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Efficacy of acupressure on quality of recovery after surgery

Randomised controlled trial

Noll, Eric; Shodhan, Shivam; Romeiser, Jamie L.; Madariaga, Maria C.; Page, Christopher; Santangelo, Diane; Guo, Xiaojun; Pryor, Aurora D.; Gan, Tong J.; Bennett-Guerrero, Elliott

European Journal of Anaesthesiology (EJA): August 2019 - Volume 36 - Issue 8 - p 557–565
doi: 10.1097/EJA.0000000000001001
Postoperative nausea and vomiting

BACKGROUND Acupressure therapy is associated with favourable efficacies on postoperative nausea, pain and sleep disturbance, although the quality of the evidence is generally low. No randomised clinical trial has yet assessed the effect of acupressure on postoperative quality of recovery (QoR).

OBJECTIVE The objective was to study acupressure efficacy on patient-reported postoperative recovery.

DESIGN We conducted a single centre, three-group, blind, randomised controlled, pragmatic trial assessing acupressure therapy on the PC6, LI4 and HT7 acupoints.

PATIENTS Postoperative patients expected to stay in hospital at least 2 days after surgery.

INTERVENTIONS In the acupressure group, pressure was applied for 6 min (2 min per acupoint), three times a day after surgery for a maximum of 2 postoperative days during the hospital stay. In the sham group, extremely light touch was applied to the acupoints. The third group did not receive any touch.

MAIN OUTCOME MEASURES The primary outcome was the change in the QoR, using the QoR-15 questionnaire, between postoperative days 1 and 3. Key secondary outcomes included patients’ satisfaction, postoperative nausea and vomiting, pain score and opioid (morphine equivalent) consumption. Assessors for the primary and secondary endpoints were blind to the group allocation.

RESULTS Overall, 163 patients were randomised (acupressure n=55, sham n=53, no intervention n=55). The mean (SD) postoperative change in QoR-15 did not differ statistically (P = 0.27) between the acupressure, sham and no intervention groups: 15.2 (17.8), 14.2 (21.9), 9.2 (21.7), respectively. Patient satisfaction (on a 0 to 10 scale) was statistically different (P = 0.01) among these three groups: 9.1 (1.5), 8.4 (1.6) and 8.2 (2.2), respectively. Changes in pain score and morphine equivalent consumption were not significantly different between the groups.

CONCLUSION Two days of postoperative acupressure therapy (up to six treatments) did not significantly improve patient QoR, postoperative nausea and vomiting, pain score or opioid consumption. Acupressure, however, was associated with improved patient satisfaction.

TRIAL REGISTRATION, identifier: NCT02762435.

From the Department of Anesthesiology, Stony Brook Medicine, Brookhaven, New York, USA (EN, SS, JLR, MCM, CP, DS, XG, TJG, EB-G), Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg (EN), Institut de Chirurgie guidée par l’image, IHU Hôpitaux Universitaires de Strasbourg, Strasbourg, France (EN) and Department of Surgery, Stony Brook Medicine, Brookhaven, New York, USA (ADP)

Correspondence to Eric Noll, MD, PhD, Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg, France Tel: +33 3 88127076; fax: +33 3 88127074; e-mail:

Published online 5 April 2019

© 2019 European Society of Anaesthesiology