The effect of auricular acupressure on short-term postoperative pain intensity after cesarean section: A three-arm randomized controlled trial

Abstract

: Pain control after a cesarean section remains a challenge for healthcare professionals and both pharmacological and non-pharmacological treatment methods can be used to reduce this pain. The present study evaluated the effect of auricular acupressure (applied using the finger) combined with routine care on the short-term pain severity compared to sham acupressure or routine care alone. : A randomized controlled clinical trial with three parallel groups was conducted between April and May 2021. Participants were pregnant women aged 18-35 years, of gestational age 37-40 weeks who underwent cesarean section according to the anesthesia protocol provided in Imam Ali Hospital, Amol, Mazandaran, Iran. Using the balanced blocks randomization method, participants were randomly allocated into three study groups. Participants (N=180) were randomly assigned to either routine care with auricular acupressure (n=60), routine care with sham control (n=61), or routine care only (n=59). The intervention (auricular acupressure) was performed by a trained nurse three times (three, five, and seven hours after surgery) on ear acupoints including Shen Men, Point Zero, Pelvic, abdomen, Endocrine, and Uterus points, in both ears. The primary outcome was pain severity assessed using the Visual Analog Scale (VAS) at eight time points (i.e., before the intervention, and then 15, 30, and 60 minutes after the intervention, and 3, 6, 12, and 24 hours after the intervention). Patients and outcome assessors were blind. : The pain intensity in the three groups was not significantly different until 6 hours after the intervention. The level of pain in the intervention group receiving auricular acupressure was significantly lower than the sham group at 6 hours (MD: -1.06 [95% CI: -1.83; -0.30]), 12 hours (MD: -1.24 [95% CI: -1.96; -0.52]), and 24 hours (MD: -1.21 [95% CI: -1.96; -0.47]) after the intervention. Also, the pain intensity in the intervention group was significantly lower than the control group at 6 hours (MD: -0.80 [95% CI: -1.53; -0.08]), 12 hours (MD: -0.98 [95% CI: -1.67; -0.30]) and 24 hours (MD: -1.00 [95% CI: -1.70; -0.29]) after the intervention. Moreover, no adverse outcomes were observed related to auricular acupressure. : Auricular acupressure might be an effective adjuvant complementary treatment for post-operative cesarean pain in controlling pain and reducing the need for analgesics with no adverse effect. : Registered prospectively in the Iranian Registry of Clinical Trials (Decree code: IRCT20130822014436N1). : Mazandaran University of Medical Sciences.