Acupuncture-assisted anaesthesia

Acupuncture-assisted anaesthesia means adding acupuncture or a related technique to general or regional anaesthesia, so that the same operation can be done with less anaesthetic drug or less opioid. Trials measure it in three ways: the total dose of drugs such as propofol, remifentanil or sevoflurane given during the operation; the minimum alveolar concentration (MAC), the concentration of an inhaled anaesthetic at which half of people do not move in response to a painful stimulus; and the opioid people take in the days after surgery. Three techniques are tested and are kept apart below: manual acupuncture, needles turned by hand; electroacupuncture, in which a current runs between inserted needles; and transcutaneous electrical acupoint stimulation (TEAS), current delivered through pads on the skin over the points with no needle. Cochrane has not published a review of acupuncture to reduce anaesthetic or opioid dose. Its review of wrist-point stimulation covers nausea and vomiting, which Nausea after surgery reports; Pain after surgery reports pain scores and opioid use after the operation; and Postoperative delirium and cognitive dysfunction reports the trials of stimulation during anaesthesia for confusion and memory problems afterwards.

Reviews across operations

A 2023 network meta-analysis by Qiu and colleagues at the Affiliated Hospital of Yunnan University searched English and Chinese databases to June 2022 and included 76 randomised trials with 5,877 adults having surgery under general anaesthesia. A network meta-analysis compares several treatments at once, including pairs that no trial tested head to head. The control groups had general anaesthesia alone or general anaesthesia with sham acupuncture, a procedure made to resemble acupuncture without being it, and the review pooled the two; it ran a subgroup analysis by control type. The authors rated each result with GRADE, the scale reviews use to say how far a result can be trusted.

Only 2 of the 62 trials in the propofol comparison tested manual acupuncture, and the authors ask for its result to be read with caution. They list three further limitations: the review measured only drug dose during the operation, not pain, nausea, later drug use or length of stay; acupuncture-assisted anaesthesia has no standard form, so the trials started from different baselines; and some comparisons were rated low for inconsistency and indirectness. They concluded that electroacupuncture appears to be the technique that most reduces the anaesthetic dose required.

Reviews of single operations

A 2017 meta-analysis in the Journal of Neurosurgical Anesthesiology by Asmussen and colleagues at the University of Texas Medical Branch pooled 10 randomised trials with 700 people having a craniotomy, an operation that opens the skull, under general anaesthesia with or without added acupuncture. The acupuncture groups used less volatile anaesthetic, the inhaled kind, and had their breathing tubes removed sooner. Nausea and vomiting were less common, and no patient was aware during surgery. The authors call for further trials before definitive recommendations can be made.

A 2019 meta-analysis by the same group, in the Journal of Intensive Care Medicine, found 7 randomised trials with 321 people having open-heart surgery under general anaesthesia with or without electroacupuncture. The electroacupuncture groups were given lower doses of anaesthetic drugs during the operation, spent less time on a ventilator and in intensive care, and needed lower doses of drugs to support blood pressure afterwards.

A 2025 review by Lv and colleagues at Zhejiang Chinese Medical University included 23 randomised trials with 2,031 people having their gallbladder removed by keyhole surgery (laparoscopic cholecystectomy), against general anaesthesia with or without sham acupuncture. Propofol use during the operation was 90 mg lower and remifentanil use 89 micrograms lower with acupuncture, with high inconsistency between trials (I² 98% and 90%, where higher values mean the trials disagree more). Sufentanil use did not differ. The authors rated the evidence on all four drug doses as moderate certainty. Every participant in the included trials was from China, which the authors name as a limitation, and every trial carried some concerns on the risk-of-bias tool.

For thyroid surgery done under a cervical plexus block, an injection of local anaesthetic that numbs the neck, a 2023 review by Zhang and colleagues pooled 18 randomised trials with 1,211 people. Adding TEAS or electroacupuncture to the block raised the proportion of operations the trials rated as adequately anaesthetised, lowered heart rate and blood pressure during surgery, and cut adverse reactions after it (relative risk 0.30). The authors call for higher-quality studies.

