Acupuncture reduces sedative and anaesthetic consumption and improves pain tolerance in patients undergoing colonoscopy: a Meta-analysis

doi:10.19852/j.cnki.jtcm.20240926.001

Abstract

Abstract:

OBJECTIVE: To evaluate the effects of acupuncture anesthesia on the consumption of sedatives and anesthetics, pain, and time consumption in patients undergoing colonoscopy, thus providing evidence that acupuncture anesthesia should be extended to endoscopists and anesthetists.

METHODS: Four English and four Chinese databases were searched for randomised controlled trials of acupuncture anaesthesia in patients undergoing colonoscopy, published from database inception to 1 March 2023. Outcomes were consumption of sedatives and anaesthetics, pain tolerance, visual analog scale (VAS) score, the meantime consumption of examination, satisfaction, and adverse reactions.

RESULTS: Thirty-one randomized controlled trials with a total of 4790 participants were included. Results showed that acupuncture anaesthesia significantly reduced consumption of sedatives and anaesthetics [9 studies, n = 944, standardized mean difference (SMD) = －0.82, 95% CI (－1.31, －0.33), P = 0.001], VAS score [9 studies, n = 1790, mean difference (MD) = －1.13, 95% CI (－1.70, －0.57), P < 0.001], meantime consumption [21 studies, n = 3799, MD = －2.09, 95% CI (－3.15, －1.03), P<0.001] and adverse reactions of colonoscopy [7 studies, n = 738, odds ratio (OR) = 0.17, 95% CI (0.10, 0.28), P<0.001]. Acupuncture also significantly improved pain tolerance [14 studies, n = 1661, OR = 7.05, 95% CI (3.79, 13.12), P<0.001], while no beneficial effects were found for satisfaction [7 studies, n = 843, SMD = 0.02, 95% CI (－0.38, 0.43), P = 0.91].

CONCLUSION: Acupuncture has beneficial effects on patients undergoing colonoscopy, particularly in reducing consumption of sedatives and anaesthetics, alleviating pain, shortening the time consumption of examination and preventing adverse events. As an alternative, effective, inexpensive, and accessible approach, acupuncture anaesthesia should be extended to endoscopists and anaesthesiologists.

Key words: acupuncture anesthesia, pain, colonoscopy, Meta-analysis

WANG Bingyu, JIN Fangfang, GAO Jiawei, YANG Liuxin, ZHANG Yali, YUAN Xingxing, ZHANG Yang. Acupuncture reduces sedative and anaesthetic consumption and improves pain tolerance in patients undergoing colonoscopy: a Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2024, 44(6): 1091-1103.

