Acupuncture for post anaesthetic recovery and postoperative pain: study protocol for a randomised controlled trial
Acupuncture for post anaesthetic recovery and postoperative pain: study protocol for a randomised controlled trial
Johannes Fleckenstein 0 1
Petra I Baeumler 1
Caroline Gurschler 1
Thorsten Annecke 0
Thomas Geisenberger 0
Dominik Irnich 0 1
0 Department of Anaesthesiology, University of Munich , Munchen , Germany
1 Multidisciplinary Pain Centre, Department of Anaesthesiology, University of Munich , Pettenkoferstrasse 8 A, 80336 Munchen , Germany
Background: We report on the design and implementation of a study protocol entitled Acupuncture randomised trial for post anaesthetic recovery and postoperative pain - a pilot study (ACUARP) designed to investigate the effectiveness of acupuncture therapy performed in the perioperative period on post anaesthetic recovery and postoperative pain. Methods/Design: The study is designed as a randomised controlled pilot trial with three arms and partial double blinding. We will compare (a) press needle acupuncture, (b) no treatment and (c) press plaster acupressure in a standardised anaesthetic setting. Seventy-five patients scheduled for laparoscopic surgery to the uterus or ovaries will be allocated randomly to one of the three trial arms. The total observation period will begin one day before surgery and end on the second postoperative day. Twelve press needles and press plasters are to be administered preoperatively at seven acupuncture points. The primary outcome measure will be time from extubation to 'ready for discharge' from the post anaesthesia care unit (in minutes). The 'ready for discharge' end point will be assessed using three different scores: the Aldrete score, the Post Anaesthetic Discharge Scoring System and an In-House score. Secondary outcome measures will comprise pre-, intra- and postoperative variables (which are anxiety, pain, nausea and vomiting, concomitant medication). Discussion: The results of this study will provide information on whether acupuncture may improve patient post anaesthetic recovery. Comparing acupuncture with acupressure will provide insight into potential therapeutic differences between invasive and non-invasive acupuncture techniques.
Perioperative care has improved over the last decades.
To continue this trend it is important note that the
quality and speed of post anaesthetic recovery is influenced
by multiple factors such as the occurrence of pain,
postoperative nausea and vomiting (PONV), paralytic ileus,
fatigue and sleep disturbances . Hence, a multimodal
approach to prevent and minimise these factors is
considered to be essential in order to enhance recovery .
These include a series of elements such as providing the
patient with thorough preoperative information and
education concerning perioperative care, the use of safe and
short-acting anaesthetics and optimal dynamic pain
relief with minimal use of opioids, management of PONV,
enteral nutrition, early mobilization and use of minimal
invasive surgery. As a result of optimised anaesthetic
protocols, patients might be fully awake earlier and breathe
comfortably in the operating theatre . As a result of a more
rapid recovery, fewer patients arrive in the post anaesthesia
care unit (PACU) sedated, and the period during which
they are at risk for airway obstruction and hemodynamic
instability is reduced .
For achieving an optimised management of postoperative
pain and PONV, acupuncture may be a hitherto
underestimated option. Interest in the use of acupuncture in
anaesthesia leads back to 1971, when James Reston, a
The New York Times columnist, introduced the western
world to the ancient Chinese therapy of acupuncture
. Reston underwent an emergency appendectomy in
China, and described acupunctures success in relieving
his postoperative pain. From this point on, several
scientists started investigating possible effects of
acupuncture. Soon, Bruce Pomeranz revealed that an analgesic
effect of acupuncture is mediated by the release of
endorphins and can therefore be abolished by the
administration of naloxone in humans . Mice deficient in opiate
receptors did not experience acupuncture-mediated
analgesia , which confirms the opioid-related mechanism of
acupuncture-analgesia. Soon, first articles reported on the
benefits of acupuncture anaesthesia in various
operative procedures in China [8,9]. As a consequence, first
attempts were made to implement acupuncture in the
anaesthetic framework , for example, as an option
for sedation of the patient during tonsillectomy . A new
modified method of anaesthesia in open heart surgery
combining acupuncture analgesia and controlled respiration
was established at the Department of Anaesthesiology in
Gieen, Germany . Since then, general anaesthesia has
markedly improved and acupuncture anaesthesia cannot
be considered a first-line procedure.
