Functional recovery after abdominal surgery and the emerging role of acupuncture

Table 1 Summary of acupuncture and non-pharmacological interventions within enhanced recovery after surgery pathways for enhancing gastrointestinal recovery after abdominal surgery

Category	Key components	Main findings on gastrointestinal recovery	Mechanistic basis	Safety profile	Clinical implications
EA	EA at ST36, PC6, ST37 and related acupoints	Significantly shortens time to first flatus, defecation, and bowel sound recovery; reduces postoperative ileus and hospital stay	Vagal nerve activation, neuroimmune modulation, anti-inflammatory signaling, regulation of enteric nervous system	Generally safe with minimal mild adverse events	Effective core adjunct modality for ERAS to accelerate functional recovery after abdominal surgery
TEAS	Non-invasive electrical stimulation at specific acupoints	Improves bowel motility, reduces postoperative nausea and vomiting, enhances early gastrointestinal function restoration	Autonomic nervous system regulation and brain-gut axis modulation	High safety and patient acceptability due to non-invasive nature	Suitable for standardized integration into perioperative ERAS protocols
Combined EA + TEAS	Multimodal acupoint stimulation strategies	Additive or synergistic effects on gastrointestinal recovery and shorter length of hospital stay	Enhanced neuroimmune and autonomic co-regulation	Favorable safety with good tolerability	Promising optimized strategy for multimodal ERAS care
Thumbtack needle and intradermal acupuncture	Continuous low-intensity acupoint stimulation	Accelerates recovery of bowel sounds and exhaust time; improves postoperative symptoms	Sustained neuromodulation and microcirculation improvement	Minimal complications and high compliance	Practical for long-duration perioperative stimulation within ERAS pathways
Acupuncture plus rehabilitation or integrative therapies	Acupuncture combined with rehabilitation or multimodal care	Further improvement in gastrointestinal recovery, symptom relief, and quality of recovery	Multi-target regulation including neural, immune, and hormonal pathways	Safe with low incidence of adverse events	Supports multidisciplinary perioperative recovery models
Other non-pharmacological ERAS components	Gum chewing, early mobilization, supportive NPIs	Moderate improvement in intestinal motility and symptom relief	Gastrointestinal reflex stimulation and autonomic activation	Generally safe	Complementary strategies but usually less effective than acupuncture-based interventions
Mechanistic evidence (overall)	Neuroimmune and autonomic modulation pathways	Restoration of gastrointestinal motility and reduced inflammation contributing to faster recovery	Vagal tone enhancement, cytokine inhibition (e.g., inflammatory mediators), brain-gut axis regulation	Mechanistically plausible and biologically supported	Provides theoretical basis for integrating acupuncture into ERAS
Safety and feasibility in ERAS	Multimodal non-pharmacological integration	No significant increase in postoperative complications; improved patient-centered outcomes	Non-pharmacological neuromodulation without systemic drug burden	Excellent overall safety profile	Feasible, acceptable, and cost-effective adjunct in modern ERAS pathways

EA: Electroacupuncture; ERAS: Enhanced recovery after surgery; TEAS: Transcutaneous electrical acupoint stimulation; NPIs: Non-pharmacological interventions.