Figures/Tables 6

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Study ID	Country	Sample size (M/F)	Age (years)	Study group (n)	Intervention group	Control group	Outcome
Li CK et al 1991²⁶	Germany	36 (18/18)	50/55/47	Intervention (12)	Acupuncture before and during colonoscopy	Sham acupuncture	③④
				Control-1 (12)	Acupoint: LI4, PC6, ST36, SP4, bilaterally	None
				Control-2 (12)
Wang HH et al 1997²⁷	Taiwan, China	59 (34/25)	49/50	Intervention (30)	Electroacupuncture before and during colonoscopy	Meperidine 50 mg	②④⑥
				Control (29)	Acupoint: ST36, ST37, unilaterally
					Aurical acupoint: EP11, bilaterally
Zhang ZH 2000²⁸	China	68 (NR)	NR	Intervention (34)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	⑤
Zhang ZH 2000²⁸	China	68 (NR)	NR	Control (34)	Acupoint: ST36, unilaterally + Atropine 0.15mg	Atropine 0.5 mg	⑤
Zhao DS et al 2001²⁹	China	267 (148/119)	42.7/43.1	Intervention (136)	Acupressure during colonoscopy	None	④
Zhao DS et al 2001²⁹	China	267 (148/119)	42.7/43.1	Control (131)	Acupoint: LI4, unilaterally	None	④
Chen Y et al 2002³⁰	China	82 (50/32)	NR	Intervention (41)	Acupuncture before and during colonoscopy	None	②④
Chen Y et al 2002³⁰	China	82 (50/32)	NR	Control (41)	Acupoint: LI4, PC6, LI10, ST36, unilaterally	None	②④
Fanti L et al 2003³¹	Italy	30 (10/20)	63/60/55	Intervention (10)	Electroacupuncture before and during colonoscopy	Sham acupuncture + Midazolam/	①②④
				Control-1 (10)	Acupoint: LI4, ST36, SP6, SP9, EP11, bilaterally	Midazolam
				Control-2(10)	Midazolam
Mi XL et al 2003³²	China	100 (60/40)	NR	Intervention (50)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	②
				Control (50)	Acupoint: ST36, unilaterally
					Atropine 0.25 mg.
Qin FR et al 2003³³	China	80 (62/18)	NR	Intervention (40)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	⑤
				Control (40)	Acupoint: ST36, unilaterally
					Atropine 0.15 mg.
Yang AL et al 2003³⁴	China	80 (62/18)	NR	Intervention (40)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	⑤
				Control (40)	Acupoint: ST36, unilaterally
					Atropine 0.15 mg
Yang AL et al 2005³⁵	China	200 (142/58)	37.4/38.7	Intervention (100)	Acupressure before and during colonoscopy	None	②④
Yang AL et al 2005³⁵	China	200 (142/58)	37.4/38.7	Control (100)	Acupoint: PC6, ST36, unilaterally	None	②④
Li Q et al 2005³⁶	China	200 (78/122)	38.6/39.1	Intervention (100)	Auricular acupressure	None	②⑥
Li Q et al 2005³⁶	China	200 (78/122)	38.6/39.1	Control (100)	Auricular acupressure	None	②⑥
Du YJ et al 2006³⁷	China	185 (99/86)	42.7/43.2	Intervention (93)	Acupuncture before colonoscopy	None	④
Du YJ et al 2006³⁷	China	185 (99/86)	42.7/43.2	Control (92)	Acupoint: LI4, bilaterally	None	④
Ni YF et al 2007³⁸	China	80 (40/40)	43/45	Intervention (40)	Electroacupuncture before and during colonoscopy	None	④⑥
Ni YF et al 2007³⁸	China	80 (40/40)	43/45	Control (40)	Acupoint: LI4, bilaterally; ST36, ST37, SP9, SP6, unilaterally	None	④⑥
Ni YF et al 2009³⁹	China	60 (29/31)	43.25/45.31	Intervention (30)	Electroacupuncture before and during colonoscopy	Midazolam 0.02 mg/kg	①③④⑥
				Control (30)	Acupoint: LI4, bilaterally; ST36, ST37, SP9, SP6, unilaterally
					Midazolam 0.02 mg/kg
Study ID	Country	Sample size (M/F)	Age (years)	Study group (n)	Intervention group	Control group	Outcome
Lin JL et al 2010⁴⁰	China	100 (43/57)	NR	Intervention (50)	Pharmacoacupuncture before colonoscopy	Tramadol 100 mg Anisodamine 0.5 mg	②④
				Control (50)	Acupoint: SP6, bilaterally,
					Tramadol 100 mg
					Anisodamine 0.5 mg
Xu JH et al 2010⁴¹	China	93 (65/28)	45.21/46.18	Intervention (34)	Auricular acupressure	None	③