However, there is evidence that acupuncture is
effective in facilitating multimodal approaches in perioperative
care. An approved acupuncture effect is the reduction of
PONV and antiemetic consumption by stimulation of the
acupuncture point PC 6 . Recent reviews support
the effectiveness of acupuncture regimen in reducing
postoperative pain, cumulative opioid consumption or
opioid related side effects [14,15]. However, trials are
of varying quality and show heterogeneity with regard
to the applied acupuncture treatments (acupuncture
points used, time point of application). Accordingly, a
meta-analysis on the effects of acupuncture on the
intraoperative analgesic consumption and quality of anaesthesia
revealed inconclusive results .
We aim to investigate the effects of a three-day permanent
needle acupuncture treatment, starting in the preoperative
phase at seven different acupuncture points only - five
of them bilaterally - on a comprehensive set of above
mentioned variables important to anaesthetic recovery
(which are, preoperative anxiety, improving anaesthetic
protocols, awakening, nausea and vomiting, and
Patients and methods
The study is a single-center, partially double blinded,
randomised pilot trial comparing (a) press needle
acupuncture versus (b) no treatment versus (c) press plaster
acupressure in a standard anaesthetic setting of programmed
gynaecologic laparoscopic operations. Main outcome
measure is the time from extubation to ready for discharge
from the PACU. Analysis of all records is performed by
blinded evaluators. The total follow-up period per patient
is two days (see Figure 1). The study has been approved
by the Ethics Committee of the University of Munich,
Germany (reference 009-12) and is in agreement with
the Declaration of Helsinki (Version Fortaleza 2012).
Trial registration is NCT01816386.
Subjects presenting with any of the following exclusion
criteria may not be included in the trial:
General exclusion criteria:
Subject without legal capacity
Subject who is unable to understand the nature, scope,
significance and consequences of this clinical trial
Simultaneously participation in another clinical
trial or participation in any clinical trial involving
administration of acupuncture within 30 days prior
Subjects with a physical or psychiatric condition which
at the investigators discretion may put the subject at
risk, may confound the trial results, or may interfere
with the subjects participation in this clinical trial
Known or persistent abuse of medication, drugs or
Current or planned pregnancy or nursing women
Females of childbearing potential, who are not using
and not willing to use medically reliable methods of
contraception for the entire study duration (such as
oral, injectable, or implantable contraceptives, or
intrauterine contraceptive devices) unless they are
surgically sterilised/hysterectomised or there are any
other criteria considered sufficiently reliable by the
investigator in individual cases.
Indication specific exclusion criteria:
Surgery within the last three months
Chronic pain > three months
Continuous analgesic medication with opioids
longer than three days
Figure 1 Study design. Patients are randomly allocated to either the group ACU (press needle acupuncture), no treatment group (control) or the
group APU (press plaster acupressure). After surgery, press needles and press plasters will be kept on the patients skin for the next two postoperative
days or until discharge from the hospital. The listed outcome measures will be assessed at the marked time points respectively.
Massive degenerative diseases
Pre-treatment with acupuncture or trigger point
injection within the last two months
Randomised treatment allocation, blinding and
Informed consent will be obtained from each participant.
Subjects eligible for participation will be randomly
assigned to one of the following study groups by using the
Internet based randomisation software RANDOULETTE
(Institute of Medical Information Sciences, Biometry and
Epidemiology, University of Munich):
press needle acupuncture: 25 subjects
no treatment control: 25 subjects
press plaster acupressure: 25 subjects
Stratification for age will be performed, and an equal
distribution between treatment arms (ratio of 1:1:1) will
In this trial we will use acupressure (group C) as
an intervention to compare acupuncture (group A).
