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Table 1 Study characteristics of all randomized, controlled trials included in the analysis

From: Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice

Study ID

anesthesia type

Surgery type

Number of patients (A/C)

Stimulation style

Points used in the real acupuncture treatment

Sham/control

Duration

time select

Peri-incisional stimulation

 Binder et al. (2011) [23]

EDA

cesarean section

22/20

Hi-TENS

Incision: 2–3 cm distance from the wound

Non treatment

24 h*1 day

Post-surgery:immediately after surgery, at least 24 h/one day

 Bjersa and Andersson(2014) [50]

GA

pancreas resection

9/11

High frequency TENS

Incision:cranial of the incision, sacral of the incision, and columna innervating the dermatome for Th5 to Th9

‘increase stimulation until first sensitivity occurs and keep the stimulation as low as possible

At least 30 min, as much as possible

Post-surgery:two to four hours prior to epidural anlgesia ended

 Smith et al. (1986) [30]

GA

caesarean section

9/9

TENS

Incision:the incision site

No electrical current was applied

3 days, with the stimulator being turned off only occasionally, for short intervals (less than 15 min),

Post-surgery:As soon as the patient’s admission to the recovery room

 Rakel et al. (2003) [31]

GA

abdominal surgery

32/32

TENS

Incision:parallel to the incision,

No stimulation

No reported

Post-surgery: After surgery,details

 Hamza et al. (1999) [32]

GA

gynecologic surgery

25/25

TENS

Incision:surgical incision

No electrical current was applied

30 min, every 2 h

Post-surgery::in the postanesthesia care unit for 30 min at intervals of 2 h or longer

 Jaafarpour et al. (2008) [25]

SA

ceserean section

54/54

TENS

Incision: paraspinus muscles at T10-L1, and S2–4. 5 cm above and below the surgical incision,

Non-acu

continuously used for first 24 h except temporary breaks for walking,

Post-surgery: After surgery

 Galloway et al. (1984) [36]

GA

Cholecystectomy with or without choledochotomy

14/14

tes

Incision:details

Nonsegmental TES

Not reported

Post-surgery: In the recovery room

 Kayman-Kose et al. (2014) [24]

GA

cesarean section

50/50

TENS

Incision:above and below the incision line in women

no electrical current was transmitted in the placebo group

Not reported

Post-surgery: 30 min after childbirth was completed.

 Gary et al. (1993) [33]

GA

gynecological operations.

17/13

TENS

Incision:2 cm away from and parallel to the incision

No current applied

24 h, and 20 min on days 2 and 3

Post-surgery: first 24 h after the operation.

 Hershman et al. (1989) [37]

GA

cholecystectomy or colorectal surgery

23/22

TENS

Incision:

Non-functioning batteries

Not reported

Post-surgery: until the end of the second post-operative day,

 Lim et al. (1983) [51]

GA

upper abdominal surgery

15/15

TENS

Incision:1 cm away from the incision

Reversed batteries

Not reported

Post-surgery: After surgery, the stimulator was turned on in the recovery room

 Sodipo et al. (1980) [52]

GA

upper abdominal surgery

15/15

TENS

Incision:2 cm away from the incision

Non-acu

Not reported

Post-surgery: post operation, details

 Conn et al.(1986) [39]

GA

Appendectomy

15/13

TENS

Incision:either side of the wound

The machine was switched off

Not reported

Post-surgery: At the end of the procedure

 Hargreaves et al. (1989) [53]

Not mentioned

abdominal surgery

25/25

TENS

Incision: NR

No stimulation

Maybe 2 days

Post-surgery:depended on both time of return from surgery and time of dressing change.

 Dougal T et al. (1991) [38]

GA

Cholestectomy

15/15

TENS

Incision:each side of incision

Non-acu

Not reported

Post-surgery: in recovery room

 CUSCHIERI et al. (1985) [54]

GA

abdominal surgery

53/53

TENS

Incision:bilaterly in the paravertebral area;electroacupuncture:

The batteries are reversed

30 min

Post-surgery: In the recovery room

 Bjersa et al. (2015) [43]

EDA

COLON SURGERY

15/13

TENS

Incision:bilaterally of the incision,and columna innervating Th10 to L1

“increase stimulation until first sensitivity occurs and keep the stimulation as low as possible”

no time limitations

Post-surgery: 1 h prior to EDA termination

Distal acupoint stimulation

 Hui et al. (2002) [20]

