Effect of Acupressure on Postoperative Pain After Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

The Effect of Acupressure on Postoperative Pain After Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: A Prospective Three-Arm Randomized Sham-Controlled Clinical Trial

This randomized, sham-controlled clinical trial aims to evaluate the effect of acupressure on postoperative pain following laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

A total of 90 participants will be randomly assigned to one of three groups: standard postoperative care alone (control group), true acupressure plus standard care, or sham acupressure plus standard care. Acupressure will be applied at postoperative hours 1, 4, and 8 using the bilateral P6 (Neiguan), LI4 (Hegu), ST36 (Zusanli), and SP6 (Sanyinjiao) acupoints. The sham group will receive pressure at non-acupuncture points.

The primary outcome is postoperative pain intensity measured using the Visual Analog Scale (VAS). Secondary outcomes include analgesic consumption, postoperative nausea and vomiting, time to mobilization, patient satisfaction, and postoperative complications.

Postoperative pain after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains an important clinical problem despite advances in minimally invasive surgery. Acupressure is a non-invasive complementary therapy that may reduce postoperative pain and improve recovery.

This prospective, randomized, sham-controlled, three-arm clinical trial will enroll 90 adult patients undergoing elective laparoscopic TEP inguinal hernia repair.

Participants will be randomly allocated in a 1:1:1 ratio into:

• Control group: Standard postoperative care only.
• Acupressure group: Standard postoperative care plus bilateral acupressure applied at P6 (Neiguan), LI4 (Hegu), ST36 (Zusanli), and SP6 (Sanyinjiao).
• Sham acupressure group: Standard postoperative care plus pressure applied to non-acupuncture points.

Each intervention will be administered at postoperative hours 1, 4, and 8. Pressure will be applied manually for approximately 3 minutes at each point bilaterally by trained personnel.

Pain intensity will be evaluated using the Visual Analog Scale (VAS) at predetermined postoperative time points. Secondary outcomes include total analgesic consumption, incidence of postoperative nausea and vomiting, time to mobilization, patient satisfaction, and postoperative complications.

The study is designed to determine whether true acupressure provides additional benefit beyond standard care and whether its effects differ from sham acupressure, thereby distinguishing specific therapeutic effects from placebo responses.

Inclusion Criteria:

• Adults aged 18 to 75 years
• Diagnosis of a unilateral primary inguinal hernia
• Scheduled to undergo elective laparoscopic total extraperitoneal (TEP) inguinal hernia repair
• American Society of Anesthesiologists (ASA) physical status I to III without an anticipated need for postoperative intensive care
• Ability to understand the study procedures and provide written informed consent

Exclusion Criteria:

Bilateral inguinal hernia

• Recurrent inguinal hernia
• Strangulated inguinal hernia
• History of open lower abdominal surgery
• Skin infection, wound, or surgical scar at any of the acupressure application sites
• ASA physical status III with an anticipated need for postoperative intensive care
• ASA physical status IV
• Participation in another clinical study within the previous 4 weeks
• Receipt of acupressure or a similar complementary treatment within the previous 4 weeks
• Refusal or inability to provide written informed consent