Xu JH et al 2010⁴¹	China	93 (65/28)	45.21/46.18	Control (59)	Auricular acupressure	None	③
Lin JX et al 2013⁴²	China	220 (149/71)	37.2/38.4	Intervention (110)	Acupressure before and during colonoscopy	None	②④
Lin JX et al 2013⁴²	China	220 (149/71)	37.2/38.4	Control (110)	Acupoint: LI4, ST36, unilaterally	None	②④
Ng S et al 2013⁴³	Hong Kong, China	128 (64/64)	NR	Intervention (64)	Acupuncture before and during colonoscopy	Sham acupuncture	①③④
				Control (64)	Acupoint: LI4, PC6, ST36, unilaterally	Propofol
					Propofol
Wu CL et al 2016⁴⁴	China	199 (100/99)	51.8/52.1	Intervention (98)	Auricular acupressure	None	③④
Wu CL et al 2016⁴⁴	China	199 (100/99)	51.8/52.1	Control (101)	Auricular acupressure	None	③④
Zhao J et al 2016⁴⁵	China	72 (39/33)	51/52	Intervention (36)	Acupuncture before and during colonoscopy	None	②④
Zhao J et al 2016⁴⁵	China	72 (39/33)	51/52	Control (36)	Acupoint: ST36, unilaterally	None	②④
Guo HY et al 2017⁴⁶	China	140 (86/54)	42.6/43.1	Intervention (70)	Pharmacoacupuncture before colonoscopy	Anisodamine 10 mg	④
				Control (70)	Acupoint: ST36, bilaterally
					Anisodamine 10 mg
					Acupressure during colonoscopy
					Acupoint: PC6
Liang H	China	1310 (687/623)	43.4/40.3/42.6	Intervention (455)	Auricular acupressure		③④
201747				Control-1 (407)		Propofol
				Control-2 (448)
Luo YY et al 2018⁴⁸	China	120 (69/51)	43.8/44.0	Intervention (60)	Acupuncture before colonoscopy	Propofol 1-2 mg/kg	①②⑤
Luo YY et al 2018⁴⁸	China	120 (69/51)	43.8/44.0	Control (60)	Acupoint: LI4, PC6, ST36	Propofol 1-2 mg/kg	①②⑤
Luo YY et al 2019⁴⁹	China	80 (42/38)	48.5/48.8	Intervention (40)	Acupuncture before colonoscopy	Propofol 1-2 mg/kg	①④⑤⑥
				Control (40)	Acupoint: LI4, PC6, LI10, Ashi, ST36, unilaterally
					Propofol 1-2 mg/kg
Eberl S et al 2020⁵⁰	Netherlands	153 (60/93)	62/65/63	Intervention (51)	Electroacupuncture before and during colonoscopy	Sham acupuncture Placebo-acupuncture Propofol/Alfentanil	①③④
				Control-1 (51)	Acupoint: ST36, PC6, LI4, unilaterally
				Control-2 (51)	Propofol/Alfentanil
Zheng XY et al 2020⁵¹	China	160 (87/73)	62.38/62.34	Intervention (80)	Acupuncture before and during colonoscopy	None	②④
Zheng XY et al 2020⁵¹	China	160 (87/73)	62.38/62.34	Control (80)	Acupoint: LI10, ST36, PC6, bilaterally, LI4, unilaterally	None	②④
Study ID	Country	Sample size (M/F)	Age (years)	Study group (n)	Intervention group	Control group	Outcome
Chen Y et al 2021⁵³	China	32 (21/11)	71.3/71.6	Intervention (16)	Transcutaneous electrical acupuncture point stimulation before colonoscopy	Sham transcutaneous electrical acupuncture point stimulation	①
				Control (16)	Acupoint: PC6, bilaterally	fentanyl 50 μg
					fentanyl 50 μg	Propofol 1.5-2.5 mg/kg
					Propofol 1.5-2.5 mg/kg
Joan Gan CY et al 2021⁵⁴	Malaysia	37 (20/17)	65/61	Intervention (19)	Transcutaneous electrical acupuncture point stimulation during colonoscopy	Sham transcutaneous electrical acupuncture point stimulation	③④
Joan Gan CY et al 2021⁵⁴	Malaysia	37 (20/17)	65/61	Control (18)	Acupoint: ST36 bilaterally		③④
He T et al 2022⁵⁵	China	181 (86/95)	49.34/49.73	Intervention (91)	Acupuncture before and during colonoscopy	Nabufine 0.025 mg/kg	①③④⑥
				Control (90)	Acupoint: wrist-ankle, unilaterally	Propofol 0.5 mg/kg
					Nabufine 0.025 mg/kg
					Propofol 0.5 mg/kg
Li Y et al 2023⁵⁶	China	78 (51/27)	67.01/67.63	Intervention (39)	Acupuncture before and during colonoscopy	Propofol 1 mg/kg	②⑤⑥
				Control (39)	Acupoint: ST36, PC6, LI4, bilaterally
					Propofol 1 mg/kg
					Fentanyl 5 μg/kg