Patients and examiners will be blinded for the patients
assignment to treatment arms A and C. Therefore, we use
press needles (0.2 mm 1.5 mm; Seirin New Pyonex,
Seirin Corp., Shizuoka City, Japan) in group A and
noninvasive Seirin press plasters in group C - a device that
has successfully been validated for blinding in
acupuncture trials . Press plasters do not contain a needle but
a blunt knob and are in all other aspects identical to the
press needles. According to group allocation, press needles
or press plasters will be administered by an independent
acupuncturist at the same defined acupuncture points.
Instructions regarding point stimulation for subjects and
study staff will also be identical. Thereby, patients and
examiners will be blinded as laid down in the trial of
Myazaki and colleagues who showed that neither patients
nor therapists nor examiners know if a sharp tip or a
blunt knob is located below the plaster. In contrast to
Myazaki, patients will be allowed to stimulate their
press device, so that an additional acupressure effect
may be elicited, thereby enhancing the overall effects.
Participating trial physicians
Participating trial physicians are employees of the
Multidisciplinary Pain Centre, Department of Anaesthesiology,
University of Munich, Germany. Their average
qualification is at least equal to a third year resident in the field of
anaesthesiology and specialised pain medicine. They
contribute to all medical duties.
The acupuncturists are physicians at the Multidisciplinary
Pain Centre, Department of Anaesthesiology, University of
Munich, Germany, who have passed more than 360 hours
of curricular teaching in TCM and acupuncture and who
routinely use acupuncture in daily clinical practice.
All standardised medication will be permitted according to
the perioperative anaesthetic guideline and to the standard
perioperative pain guideline, Department of Anaesthesiology,
University of Munich, both based on general
recommendations and guidelines of the German Society for
Anaesthesiology (DGAI). In particular:
opioids and propofol for intraoperative anaesthesia will
be administered by Target Control Infusion (TCI)
according to the standard protocol. TCI is a software based on
pharmacokinetic models according to Schnider, used in
the Fresenius-Kabi Orchestra Base Primea syringe pumps
(Fresenius Kabi Group, Bad Homburg, Germany). It
requires age, gender, height and total body weight as input
for programming. The software calculates the lean body
mass for the patient and determines doses and infusion
rates accordingly to achieve the necessary drug
concentrations at the effect site (brain). The aspired effect-site
concentrations are reported in Table 1.
To avoid postoperative pain all patients receive metamizol
2.5 g iv-infusions and to prevent PONV they receive
dexamethasone 8 mg iv and for prevention of gastric stress ulcer
they receive ranitidine 50 mg iv during surgery.
Postoperatively, subjects are treated for pain with
metamizol (4 1.25 g/day) and the opioid piritramide (PCA; 2 mg
each 10 minutes; maximum dosage 30 mg/4 hours). In
case of nausea and vomiting or shivering, patients are
treated according to the clinical standard.
Variations of this guideline based regimen are allowed if
medically indicated. All concomitant therapies or
medication are documented in the subjects clinical record file.
Patients in the acupuncture and the acupressure group
will receive a standardised treatment with either 12 press
needles (sharp tip) or 12 press plasters (blunt knob) at 7
acupuncture points (Du 26 and Ren 17 (on the middle
body line), and bilateral LI 4, HE 7, LV 3, ST 36 and PC 6;
Table 1 Estimated effect-site concentrations
Induction of anaesthesia
Maintenance of anaesthesia
0.12 to 0.22 ng/ml
The effect-site concentrations are targeted during induction and maintenance
of anaesthesia and form part of the standardised anaesthetic procedure
see Figure 2). The needles have been provided by the
SEIRIN Corporation, Shizuoka City, Japan. The point
regimen is based on inquiring national experts. Application of
the press needles or press plaster is performed and
documented by a licensed medical acupuncturist 12 to 24 hours
prior to surgery. Application time is supposed to be 72 to
96 hours. Modification will be allowed, in particular less
points according to the patients reaction during treatment.
