Efficacy of Acupuncture in Reducing Preoperative Anxiety: A Meta-Analysis

Anxiety preceding surgery is a common and distressing experience that affects approximately 60% to 70% of adult patients. When we feel anxious before an operation, our body reacts in various ways: heart rate may rise, blood pressure may increase, and hormonal changes occur that can interfere with both the surgical procedure and subsequent recovery. These effects of preoperative anxiety can manifest through greater need for analgesics after surgery, slower recovery, higher pain intensity, and even additional treatment costs. Traditionally, physicians use anti-anxiety medications such as benzodiazepines and opioids, along with psychological interventions such as music and patient education about the procedure to reduce this anxiety.

However, these conventional treatments have only moderate efficacy and frequently cause problematic adverse effects, including reduced heart rate, drops in blood pressure, drowsiness, respiratory depression, itching, laryngeal stiffness, postoperative nausea and vomiting, delayed emergence from anesthesia, and even chemical dependence. These problems can significantly prolong patient recovery time and increase treatment costs, creating an urgent need for safer and more effective alternatives.

To address this question, the researchers conducted a rigorous meta-analysis aimed at scientifically evaluating whether acupuncture can be an effective alternative to reduce preoperative anxiety. A meta-analysis is a special type of study that combines and statistically analyzes the results of multiple independent investigations on the same topic, providing more robust evidence than individual studies. The authors performed a comprehensive search across four major international medical databases, looking for all randomized controlled trials published through February 2014 that compared acupuncture with control treatments in patients scheduled for surgery. Only high-quality studies were included that used rigorous randomization and control methods, in which some patients received real acupuncture and others received sham acupuncture or no treatment.

The methodology was carefully planned according to international guidelines for systematic reviews, ensuring that the results were reliable and scientifically valid.

After careful selection, 14 high-quality studies were included involving a total of 1,034 participants. Of these, 439 patients received acupuncture treatment and 595 served as controls. The studies analyzed different types of surgery, from minor procedures to major operations, including orthopedic, gynecologic, urologic, ophthalmologic, and even dental procedures. Acupuncture sessions lasted between 10 and 30 minutes and were performed on the day of surgery itself, generally in surgical center waiting rooms.

The researchers used both traditional acupuncture needles and acupressure techniques with small spheres or beads applied at specific points. The most commonly used points included the "third eye" (located between the eyebrows) and auricular points related to relaxation. To measure patient anxiety, the studies used scientifically validated scales such as the State-Trait Anxiety Inventory and visual analog scales, applied before and after treatment.

The results of the meta-analysis were impressive and consistent. When the researchers analyzed six studies that used the State-Trait Anxiety Inventory, involving 378 participants, they found that patients who received real acupuncture had a significantly greater reduction in anxiety compared with those who received sham acupuncture. The mean difference was 5.63 points on the anxiety scale, with a very high level of statistical confidence. Even more striking results were found when they analyzed eight studies that used visual analog scales, involving 495 participants.

In this group, acupuncture produced a mean reduction of 19.23 points on the anxiety scale compared with control treatments. These numbers represent clinically significant improvements, that is, differences that truly make a difference in patients' lived experience. The results were consistent regardless of the type of acupuncture used, whether with traditional needles or acupressure techniques, and also regardless of the location of the points treated, whether on the body or on the ears.

The clinical implications of these findings are substantial for both patients and healthcare professionals. For patients, acupuncture represents a safe and effective therapeutic option that can significantly reduce the distress associated with the preoperative period without the problematic adverse effects of conventional medications. This may result in a less traumatic surgical experience, faster recovery, and possibly less need for postoperative medications. For healthcare professionals, especially anesthesiologists and surgeons, these results offer robust scientific evidence to incorporate acupuncture as part of preoperative care protocols.

The technique is relatively simple to implement, has low cost, and can be easily integrated into existing workflows in hospitals and clinics. In addition, acupuncture may be particularly valuable for patients who have contraindications to traditional anxiolytics or who prefer to avoid medications whenever possible. The studies also showed that acupuncture is very well tolerated by patients, with minimal adverse effects reported.

Despite the encouraging results, the study has some important limitations that should be considered when interpreting the findings. The relatively small number of studies included in the meta-analysis limited the researchers' ability to perform more detailed analyses on which specific factors may influence the efficacy of acupuncture, such as patient age, type of surgery, or specific acupuncture technique used. Some of the individual studies also had small samples, resulting in wide confidence intervals for certain results, which makes it difficult to draw definitive conclusions. In addition, there was heterogeneity among the studies regarding the acupuncture protocols used, specific points treated, and session duration, making it difficult to determine which approach may be most effective.

The researchers also acknowledge that not all studies were able to implement ideal blinding strategies, since it is difficult to fully mask whether a patient is receiving real or sham acupuncture.

In summary, this meta-analysis provides compelling scientific evidence that acupuncture can be a valuable tool for reducing preoperative anxiety, offering patients and healthcare professionals a safe and effective alternative to conventional treatments. Although more studies with larger samples and more standardized protocols are needed to fully consolidate these findings, the current results are sufficiently robust to support consideration of acupuncture as an integral part of preoperative care.