Study ID	Country	Sample size (M/F)	Age (years)	Study group (n)	Intervention group	Control group	Outcome
Li CK et al 1991²⁶	Germany	36 (18/18)	50/55/47	Intervention (12)	Acupuncture before and during colonoscopy	Sham acupuncture	③④
				Control-1 (12)	Acupoint: LI4, PC6, ST36, SP4, bilaterally	None
				Control-2 (12)
Wang HH et al 1997²⁷	Taiwan, China	59 (34/25)	49/50	Intervention (30)	Electroacupuncture before and during colonoscopy	Meperidine 50 mg	②④⑥
				Control (29)	Acupoint: ST36, ST37, unilaterally
					Aurical acupoint: EP11, bilaterally
Zhang ZH 2000²⁸	China	68 (NR)	NR	Intervention (34)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	⑤
Zhang ZH 2000²⁸	China	68 (NR)	NR	Control (34)	Acupoint: ST36, unilaterally + Atropine 0.15mg	Atropine 0.5 mg	⑤
Zhao DS et al 2001²⁹	China	267 (148/119)	42.7/43.1	Intervention (136)	Acupressure during colonoscopy	None	④
Zhao DS et al 2001²⁹	China	267 (148/119)	42.7/43.1	Control (131)	Acupoint: LI4, unilaterally	None	④
Chen Y et al 2002³⁰	China	82 (50/32)	NR	Intervention (41)	Acupuncture before and during colonoscopy	None	②④
Chen Y et al 2002³⁰	China	82 (50/32)	NR	Control (41)	Acupoint: LI4, PC6, LI10, ST36, unilaterally	None	②④
Fanti L et al 2003³¹	Italy	30 (10/20)	63/60/55	Intervention (10)	Electroacupuncture before and during colonoscopy	Sham acupuncture + Midazolam/	①②④
				Control-1 (10)	Acupoint: LI4, ST36, SP6, SP9, EP11, bilaterally	Midazolam
				Control-2(10)	Midazolam
Mi XL et al 2003³²	China	100 (60/40)	NR	Intervention (50)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	②
				Control (50)	Acupoint: ST36, unilaterally
					Atropine 0.25 mg.
Qin FR et al 2003³³	China	80 (62/18)	NR	Intervention (40)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	⑤
				Control (40)	Acupoint: ST36, unilaterally
					Atropine 0.15 mg.
Yang AL et al 2003³⁴	China	80 (62/18)	NR	Intervention (40)	Pharmacoacupuncture before colonoscopy	Atropine 0.5 mg	⑤
				Control (40)	Acupoint: ST36, unilaterally
					Atropine 0.15 mg
Yang AL et al 2005³⁵	China	200 (142/58)	37.4/38.7	Intervention (100)	Acupressure before and during colonoscopy	None	②④
Yang AL et al 2005³⁵	China	200 (142/58)	37.4/38.7	Control (100)	Acupoint: PC6, ST36, unilaterally	None	②④
Li Q et al 2005³⁶	China	200 (78/122)	38.6/39.1	Intervention (100)	Auricular acupressure	None	②⑥
Li Q et al 2005³⁶	China	200 (78/122)	38.6/39.1	Control (100)	Auricular acupressure	None	②⑥
Du YJ et al 2006³⁷	China	185 (99/86)	42.7/43.2	Intervention (93)	Acupuncture before colonoscopy	None	④
Du YJ et al 2006³⁷	China	185 (99/86)	42.7/43.2	Control (92)	Acupoint: LI4, bilaterally	None	④
Ni YF et al 2007³⁸	China	80 (40/40)	43/45	Intervention (40)	Electroacupuncture before and during colonoscopy	None	④⑥
Ni YF et al 2007³⁸	China	80 (40/40)	43/45	Control (40)	Acupoint: LI4, bilaterally; ST36, ST37, SP9, SP6, unilaterally	None	④⑥
Ni YF et al 2009³⁹	China	60 (29/31)	43.25/45.31	Intervention (30)	Electroacupuncture before and during colonoscopy	Midazolam 0.02 mg/kg	①③④⑥
				Control (30)	Acupoint: LI4, bilaterally; ST36, ST37, SP9, SP6, unilaterally
					Midazolam 0.02 mg/kg
Study ID	Country	Sample size (M/F)	Age (years)	Study group (n)	Intervention group	Control group	Outcome
Lin JL et al 2010⁴⁰	China	100 (43/57)	NR	Intervention (50)	Pharmacoacupuncture before colonoscopy	Tramadol 100 mg Anisodamine 0.5 mg	②④
				Control (50)	Acupoint: SP6, bilaterally,
					Tramadol 100 mg
					Anisodamine 0.5 mg
Xu JH et al 2010⁴¹	China	93 (65/28)	45.21/46.18	Intervention (34)	Auricular acupressure	None	③