The patient will be instructed to press the needles or
plasters as often as they like, especially when they are
suffering from anxiety, pain or nausea and vomiting.
Patients are given an illustrated summary of the
acupuncture points with the respective key symptoms, for
memorization (see Figure 2). Stimulation of the press
needles or press plasters has to be done at least three
times a day, each time at a minimum of four different
points, each for about 30 seconds. If the patient is not
able to perform the daily manipulation by herself, the
trial physicians are required to manipulate instead. During
emergence, that is starting with the end of anaesthetic drug
administration, the trial team or the anaesthetist is required
to stimulate at acupuncture point Du 26.
Patients allocated to the control group will undergo
the standard anaesthetic procedure only.
Main outcome measure:
Time from extubation to ready for discharge from the
PACU is defined as the latest time necessary to achieve the
minimum score allowing for discharge score as assessed in
three independent recovery scores. The used scores include
the Aldrete score , the Post Anaesthetic Discharge
Scoring System PADSS;  and the modified In-House
score for outpatients of the Department of Anaesthesiology,
University of Munich (for comparison see Table 2). All
scores consist of five items regarding different postoperative
physiologic states of the patient, which are graded from 0
to 2 (see Table 2). A summated score of 9 to 10 indicates
that the patient is ready for discharge. The In-House score
includes three additional yes-no questions assessing
orientation, input and output which have to be answered
with yes, too. If all scores are fulfilled the patient is graded
as ready for discharge.
Secondary outcome measure:
In the pre- the intra- and the postoperative period
(in PACU and at the ward) additional outcomes will be
assessed (Figure 1).
Figure 2 Acupuncture points hand out. The figure illustrates the seven acupuncture points as being distributed to the patients. The listed
symptoms indicate the key indications for the respective points. The chart is handed out to the patients in the acupuncture (ACU) and
acupressure (APU) groups, the given indications are thought as reminder for the patients of the possible treatment effects to be expected when
self-palpating the respective points. Du 26 has to be pressed by the attending anaesthetist during emergence.
Vital signs (heart rate and blood pressure) at
Pain intensity at rest at baseline
Laboratory parameters according to the surgical
preoperative standard at baseline
Intraoperative drug consumption (analgesics,
TCI effect-site concentrations
Vital signs (heart rate and blood pressure)
Bispectral Index (BIS) monitoring (recording
starts prior to induction of anaesthesia)
Organisational time points (for example,
incision to closure time; intubation to
extubation time, and so on)
During emergence, the time point when
stopping the TCI device, time to recovery of
spontaneous breathing and time to extubation,
time to eye opening, time to squeezing of the
anaesthesiologists hand on command and
orientation to time and place will be recorded if
About 15 minutes before the end of surgery,
analgesia applied through the TCI pumps will
be reduced (expected emergence 15 minutes)
YES, Pain and PONV are
both individually assessed
Table 2 Recovery scores in the post anaesthesia care unit
Sub-items (0 to 2 points)
4 extremities, 2 extremities, 0 extremities
Deep breath, Dyspnoea, Apnoea
BP 20 mm/20% to baseline, BP 20 to 50 mm/20 to 40%
to baseline, BP 50 mm/40% to baseline
Awake, Arousal on calling, Not responding
Oriented and steady gait, Oriented or steady gait, Neither
Minimal, Moderate, Severe
Score considered for discharge from PACU
Minimal, Moderate, Severe
Oral fluids and voided, Oral fluids or voided, Neither
By itself, no nausea, With assistance only, Not possible, Nausea
YES indicates that the item forms part of the questionnaire. Each item consists of three sub-items which are rated with 0 to 2 points with 2 points reflecting the normal
physiologic state. aconcerns three items of the In-House score which can only be answered as yes or no. All scores have to be 9 or greater for patients being
considered ready for discharge. In case of the In-House score, the three yes-no questions have to be answered with yes. PADSS: Post Anaesthetic Discharge Scoring System.
