Supportive Analgesic Effect of Auricular Acupressure (AA) After Cesarean Section (CS)

Participants are instructed to apply pressure to the patches three times daily (morning, noon, and evening). Supplemental acupressure is also performed whenever the participant feels pain, with the goal of achieving the 'De-qi' sensation (a feeling of soreness or tingling). All patches are maintained for 48 hours. Postoperative analgesia follows a standardized hospital protocol, with diclofenac administered as rescue medication.

Safety monitoring is strictly implemented throughout the study. If participants experience symptoms such as headache, dizziness, or syncope following the application of auricular patches, they will be managed according to standardized acupuncture safety protocols. Participants will be withdrawn from the study if they develop adverse reactions, including local allergic reactions at the patch site, persistent local pain, or severe dizziness.

• Auricular Acupressure (Other), also known as Auricular Acupuncture, Acupuncture: In the Auricular Acupressure group, participants received auricular acupressure using vaccaria seeds applied to the following points on both ears: Ear Shenmen (TF4), Lung (CO14), Internal Genitalia (TF2), Pelvis (TF5), Subcortex (AT4), and Sympathetic (AH6), in addition to standard postoperative care. Each participant received a single treatment session within 5 hours after cesarean section, once transferred to the Obstetrics Department. Seeds were retained for 2 days. All acupuncture procedures were performed by licensed traditional medicine physicians who had been trained and standardized before the study.
• Sham Auricular Acupressure Group (Other), also known as Sham Acupuncture, Sham Auricular Acupuncture: In the Sham Auricular Acupressure Group, participants received adhesive patches without seeds, identical in size and appearance to the Auricular Acupressure Group patches, applied to the same auricular points. Both groups received standard postoperative care.

Primary outcomes

• Pain relief effectiveness was assessed using the Visual Analog Scale (VAS) for pain intensity at rest, during movement and for uterine contractions at 12, 24, and 48 hours after cesarean section. [12, 24, 48 hours postoperative]: Pain relief effectiveness was assessed using the Visual Analog Scale (VAS) for pain intensity at rest, during movement and for uterine contractions at 12, 24, and 48 hours after cesarean section. The Visual Analog Scale (VAS) consists of a line where respondents are asked to mark their level of pain. The left-most point (zero) represents no pain and the right-most point (10) represents extreme pain. The higher the score, the more severe the pain.
• VAS scores for pain intensity at rest, pain intensity on movement, and uterine contraction pain [From enrollment to the end of treatment at 48 hours]: Pain relief effectiveness was assessed using the Visual Analog Scale (VAS) for pain intensity at rest, during movement and for uterine contractions at 12, 24, and 48 hours after cesarean section. The Visual Analog Scale (VAS) consists of a line where respondents are asked to mark their level of pain. The left-most point (0) represents 'no pain,' while the right-most point (10) represents 'extreme pain.' The higher the score, the more severe the pain.

Sex: Female, ages: 18 Years to 40 Years

Inclusion Criteria:

* 18-40 years of age
* Gestational age ≥ 37 weeks
* Alert and cooperative with the treating physicians
* Able to understand and use the Visual Analog Scale (VAS)
* Preoperative American Society of Anesthesiologists (ASA) Physical Status Classification System I-II
* Anesthesia: spinal anesthesia;
* Pfannenstiel suprapubic transverse incision
* Infant 5-minute Appearance, Pulse, Grimace, Activity, Respiration score (Apgar score) > 7
* Cesarean operative time ≤ 60 minutes
* Singleton pregnancy
* Voluntary agreement to participate.

Exclusion Criteria:

* Contraindication to diclofenac
* Surgical complications, including hysterectomy and postpartum hemorrhage (> 1000 ml)
* History of acupuncture syncope
* Preoperative chronic pain and/or regular preoperative use of analgesics
* Addiction to or dependence on opioids or alcohol
* Diabetes mellitus or HIV infection
* Prior Auricular acupressure
* Skin lesions of the auricle
* Surgical wound infection

• Ly, PhD, Study chair, University of Medicine and Pharmacy at Ho Chi Minh City