Xu JH et al 2010⁴¹	China	93 (65/28)	45.21/46.18	Control (59)	Auricular acupressure	None	③
Lin JX et al 2013⁴²	China	220 (149/71)	37.2/38.4	Intervention (110)	Acupressure before and during colonoscopy	None	②④
Lin JX et al 2013⁴²	China	220 (149/71)	37.2/38.4	Control (110)	Acupoint: LI4, ST36, unilaterally	None	②④
Ng S et al 2013⁴³	Hong Kong, China	128 (64/64)	NR	Intervention (64)	Acupuncture before and during colonoscopy	Sham acupuncture	①③④
				Control (64)	Acupoint: LI4, PC6, ST36, unilaterally	Propofol
					Propofol
Wu CL et al 2016⁴⁴	China	199 (100/99)	51.8/52.1	Intervention (98)	Auricular acupressure	None	③④
Wu CL et al 2016⁴⁴	China	199 (100/99)	51.8/52.1	Control (101)	Auricular acupressure	None	③④
Zhao J et al 2016⁴⁵	China	72 (39/33)	51/52	Intervention (36)	Acupuncture before and during colonoscopy	None	②④
Zhao J et al 2016⁴⁵	China	72 (39/33)	51/52	Control (36)	Acupoint: ST36, unilaterally	None	②④
Guo HY et al 2017⁴⁶	China	140 (86/54)	42.6/43.1	Intervention (70)	Pharmacoacupuncture before colonoscopy	Anisodamine 10 mg	④
				Control (70)	Acupoint: ST36, bilaterally
					Anisodamine 10 mg
					Acupressure during colonoscopy
					Acupoint: PC6
Liang H	China	1310 (687/623)	43.4/40.3/42.6	Intervention (455)	Auricular acupressure		③④
201747				Control-1 (407)		Propofol
				Control-2 (448)
Luo YY et al 2018⁴⁸	China	120 (69/51)	43.8/44.0	Intervention (60)	Acupuncture before colonoscopy	Propofol 1-2 mg/kg	①②⑤
Luo YY et al 2018⁴⁸	China	120 (69/51)	43.8/44.0	Control (60)	Acupoint: LI4, PC6, ST36	Propofol 1-2 mg/kg	①②⑤
Luo YY et al 2019⁴⁹	China	80 (42/38)	48.5/48.8	Intervention (40)	Acupuncture before colonoscopy	Propofol 1-2 mg/kg	①④⑤⑥
				Control (40)	Acupoint: LI4, PC6, LI10, Ashi, ST36, unilaterally
					Propofol 1-2 mg/kg
Eberl S et al 2020⁵⁰	Netherlands	153 (60/93)	62/65/63	Intervention (51)	Electroacupuncture before and during colonoscopy	Sham acupuncture Placebo-acupuncture Propofol/Alfentanil	①③④
				Control-1 (51)	Acupoint: ST36, PC6, LI4, unilaterally
				Control-2 (51)	Propofol/Alfentanil
Zheng XY et al 2020⁵¹	China	160 (87/73)	62.38/62.34	Intervention (80)	Acupuncture before and during colonoscopy	None	②④
Zheng XY et al 2020⁵¹	China	160 (87/73)	62.38/62.34	Control (80)	Acupoint: LI10, ST36, PC6, bilaterally, LI4, unilaterally	None	②④
Study ID	Country	Sample size (M/F)	Age (years)	Study group (n)	Intervention group	Control group	Outcome
Chen Y et al 2021⁵³	China	32 (21/11)	71.3/71.6	Intervention (16)	Transcutaneous electrical acupuncture point stimulation before colonoscopy	Sham transcutaneous electrical acupuncture point stimulation	①
				Control (16)	Acupoint: PC6, bilaterally	fentanyl 50 μg
					fentanyl 50 μg	Propofol 1.5-2.5 mg/kg
					Propofol 1.5-2.5 mg/kg
Joan Gan CY et al 2021⁵⁴	Malaysia	37 (20/17)	65/61	Intervention (19)	Transcutaneous electrical acupuncture point stimulation during colonoscopy	Sham transcutaneous electrical acupuncture point stimulation	③④
Joan Gan CY et al 2021⁵⁴	Malaysia	37 (20/17)	65/61	Control (18)	Acupoint: ST36 bilaterally		③④
He T et al 2022⁵⁵	China	181 (86/95)	49.34/49.73	Intervention (91)	Acupuncture before and during colonoscopy	Nabufine 0.025 mg/kg	①③④⑥
				Control (90)	Acupoint: wrist-ankle, unilaterally	Propofol 0.5 mg/kg
					Nabufine 0.025 mg/kg
					Propofol 0.5 mg/kg
Li Y et al 2023⁵⁶	China	78 (51/27)	67.01/67.63	Intervention (39)	Acupuncture before and during colonoscopy	Propofol 1 mg/kg	②⑤⑥
				Control (39)	Acupoint: ST36, PC6, LI4, bilaterally
					Propofol 1 mg/kg
					Fentanyl 5 μg/kg