Sample size calculation
No sample size calculation could be established because
at the time of designing the trial there were no parameters
available from prior studies. However, we estimated the
sample size on the basis of an a priori analysis using
G*Power (Version 3.1.3, University of Dsseldorf, Germany,
see Table 3). We conservatively anticipated the effect size
of the tested intervention to be small to medium (d = 0.4,
according to Jacob Cohen ), which results in a sample
size of 66 patients for three study groups. A further
adjustment for non-parametric testing and drop outs by
15% results in a total sample size of 75 patients.
The aim of the statistical analysis is the comparison of
the main outcome measure (period from extubation to
ready for discharge from PACU) between the three
study groups (intervention groups acupuncture and
acupressure and no treatment control). For this
variable, an non-normal distribution is assumed. Hence, a
nonparametric method, the Kruskal-Wallis test will be
applied. Post hoc tests will be performed by pairwise
comparisons of the three study groups by the Mann-Whitney
U-test and subsequent Bonferroni adjustment for multiple
comparison (P-value times three). Primary outcome is
defined as the time to discharge from PACU in the press
needle acupuncture group in comparison to the no
For the secondary target variables, a method according
to the distribution of data will be performed. For metric
variables, the structure of a normal distribution will be
tested by the Kolmogorov-Smirnov test. In case of a normal
Table 3 Sample size calculation
ANOVA: Fixed effects, omnibus, one-way
A priori: Compute required sample size
A priori analysis as calculated and exported by G*Power (Version 3.1.3, University of
Dsseldorf, Germany), anticipating a small to medium effect size f = 0.4, the
-error = 0.05 and the power = 0.8.
distribution, a one-way ANOVA will be calculated.
Otherwise a nonparametric test for independent observations like
the Kruskal-Wallis test will be carried out.
The analysis of categorical data is conducted by the
chi-square goodness-of-fit test. The binary case is treated
by the chi-square-test of independence.
Data analysis will be performed with the SPSS statistical
software system, version 15.0 (SPSS Inc., Chicago, IL, USA)
and with SAS/STAT Software (SAS Institute Inc., Cary,
NC, USA). All data entry will be carried out twice.
The AcuARP trial investigates the effectiveness of
acupuncture on post anaesthetic recovery and its use as an
adjunct therapy to improve patients recovery in the whole
Inclusion and exclusion criteria were held pragmatic
in order to facilitate screening and recruitment. The
chosen trial population is homogeneous and the
operations undertaken are common; hence a maximised and
improved routine care would be of general interest.
Limitations include the restricted sample size as the
trial was planned as a pilot study. In case of a positive
study outcome, further confirmatory studies will be needed.
In addition, a standardised clinical procurement, using
strictly standardised anaesthesia and standardised
acupuncture regimen may impede generalizability of the findings.
Acupressure as a control procedure
The investigators have chosen acupressure as a control
procedure in this trial as it provides the possibility of
blinding both patients and examiners. Successful
patient blinding using the press needle/plaster device has
been proven by Miyazaki et al. . Examiners will be
blinded too, since they do not know if a sharp needle
(acupuncture) or a blunt knob (acupressure) is located
below the plaster .
This special trial design will allow us to assess different
needle-specific treatment effects : on the one hand,
using a needle tip, acupuncture will be performed by
penetrating the skin causing specific physiologic effects.
Those may be distinguished from similar physiologic
effects caused by acupressure, on the other hand, which
can also be a strong stimulus by touching and kneading
the skin, but without penetration. Emotional, hormonal
and affiliative responses to touch have already been
assured . By comparing acupuncture to acupressure,
this trial will provide important evidence not only about
the importance of the needle stimulus of acupuncture
but also about whether acupressure might also bring
about a therapeutic benefit in the perioperative setting.
