Inspired by Fang et al and Zhong et al 2025.[1,2]
POD – post-operative delirium
BIS – bispectral index
EEG – electroencephalogram– key to acronyms
This week I am introducing a relatively new microsystem called buccal acupuncture. It caught my eye twice in the same week; hence I am highlighting 2 papers this time.
I am not a fan of mapping the whole body onto a region such as the ear, scalp, hand, finger, tongue, or, as a couple of female colleagues mentioned some years ago, any sticky-out bit! They had been drinking at the time, and consequently, I retired to bed forthwith!
So, why am I highlighting these papers, if I am not a fan of microsystems? Well, despite the lack of anatomical logic, or physiological support, needling almost anywhere does have some effect, whether or not I like the theoretical basis. In these two cases, it seems quite convenient to use points on the face in the perioperative period, provided that the surgery is elsewhere. Is there an advantage in using the face rather than the more well-established ear? It is too soon to tell.
“Buccal acupuncture” [ti] currently has just 10 listings on PubMed, with the first in 2014, and the second in 2017, both in Chinese. The first paper published in English was in 2023.
Both papers I am highlighting used 0.16x15mm needles and up to 8 points. One trial (Zhong et al) only applied needles during anaesthesia, whereas the other trial used needles pre-operatively and on post-operative days 1 and 2.
Fang et al used buccal acupuncture in elderly patients (n=120) undergoing lower limb orthopaedic surgery. Their primary outcome was the incidence of POD, which seems unlikely to be subject to expectation on behalf of either the practitioners or patients, neither of whom were blind. The outcome assessors were blind to treatment allocation, and they determined that the incidence of POD was 12% in the acupuncture group and 27% in the control. That is a very useful reduction in incidence. In this trial the use of opioids and the incidence of PONV was also reduced significantly in the acupuncture group.
Zhong et al used buccal acupuncture in women (n=80) undergoing laparoscopic gynaecological surgery. The primary outcome was the dosage of sufentanil used during anaesthesia. It is always difficult to objectively control dosing decisions in an unblinded environment, but here, the use of additional sufentanil was based on BIS – an EEG-based measure of conscious level or sedation where 100 corresponds to full consciousness and 0 indicates no brain activity. The target of anaesthesia is usually to maintain BIS at 40-60 and, in this paper, additional sufentanil was triggered only when the BIS level exceeded 60.
Significantly less sufentanil was used in the acupuncture group, although the difference was relatively small (<10% reduction in total sufentanil). No other parameters were significantly different between the groups in this study, unlike in the previous one (Fang et al). This may be a reflection of the total dose of needling used as well as the population difference.
References
1 Fang S, Wang X, Chen C, et al. Effect of buccal acupuncture therapy on the incidence of postoperative delirium in older adults undergoing orthopedic lower limb surgery: A randomized controlled trial. J Psychosom Res. 2025;192:112129. doi: 10.1016/j.jpsychores.2025.112129
2 Zhong Y, Deng J, Pan T, et al. Buccal Acupuncture Reduces the Dose of Sufentanil Needed in Laparoscopic Gynecological Surgery. Med Sci Monit. 2025;31:e947088. doi: 10.12659/MSM.947088