Subgroup	Number of studies	Number of participants	Random effect model		Heterogeneity
Subgroup	Number of studies	Number of participants	OR/SMD/MD (95% CI)	P value	I ² value (%)	P value
Consumption of sedatives and anesthetics
Manual acupuncture	^{43,48,49,52,55}	669	－1.37 (－1.93, 0.82)	<0.001	90	<0.001
Electroacupuncture	^31,39,50	243	－0.45 (－0.98, 0.07)	0.09	77	0.002
Transcutaneous electrical acupuncture point stimulation	⁵³	32	0.83 (0.10, 1.55)	0.03	/	/
Pain tolerance
Manual acupuncture	^{30,45,48,51,52,56}	672	4.65 (1.86, 11.64)	0.001	83	<0.001
Electroacupuncture	^27,31	89	5.51 (0.56, 54.51)	0.14	71	0.03
Pharmacoacupuncture	^32,34,40	280	9.33 (4.25, 20.49)	<0.001	16	0.30
Auricular acupressure	³⁶	200	85.09 (28.14, 257.28)	<0.001	/	/
Acupressure	^35,42	420	9.28 (5.78, 14.91)	<0.001	11	0.29
VAS score
Manual acupuncture	^26,43,55	345	－0.71 (－1.35, 0.07)	0.03	95	<0.001
Electroacupuncture	^39,50	213	－0.79 (－1.63, 0.06)	0.07	97	<0.001
Auricular acupressure	^41,44,47	1195	－2.15 (－3.60, 0.69)	0.004	97	<0.001
Transcutaneous electrical acupuncture point stimulation	⁵⁴	37	－1.40 (－4.36, 1.56)	0.35	/	/
Mean time consumption of examination
Manual acupuncture	^{26,30,35,37,43,45,49,51,55}	1124	－3.20 (－5.48, 0.92)	0.006	98	<0.001
Electroacupuncture	^{27,31,38,39,50}	402	－0.10 (－2.62, 2.43)	0.94	75	0.0005
Pharmacoacupuncture	^40,46	240	－3.77 (－4.47, 3.08)	<0.001	0	0.94
Auricular acupressure	^44,47	1509	－1.51 (－4.10, 1.07)	0.25	97	<0.001
Acupressure	^29,42	487	－3.39 (－3.89, 2.89)	<0.001	0	0.59
Transcutaneous electrical acupuncture point stimulation	⁵⁴	37	1.00 (－0.30, 2.30)	0.13	/	/
Satisfaction
Manual acupuncture	⁵⁵	181	0.26 (－0.03, 0.55)	0.08	/	/
Electroacupuncture	^31,38,39,50	323	－0.21 (－0.77, 0.35)	0.47	85	<0.001
Pharmacoacupuncture	⁴⁶	140	0.84 (0.49, 1.18)	<0.001	/	/
Auricular acupressure	⁴⁴	199	0.16 (－0.12, 0.44)	0.27	/	/
Adverse reactions
Manual acupuncture	^49,55,56	339	0.17 (0.10, 0.30)	<0.001	0	0.43
Electroacupuncture	^27,38,39	199	0.15 (0.04, 0.52)	0.003	0	0.86
Auricular acupressure	³⁶	200	0.20 (0.01, 4.14)	0.29	/	/

