Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Table 3

Characteristics of RCTs examining auricular acupoint stimulation included in the meta-analysis.

First author, year, setting	Study design	Participants (), 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.