This in particular seems to be of interest when taking
into account patient populations that are at higher risk
of suffering from side effects from local bleeding.
The use of press needles was also chosen for other
reasons. Perioperative treatment has to be practicable,
applicable, safe and scientifically approved. The
practicability will be given, as press needles have only to be
fixed once: for this trial after inclusion, feasible in daily
routine along with the anaesthesiologic consent. The
chosen acupuncture sites are not within the surgical
area. Patients can easily access the needles and press
them if necessary. Press plasters are water resistant and
sustain up to one week. The safety of acupuncture has
been described in depth, suggesting that acupuncture
is free of severe side effects and being considered a safe
intervention . Blunt rather than sharp knobs are
even less traumatic. There is a small number of trials
dealing with the safety of press needles; one long-term
observation over one year in cancer patients suggests a
ratio of 10% of minor side effects, mostly rashes .
Furthermore, press needles are short (1.7 mm) and
needling sites are located in a safe distance from inner organs.
Thus, severe adverse events such as pneumothorax or
injury of inner organs are avoided. The scientific proof was
previously subject to other trials, suggesting that it is worth
using acupuncture in the perioperative setting [14,15].
We have chosen to apply acupuncture or acupressure as
interventions in a three-armed double blinded randomised
First, acupuncture in its philosophic meaning is not
primarily supposed to cure illness - the underlying idea
is that acupuncture may harmonise Qi, which is a Chinese
concept of vitality or energy, and other tensions of the
human body which can lead to feelings of pleasantness,
and the alleviation of respective symptoms . Several
trials have shown its use different settings, for example
in pain at obstetric delivery , chronic pain conditions
, nausea and vomiting , seasonal allergic rhinitis
, dysmenorrhoea , and so on. Hence acupuncture
is known to alleviate primary symptoms.
Second, previous trials showed that single acupuncture
points exist which are sensitive to alleviate specific
symptoms relevant to the perioperative period, such as
pericardium 6 (PC 6) in the treatment of postoperative nausea and
vomiting . Other reports suggest Governing Vessel 26
(Du 26) may be successful in shock resuscitation  or the
area between Large intestine 8 and 10 (LI 8 and LI 10) in
acute tonsillitis and pharyngitis . Acupressure at Stomach
36 (ST 36) was able to shorten the time to first flatus
passage, oral liquid intake, and improve gastrointestinal
function in patients after abdominal surgery .
Third, several trials could already demonstrate its
effectiveness in reducing preoperative anxiety , the
amount of anaesthetic medications  or
postoperative pain . Most of these trials have been performed
using ear acupuncture and only a minority using
All these key facts regarding acupuncture taken together
suggest that it may be a useful adjunct in the perioperative
period. Thus, our aim was to develop an effective and easily
applicable acupuncture regimen for the complementary
support of post anaesthetic recovery. Emphasis should
focus on applicability, which is to reduce the number of
needling events: therefore we choose the use of press
needles in this trial, providing availability of the treatment
for the patients during the whole perioperative period.
Regarding an effective acupuncture, we have chosen
acupuncture points which are supposed to alleviate
perioperative symptoms. The decision has been made on the
basis of a consensus process taking historic transmission
but also scientific knowledge into account.