Subgroup	Number of studies	Number of participants	Random effect model		Heterogeneity
Subgroup	Number of studies	Number of participants	OR/SMD/MD (95% CI)	P value	I ² value (%)	P value
Consumption of sedatives and anesthetics
Manual acupuncture	^{43,48,49,52,55}	669	－1.37 (－1.93, 0.82)	<0.001	90	<0.001
Electroacupuncture	^31,39,50	243	－0.45 (－0.98, 0.07)	0.09	77	0.002
Transcutaneous electrical acupuncture point stimulation	⁵³	32	0.83 (0.10, 1.55)	0.03	/	/
Pain tolerance
Manual acupuncture	^{30,45,48,51,52,56}	672	4.65 (1.86, 11.64)	0.001	83	<0.001
Electroacupuncture	^27,31	89	5.51 (0.56, 54.51)	0.14	71	0.03
Pharmacoacupuncture	^32,34,40	280	9.33 (4.25, 20.49)	<0.001	16	0.30
Auricular acupressure	³⁶	200	85.09 (28.14, 257.28)	<0.001	/	/
Acupressure	^35,42	420	9.28 (5.78, 14.91)	<0.001	11	0.29
VAS score
Manual acupuncture	^26,43,55	345	－0.71 (－1.35, 0.07)	0.03	95	<0.001
Electroacupuncture	^39,50	213	－0.79 (－1.63, 0.06)	0.07	97	<0.001
Auricular acupressure	^41,44,47	1195	－2.15 (－3.60, 0.69)	0.004	97	<0.001
Transcutaneous electrical acupuncture point stimulation	⁵⁴	37	－1.40 (－4.36, 1.56)	0.35	/	/
Mean time consumption of examination
Manual acupuncture	^{26,30,35,37,43,45,49,51,55}	1124	－3.20 (－5.48, 0.92)	0.006	98	<0.001
Electroacupuncture	^{27,31,38,39,50}	402	－0.10 (－2.62, 2.43)	0.94	75	0.0005
Pharmacoacupuncture	^40,46	240	－3.77 (－4.47, 3.08)	<0.001	0	0.94
Auricular acupressure	^44,47	1509	－1.51 (－4.10, 1.07)	0.25	97	<0.001
Acupressure	^29,42	487	－3.39 (－3.89, 2.89)	<0.001	0	0.59
Transcutaneous electrical acupuncture point stimulation	⁵⁴	37	1.00 (－0.30, 2.30)	0.13	/	/
Satisfaction
Manual acupuncture	⁵⁵	181	0.26 (－0.03, 0.55)	0.08	/	/
Electroacupuncture	^31,38,39,50	323	－0.21 (－0.77, 0.35)	0.47	85	<0.001
Pharmacoacupuncture	⁴⁶	140	0.84 (0.49, 1.18)	<0.001	/	/
Auricular acupressure	⁴⁴	199	0.16 (－0.12, 0.44)	0.27	/	/
Adverse reactions
Manual acupuncture	^49,55,56	339	0.17 (0.10, 0.30)	<0.001	0	0.43
Electroacupuncture	^27,38,39	199	0.15 (0.04, 0.52)	0.003	0	0.86
Auricular acupressure	³⁶	200	0.20 (0.01, 4.14)	0.29	/	/

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