Table 3.
Characteristics of RCTs examining auricular acupoint stimulation included in the meta-analysis.
| First author, year, setting | Study design | Participants (n), age (years) | Surgery type | APS type | Intervention | Follow-up | Main outcomes |
|
|---|---|---|---|---|---|---|---|---|
| Intervention group | Sham/control group | |||||||
| Zhang, 2013, China [62] | RCT | Randomized = 120 Completed = 120 Intervention group: 60, 35 (7) Placebo group: 60, 34 (8) |
Gynecological laparoscopy | Seed embedding |
TF4, CO4, and AH6A auricular points Duration: pressed for 5 min preoperatively and 1, 5, 9, and 23 h postoperatively |
No sticking or pressing of vaccaria seeds | NR | PONV, VAS, tropisetron and morphine usage rates, adverse effects |
|
| ||||||||
| He, 2013, China [24] |
Prospective, randomized, sham-controlled trial | Randomized = 90 Completed = 90 Intervention group: 45, 61.58 (6.66) Control group: 45, 65.62 (6.10) |
Total knee arthroplasty | Seed embedding |
Site-knee joint, Shen Men, subcortex, and sympathesis auricular points Duration: pressed for 3 min four times per day until 7 days postoperatively |
Sham acupuncture at four nonacupoints on helix ipsilateral to surgical site | 3 months after operation | VAS, analgesic, analgesic-related adverse effects, HSS, ROM |
|
| ||||||||
| Chang, 2012, Taiwan [6] | Double-blind RCT |
Randomized = 62 Completed = 62 Intervention group: 31, 71.23 (7.09) Sham group: 31, 70.74 (8.09) |
Total knee arthroplasty | Seed embedding |
TF4 and AT4 auricular points Duration: pressed for 3 min three times per day (9 am, 1 pm, and 5 pm) |
Regular care | NR | VAS, SF-MPQ, analgesic dosage, ROM |
|
| ||||||||
| Kong, 2012, China [64] |
RCT | Randomized = 60 Completed = 60 Intervention group: 30, 39.02 (11.19) Control group: 30, 38.17 (13.02) |
Calcaneal fracture surgery | Seed embedding |
Shen Men, thalamus lung, liver, kidney, and knee joint auricular points Duration: 10–15 min five times per day |
Standard treatment (PCIA) | NR | VAS, analgesic, adverse reactions, urinary retention |
|
| ||||||||
| Yeh, 2010, Taiwan [65] |
Single-blind RCT |
Randomized = 94 Completed = 74 Intervention group: 36, 58.8 (13.6) Control group: 38, 55.1 (16.1) |
Lumbar spinal surgery | Seed embedding |
TF4, AT3, AH9, CO4, CO3, and CO18 auricular points Duration: 3 minutes per point, four times per day until 72 h postoperatively |
Standard treatment with no acupressure | NR | APSPOQ, pain intensity, analgesic dose, PONV, satisfaction |
|
| ||||||||
| Tsang, 2011, Hong Kong [19] |
Patient- and assessor-blinded RCT | Randomized = 48 Completed = 48 Intervention group: 16, 45.31 (2.68) Sham group: 16, 45.88 (3.91) Control group: 17, 44.63 (4.92) |
Hysterectomy | EA | Uterus, abdomen, sympathetic, Shen Men, and subcortex auricular points Duration: several hours postoperatively |
Sham TENS group: 90 s stimulation at 1 Hz Control group: 20 min bed rest |
NR | VAS, PEFR |
|
| ||||||||
| Kager, 2009, Austria [66] | Double-blind, randomized study | Randomized = 33 Completed = 33 Intervention group: 16, 30.78 (7.19) Placebo: 17, 30.92 (7.78) |
Tonsillectomy | EA | Point 55 (entrance of the spirit, Shen Men), point 29 (occiput, pillow, Zhen), and point 73 (BIAN TAO Ti 1) Duration: 3 h application, 3 h pause for 96 h |
Placement of acupuncture needles without stimulation, removed after 96 h | NR | VAS, NRS, oral analgesia, PONV |
|
| ||||||||
| Michalek-Sauberer, 2007, Austria [67] | Prospective, randomized, double-blind, placebo- controlled study |
Randomized = 149 Completed = 119 AA + AE group: 60, 27 (18–35) AA group: 41, 24 (20–35) Sham AE group: 41, 26 (19–35) |
Unilateral mandibular third molar extraction | EA | AA points 1 (tooth), 55 (Shen Men), and 84 (mouth) Duration: 30 min prior to procedure, 3 h stimulation with 3 h pause |