The choice of a strictly standardised anaesthetic regimen
allows for comparability of all intra- and postoperative
measures. The decision to conduct the study within the
gynaecologic theatre was on the one hand due to the
above mentioned uniform study population, on the other
hand driven by the fact that the anaesthetic regimen in
this clinic is extended for the use of TCI. TCI systems
for dosage of propofol have been available since 1997,
were initially developed for adult patients, with the
dosage based on the basis of simulated concentration of the
drug in the plasma for review: . In the following,
taking into account the rate at which the drug enters
the biophase of other tissues, that is the brain, the systems
were adjusted to the concentration in the so-called effector
sites. Today, the systems give the possibility to programme
the dosage of various intravenous drugs according to
different pharmacokinetic models, which, in brief, differ on the
basis of research conducted to assess the suggested rates of
infusion. The two systems mainly used are the
pharmacokinetic models for propofol as established by Marsh  and
Schnider . The Marsh model operates with fixed rate
constants, whereas compartment volumes and clearances
are weight proportional. The Schnider model was
developed during combined pharmacokinetic-pharmacodynamic
modelling studies, adjusting according to total weight, lean
body mass, and height. It is recommended for the use in
effect-site targeting mode for review: .
The time course of plasma/effect-site equilibration is
used to describe the rate of removal of drug from the
effect-site out of the body. With effect-site targeting,
the TCI system manipulates the plasma concentration
to achieve the effect-site concentration as rapidly as
possible. When the effect-site target concentration is
increased, the TCI system briefly increases the plasma
concentration to an optimal level above the target
effectsite concentration before temporarily stopping the infusion
to allow the plasma concentration to decrease to the
level of the target effect-site concentration. If the target
effect-site concentration is reduced, the system stops
the infusion allowing the plasma concentrations to fall,
thereby generating a concentration gradient out of the
effect-site, until the estimated effect-site concentration
has fallen to the new target .
In our believe, the use of TCI is an adequate variable to
monitor and compare intraoperative drug consumption
when the estimated effect site concentrations is defined
a priori, and may therefore be helpful in reducing bias
from individually administered anaesthetic drugs. To our
knowledge, to date, there is no better system which would
improve comparability of different study groups.
This study is a three-armed, partially double blinded,
randomised controlled trial to evaluate the effectiveness
of acupuncture on the post anaesthetic recovery period
as assessed by the time from extubation to ready for
discharge from the PACU. It can be expected to provide
valuable new information on the clinical effectiveness
of acupuncture improving post anaesthetic recovery
parameters, which are a) preoperative anxiety relief,
b) perioperative variables of anaesthesia and narcotic
guidance, c) the occurrence of postoperative pain and
anaesthetic side effects such as PONV or shivering.
The comparison between press needle acupuncture
involving a sharp needle tip and acupressure will provide
important information about a) the physiologic effect
of the needle stimulus compared to pressure and its impact
on relieving perioperative symptoms and b) if both
treatments are useful adjuncts in the routine perioperative care.
The status of the study at the time of first manuscript
submission is ongoing, and we had included 50 patients.
ACU: acupuncture; APU: acupressure; ASA: American Society of
Anaesthesiologists; BIS: Bispectral Index; DGAI: German Society for
Anaesthesiology; PACU: post anaesthesia care unit; PADSS: Post Anaesthetic
Discharge Scoring System; PCA: patient controlled analgesia;
PONV: postoperative nausea and vomiting; STAI: State-Trait Anxiety
Inventory; TCI: Target Controlled Infusion; TCM: Traditional Chinese medicine.
All authors declare that they have no competing interests and did not
receive any honorarium from SEIRIN or other partners. The investigator-initiated
grant received by SEIRIN guarantees independent conceivability of the study
design, its coordination, realisation and independent report of the study results.
JF: conception and design, funding, data collection, manuscript writing and
final approval of the manuscript. PB: conception and design, data collection,
manuscript writing and final approval of the manuscript. CG: design, data
collection, manuscript writing and final approval of the manuscript. TW: data
acquisition, critical revision and final approval of the manuscript. MS:
statistical study design, critical revision and final approval of the manuscript.
TA: data acquisition, critical revision and final approval of the manuscript. TG:
conception and design, critical revision and final approval of the manuscript.
DI: conception and design, financial support, manuscript writing, final
approval of manuscript. All authors read and approved the final manuscript.
Parts of the study constitute the topics of the medical thesis of Caroline
Gurschler. The study has been funded in parts by SEIRIN.
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