| | 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 |
|
|