Sham AE with metal plates instead of needles, no electrical stimulation | NR | VAS, acetaminophen requirement, patient satisfaction |
|
| ||||||||
| Sator-Katzenschlager, 2006, Austria [69] |
Prospective, randomized, double-blind, controlled study | Randomized = 94 Completed = 93 EA group: 32, 33.3 (1.7) A group: 32, 34.2 (1.1) Control group: 30, 33.9 (1.9) |
IVF treatment | EA | Auricular points 57 (uterus), 55 (Shen Men), and 29 (cushion) Duration: 30 min preoperatively until 1 h postoperatively |
Adhesive tape over whole ear | NR | Side effects, satisfaction, IVF outcome data |
|
| ||||||||
| Wang, 2012, China [63] |
RCT | Randomized = 60 Completed = 60 Intervention group: 31, 60.19 (6.33) Control group: 29, 60.10 (6.10) |
Total knee arthroplasty | Manual auriculotherapy |
Shen Men, thalamus lung, and knee joint auricular points Duration: the night before surgery until the end of their surgeries. |
Sham needle embedding at nonacupoints | NR | VAS, PONV, dizziness, drowsiness, PCA |
|
| ||||||||
| Usichenko, 2007, Germany [68] |
Prospective, patient- and evaluator-blinded, controlled study | Randomized = 120 Completed = 120 Intervention group: 61, 42.0 (14.6) Control group: 59, 43.8 (12.6) |
Ambulatory knee surgery | Manual auriculotherapy |
Knee joint, Shen Men, and lung auricular points Duration: preoperatively until first morning postoperatively |
Invasive needle control at three nonacupoints of helix ipsilateral to surgical site | NR | VAS, analgesia, discharge time, nighttime sleep quality, adverse events |
|
| ||||||||
| Usichenko, 2005, Germany [70, 71] |
Prospective, patient- and evaluator-blinded, controlled pilot study | Randomized = 20 Completed = 18 Intervention group: 10, 33 (13) Control group: 8, 45 (15) |
Ambulatory knee surgery | Manual auriculotherapy |
Knee joint, Shen Men, and lung auricular points Duration: 5 min each before tracheal intubation, during most painful phase of surgery, and before extubation |
Invasive needle control at nonacupoints of helix ipsilateral to surgical site | NR | VAS, analgesia requirement, discharge time, night sleep, adverse events |
|
| ||||||||
| Usichenko, 2005, Germany [70, 71] |
Prospective randomized patient-, anesthesiologist-, evaluator-, and analyst-blinded, sham-controlled study | Randomized = 61 Completed = 54 Intervention group: 29, 68 (10) Control group: 25, 66 (11) |
Total hip arthroplasty | Manual auriculotherapy |
Hip joint, Shen Men, lung, and thalamus auricular points Duration: AA needle retention up to 3 days postoperatively |
Nonacupoints of helix ipsilateral to surgical site | NR | PCA demand, VAS, analgesia-related side effects |
|
| ||||||||
| Li, 1994, China [72] |
Double-blind, randomized study | Randomized = 48, 48.64 (11.35) Completed = 48 Chinese herb group: 16 Auricular acupoint group: 16 Epidural morphine group: 16 |
Surgery for liver cancer | Manual auriculotherapy |
Chinese herb group: Astragalus L., Angelica L., Ophiopogon J., Corydalis, and Rhizome Pinelliae (10 mL, w/v = 1 g/mL) Duration: orally three times a day Auricular acupoint group: heart, lung, and Shen Men acupoints Duration: three times a day, 24 h postoperatively |
Epidural morphine group: 2 mg epidural morphine before peritoneum suturing | NR | VAS, pethidine requirement, leucine enkephalin level |
RCT, randomized controlled trial; APS, acupoint stimulation; NR, not reported; PONV, postoperative nausea and vomiting; VAS, visual analog scale; HSS, New York Hospital for Special Surgery score; ROM, range of motion; PCA, patient-controlled analgesia; SF-MPQ, Short-Form McGill Pain Questionnaire; PEFR, peak expiratory flow rate; APSPOQ, American Pain Society Patient Outcome Questionnaire; TENS, transcutaneous electrical nerve stimulation; NRS, numerical rating scale; AA/A, auricular acupuncture; AE/EA, auricular electroacupuncture; IVF, in vitro fertilization.