5 s at insertion, after 10 min, before removal after 20 min |
Standard treatment with no additional acupuncture | NR | PPR, FVC |
|
| ||||||||
| Langenbach, 2012, Germany [53] |
Patient-blind RCT, three groups |
Randomized = 50 Completed = 50 Intervention: 17, 62 (15) Sham: 16, 48 (17) Control: 17, 57 (16) |
Stapled hemorrhoidopexy | Manual acupuncture | DU2, DU20, BI30, BI57, MA44, PE6 Duration: 20–30 min at 4 pm on day of surgery, mornings, and afternoons of postoperative days 1 and 2 |
Sham: needles placed away from meridians Control: analgesic drug regimen |
NR | NRS, analgesics, cardiovascular parameters, complications |
|
| ||||||||
| Marra, 2011, Italy [54] |
Pilot RCT | Randomized = 42 Completed = 42 Intervention: 21, >18 Control: 21, >18 |
Mediolateral episiotomy | Manual acupuncture | Lower 1 acupoint according to wrist-ankle acupuncture, right ankle Duration: needle left in place from discharge on day 2 or 3 after delivery, removed by midwife |
Standard treatment without acupuncture | NR | Oral analgesics, perineal pain, acupuncture acceptability, AE |
|
| ||||||||
| Wu, 2009, China [55] |
RCT, three groups |
Randomized = 60 Completed = 60 PCA only: 20, 30.8 (3.2) PCA + acupuncture: 20, 31.0 (4.2) PCA + EA: 20, 30.1 (4.1) |
CS | Manual acupuncture, EA | SP6 Duration: 30 min, prior to PCA |
No special treatment, PCA machine applied | NR | VAS, PCA demand, AE |
|
| ||||||||
| Sertel, 2009, Germany [56] |
Single-blind, randomized, prospective bicenter study | Randomized = 123 Completed = 123 Verum acupuncture: 41, 29.51 (16–58) Control acupuncture: 41, 26.6 (16–50) Medication: 41, 28.21 (16–58) |
Tonsillectomy | Manual acupuncture | S34, S44, PC5 Duration: 20 min |
Control acupuncture: nonspecific points away from meridians Medication: standard pain medication |
NR | VAS, AE |
|
| ||||||||
| Tsang, 2007, Hong Kong [57] |
Prospective patient- and assessor- blinded RCT |
Randomized = 36 Completed = 30 Intervention group: 15, 70.6 (5.8) Sham group: 15, 66.1 (7.5) |
Bilateral total knee arthroplasty | Manual acupuncture | ST32, ST33, GB31, GB35, GB34, ST36 Duration: 20 min, with needle manipulation every 5 min to achieve numbness |
No needle manipulation, no inducement of or inquiry about numbness, tingling, or heaviness | NR | VAS, analgesics, ROM, timed up-and-go test |
|
| ||||||||
| Kotani, 2001, Japan [58] |
RCT |
Upper abdominal surgery
Randomized = 107 Completed = 98 Intervention group: 50, 52 (15) Control group: 48, 55 (14) Lower abdominal surgery Randomized = 84 Completed = 77 Intervention group: 39, 55 (10) Control group: 38, 55 (11) |
Abdominal surgery | Manual acupuncture | Upper abdominal surgery: bilateral BL18–BL24 Lower abdominal surgery: bilateral BL20–BL26 Duration: NR |
Needles positioned at acupoints but not inserted into intradermal space | NR | VRS, analgesics, analgesic-related effects, PONV, plasma cortisol level, epinephrine requirement |
|
| ||||||||
| Gupta, 1999, UK [59] |
Prospective, double-blind, randomized controlled study |
Randomized = 42 Completed = 42 Intervention group: 21, 40.1 (19.4) Control group: 21, 47.4 (19.6) |
Elective single-knee arthroscopy | Manual acupuncture | SP9, SP10, ST34, ST36s Duration: 15 min, with manual stimulation for 5 s by 180° needle rotation every 5 min, and just before needle removal |
Standard treatment | NR | VAS, analgesic requirement |
|
| ||||||||
| Lao, 1999, USA [60] |
Randomized, double-blind, placebo- controlled trial |
Randomized = 39 Completed = 39 Intervention group: 19, 18–34 Control group: 20, 18–34 |
Oral surgery | Manual acupuncture | LI4, ST6, ST7, SJ17 Duration: 20 min, with manual manipulation for 20–30 s immediately after insertion, at midpoint, and at end of treatment |
Identical to intervention treatment but no needle insertion into skin | 7 days | Medication consumption, pain, psychological impact, AE |
|
| ||||||||
| Lao, 1995, USA [61] |
Randomized, single-blind, placebo- controlled trial |
Randomized = 22, (18–40) Completed = 19 Intervention group: 11 Placebo acupuncture group: 8 |
Oral surgery | Manual acupuncture | LI4, ST6, ST7, SJ17s Duration: 20 min, with manual acupuncture on initially and at midpoint of treatment |
Tapping next to acupoints to produce discernible sensation | 7 days | Pain, medication consumption, AE, local discomfort |
RCT, randomized controlled trial; APS, acupoint stimulation; EA, electroacupuncture; LF, low frequency; HF, high frequency; TEAS, transcutaneous electrical acupoint stimulation; NR, not reported; VAS, visual analog scale; PCA, patient-controlled analgesia; TAES, transcutaneous acupoint electrical stimulation; PONV, postoperative nausea and vomiting; RSS, Ramsay Sedation Scale; TENS, transcutaneous electrical nerve stimulation; HSS, New York Hospital for Special Surgery score; ROM, range of motion; MMT, manual muscle test; AES, acupoint electrical stimulation; AE, adverse effects/side effects; BPI, Brief Pain Inventory; BP, blood pressure; HR, heart rate; BCS, Bruggemann Comfort Scale; SF-36, Short Form 36; CS, cesarean section; PPR, percentile pain reduction; FVC, forced vital capacity; NRS, numerical rating scale; VRS, verbal rating scale; DDQ, Demographic Data Questionnaire; RINV, Rhodes Index of Nausea and Vomiting; VASA, Visual Analog Scale for Anxiety; STAI, State-Trait Anxiety Inventory.