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

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.

• Acupressure (Procedure): Bilateral acupressure is applied at P6, LI4, ST36, and SP6 for 3 minutes per point at postoperative 1, 4, and 8 hours.
• Sham Acupressure (Procedure): Manual pressure is applied to non-acupuncture points using the same duration and schedule as the active acupressure intervention.

Primary outcomes

• Postoperative Pain Intensity Assessed by Visual Analog Scale [At postoperative hours 2, 4, 6, 12, and 24]: Postoperative pain intensity will be assessed using a Visual Analog Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. VAS scores will be recorded at postoperative hours 2, 4, 6, 12, and 24 and compared among the study groups.

Secondary outcomes

• Rescue Analgesic Requirement [During the first 24 postoperative hours]: The requirement for rescue analgesic medication and the number of analgesic administrations will be recorded from the patient medication chart and compared among the study groups.
• Incidence of Postoperative Nausea and Vomiting [During the first 24 postoperative hours]: The presence of postoperative nausea and the number of vomiting episodes will be recorded and compared among the study groups.
• Early Postoperative Complications [During the first 24 postoperative hours]: The occurrence and type of early postoperative complications will be recorded and compared among the study groups.
• Rescue Antiemetic Requirement [During the first 24 postoperative hours]: The requirement for rescue antiemetic medication and the number of antiemetic administrations will be recorded from the patient medication chart and compared among the study groups.

Sex: All, ages: 18 Years to 75 Years

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