This randomized controlled trial investigates the effect of electroacupuncture as an adjunct to local anesthesia on perioperative pain and stress during ambulatory surgical extraction of impacted lower third molars. Participants will be randomized into three groups: electroacupuncture, sham acupuncture, and control. Pain intensity and perceived stress will be assessed using validated scales, while biological stress and nociceptive markers (salivary cortisol, alpha-amylase, and substance P), as well as hemodynamic parameters (blood pressure and heart rate), will be measured. The study aims to provide an integrated evaluation of the effects of electroacupuncture on subjective, biological, and physiological indicators of perioperative response in oral surgery.

Perioperative pain and stress during surgical extraction of impacted lower third molars remain clinically relevant despite the use of local anesthesia. Psychological factors such as dental anxiety and physiological stress responses contribute to variability in pain perception and perioperative outcomes. Electroacupuncture has been proposed as a non-pharmacological adjunct that may modulate both nociceptive and stress-related pathways through neurohumoral mechanisms, including endogenous opioid release and autonomic regulation.

This prospective randomized controlled trial is designed to evaluate the effect of electroacupuncture as an adjunct to local anesthesia on perioperative response in patients undergoing ambulatory surgical extraction of impacted lower third molars. The study incorporates a three-arm parallel design, including electroacupuncture, sham acupuncture, and standard care without acupuncture, allowing differentiation between specific and non-specific effects of the intervention.

An integrated assessment approach will be used to capture multiple dimensions of the perioperative response, including subjective, biological, and physiological components. This design enables a comprehensive evaluation of the interaction between stress, autonomic activation, and nociceptive processing in a standardized oral surgery model. The findings are expected to contribute to the understanding of the clinical value of electroacupuncture as an adjunctive modality in perioperative care.

Inclusion Criteria:

• Adults aged 25-35 years
• ASA physical status I-II
• Indication for ambulatory surgical extraction of an impacted lower third molar
• Ability to understand the study procedures and provide written informed consent
• Willingness to comply with study procedures, including saliva sampling protocol
• Ability to abstain from food, beverages, and oral hygiene procedures for at least 1 hour prior to saliva sampling

Exclusion Criteria:

• Pregnancy
• Epilepsy
• Presence of a pacemaker or other active electronic implant
• Coagulation disorders
• Active infection at the site of acupuncture
• Systemic inflammatory diseases
• Oral inflammatory conditions (e.g., gingivitis or periodontitis)
• Hyposalivation
• Chronic opioid use
• Psychiatric conditions that may affect pain or stress assessment
• Use of nonsteroidal anti-inflammatory drugs, corticosteroids, or antibiotics within 7 days prior to the procedure
• Menstruation at the time of saliva sampling
• Inability or unwillingness to comply with study procedures

Individual participant data will not be shared due to privacy considerations and the absence of a predefined data-sharing plan within this investigator-initiated study. Data will be reported in aggregate form in scientific publications.

Participants will be blinded to group assignment through the use of a sham acupuncture procedure that mimics the active intervention without therapeutic effect. Outcome assessment will be performed using standardized measures, and laboratory analyses will be conducted on coded samples without knowledge of group allocation.