EDA

caesarean section

20/20

EA

Distal:Zusanli, Sanyinjiao

Non-acu

30 min

Combined: pre-operation and 4 h or 8 h after surgery

 Baoguo et al. (1997) [44]

GA

lower abdominal surgery

25/25

EA

Distal:hegu

No electrical current was applied

30 min, every 2 h

Post-surgery::After surgery,details

 He et al. (2007) [41]

GA

radical operation of intestinal cancer

30/30

EA

Distal:scalp

Non-acu

until the end of surgery

Pre-surgery: 20 min before surgery

 Chen et al. (1998) [27]

GA

hysterectomy or myomectomy

25/25

EA

Distal:Zusanli

Nonacupoint and no-current

every 2–3 h

Post-surgery:On arrival in the PACU,

 Lin et al.(2002) [45]

GA

lower abdominal surgery

25/25

EA

Distal:Zusanli,

with the indicator light on but with no actual current

20 min

Pre-surgery: 20 min prior to anesthesia.

 Feng et al.(2013) [28]

EDA

Gynecological surgery

20/20

EA

Distal:Zusanli, Sanyinjiao

Non-acu

Not reported

Pre-surgery:details

 Feng et al.(2010) [29]

EDA

Gynecological surgery

20/20

EA

Distal:Zusanli, Sanyinjiao

Non-acu

Not reported

Pre-surgery: Before surgery

 Adib-Hajbaghery et al. (2013) [40]

GA

appendectomy

35/35

Acupressure

Distal:Le7

the button placed right in opposite side of the Le7 point (as sham point)

1 h

Post-surgery: After surgery, started after the full patient’s consciousness

 Kim et al.(2006) [35]

GA

Abdominal hysterectomy

30/30

Capsicum Plaster

Distal:Zusanli

inactive tape (5 _ 5 mm2) without PAS was applied to the Zusanli point of both legs.

8 h per day/3 days

Combined: before induction of anesthesia

 Hsiung et al.(2015) [42]

GA

subtotal gastrectomy

26/28

Acupressure

Distal:Neiguan (P6) and Zusanli (ST36)

Non-acu

Three12-min

Post-surgery:consecutive days following surgery.

 Ntritsou et al. (2014) [46]

GA

radical prostatectomy

35/35

EA

Distal:LI4,ST36

No current was applied

30 min

Post-surgery: when the closure of the abdominal walls was initiated

 Lee et al.(2011) [47]

GA

hysterectomy

13/12

EA

Distal:Zusanli (ST36)

no stimulation

30 min

combined: before general anesthesia, and initiated once regained consciousness

 Kotani et al.(2001) [48]

GA

elective upper and lower abdominal surgery

50/48

Acupuncture

Distal:BL18 –BL24 or BL20 –BL26

a needle was positioned at each acupoint

4 days

Combined: Before induction of anesthesia,

 Wu et al. (2009)

SA

cesarean section

20/20

EA

Distal:Sanyinjiao(Sp6)

Non-acu

30 min

Post-surgery: In the recovery room

 Li et al. (2012) [22]

CESA

cesarean section

60/60

EA

Distal:auricular Shenmen point(TF4)

No current applied

30 min

Combined: before surgery and 3 h, 8 h after surgery

 Masatomo et al. (2003) [49]

GA

abdominal surgery.

23/30

Acupressure

Distal:neiguan, Zusanli, Sanyinjiao, and Gongsunpoints

Non-acu

Not

Post-surgery: On completion of surgery

 Tsang et al.(2011) [34]

GA

total abdominal hysterectomy

16/16

auricular acupuncture

Distal: “uterus”“abdomen”“sympathetic” “shenmen” and“subcortex”

The sham TENS group received auricular TENS delivered to the following five inappropriate points: “teeth,” “tongue,” “mandible,” “eye,” and “face”

20 min

Post-surgery: after surgery,

Combined distal and peri-incisional stimulation

 Sim et al. (2002) [26]

GA

gynaecologic lower abdominal surgery

30/30

EA

Distal:ST36 and PC6 bilaterally and subcutaneously along the skin incision.

No electrical current was applied.

45 min

Post-surgery:group1\2:45 min before induction of anesthesia (GA)Group 3–45 min of postoperative

  1. CESA combined epidural and spinal anesthesia, EA electroacupuncture, EDA epidural anesthesia, GA general anesthesia, NR not reported, SA spinal anesthesia, TENS Transcutaneous Electrical Nerve Stimulation