Opioid use after surgery

A 2008 review by Sun and colleagues at Duke University pooled 15 randomised trials that compared acupuncture or a related technique with sham, each given as an addition to usual pain medicine after surgery. Cumulative opioid use was lower with acupuncture by 3.1 mg at 8 hours, 8.3 mg at 24 hours and 9.1 mg at 72 hours, and opioid side effects such as nausea, sedation and itching were less common. Pain after surgery reports this review with the later ones on pain scores.

Trials that measured anaesthetic requirement directly

A group led by Daniel Sessler, then at the University of California, San Francisco, and the University of Louisville, tested the question in volunteers, using the desflurane concentration at which people stopped moving in response to an electrical stimulus as an objective outcome.

• A 2002 double-blind crossover trial by Greif and colleagues in 20 volunteers applied transcutaneous electrical stimulation to a point on the face 3 cm in front of the ear, a method German anaesthetists had used in uncontrolled trials. Desflurane requirement fell by 11% on the stimulation day compared with the day without stimulation.
• A 2002 trial by Morioka and colleagues in 14 volunteers needled ST36 (Zusanli), GB34 (Yanglingquan) and BL60 (Kunlun) on the legs with electrical stimulation. The MAC equivalent was 4.6% on both the electroacupuncture and the control days.
• A 2005 trial by Chernyak and colleagues in 7 volunteers started electroacupuncture at four points including ST36, SP06 (Sanyinjiao) and LI04 (Hegu) either 30 minutes before induction or after it. Desflurane requirement did not differ between those days and a control day.

The authors of both negative trials concluded that this type of acupuncture is unlikely to reduce the need for anaesthetic drugs. In patients, a 2003 Swedish trial by Kvorning and colleagues randomised 46 women having laparoscopic sterilisation to electroacupuncture or sham after induction. The sevoflurane MAC needed to prevent movement at the incision was higher with electroacupuncture, 2.1% against 1.8%.

Trials of drug use during surgery

A 2014 trial in the British Journal of Anaesthesia by Wang and colleagues at Xijing Hospital in Xi'an randomised 60 people having sinus surgery to 30 minutes of TEAS at LI04, PC06 (Neiguan) and ST36 before anaesthesia, or to electrodes applied with no current. The TEAS group needed 39% less remifentanil during surgery, had their breathing tubes removed sooner, and had less dizziness and itching in the first 24 hours.

A 2017 trial at Peking University People's Hospital randomised 80 people having part of a lung removed by keyhole surgery to TEAS at one of three frequencies or to electrodes with no current. Opioid use during the operation was lowest with stimulation alternating between 2 and 100 Hz, which also shortened the time to tube removal and the stay in the recovery unit.

Two other trials found less. A 2002 trial at the National University Hospital in Singapore randomised 90 women having gynaecological surgery. Electroacupuncture before anaesthesia did not reduce alfentanil use during the operation significantly compared with placebo electroacupuncture, and 24-hour morphine use did not differ significantly. A 1993 Danish trial of 50 women having a hysterectomy found no difference in morphine use, pain or stress hormones after surgery with electroacupuncture given before and during the operation.

What guidelines say

Pain after surgery reports what the 2016 US guideline on postoperative pain says about acupuncture alongside other pain treatment. The authors of the 2023 network meta-analysis write that their findings should be incorporated in future clinical guidelines.

What the reviews could not settle

The reviews pool trials that compared acupuncture with sham and trials that compared it with anaesthesia alone, where the anaesthetist may know who received acupuncture; the 2008 review is the only one here restricted to sham controls, and it measured opioid use after surgery rather than during it. The volunteer and sham-controlled trials that measured anaesthetic requirement by MAC disagree: one found an 11% reduction with ear-area stimulation, two found none with electroacupuncture on the legs, and one found a higher requirement. The single-operation reviews drew on trials from China, report high inconsistency in drug dose, and in the network meta-analysis measured dose alone without the outcomes a lower dose is meant to improve. No review on this page compares acupuncture with another way of reducing anaesthetic or opioid dose, such as a nerve block, in the same operation.

AcuiQ's anaesthesia requirement reduction page lists the protocols individual studies prescribed, each with its citation.