Asia-Pacific Journal of Oncology Nursing · 7 authors, 3 centres
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This randomized trial found that nurse-delivered acupressure at ST36 after colorectal cancer surgery significantly shortened the time to first flatus by about 11 hours after adjusting for confounders, though defecation time, abdominal distention, and bowel motility improvements were not statistically significant. The intervention is noninvasive and feasible for clinical use, suggesting it could be incorporated into enhanced recovery protocols to promote early gastrointestinal recovery.
**Background:** Postoperative gastrointestinal dysfunction occurs in up to 25% of patients after colorectal cancer surgery, leading to complications such as anastomotic fistula, malnutrition, and increased hospital costs. Current enhanced recovery after surgery (ERAS) protocols include multimodal strategies, but additional complementary interventions are needed. Acupressure at ST36 (zusanli) is theorized to improve GI function through traditional Chinese medicine meridian theory and Western neuro-endocrine mechanisms, including vagal activation and release of GI hormones. However, evidence for nurse-delivered acupressure using a single acupoint in this population was limited.
**Methods:** This randomized placebo-controlled trial was conducted in two GI surgery wards of a tertiary hospital in Shandong, China. A total of 112 adult patients (≥18 years) scheduled for elective colorectal cancer surgery under general anesthesia were randomized 1:1 to acupressure or sham control using block randomization (block size 8). Allocation was concealed in sequentially numbered, opaque, sealed envelopes. Patients and medical staff (except one research nurse) were blinded. The intervention group received acupressure at bilateral ST36 using a metal acupen with approximately 2-3 kg force, pressing once per second for 5 minutes per side, twice daily (8:00-10:00 am and 3:00-5:00 pm) for 5 postoperative days. The control group received gentle rubbing of the skin at ST36 with no pressure, same schedule. Primary outcomes were time to first flatus and defecation (hours from end of surgery). Secondary outcomes were daily abdominal distention (NRS 0-10) and bowel motility (bowel sounds per minute), analyzed as area under the curve (AUC) over 5 days. Sample size was calculated as 106 (53 per group) based on an estimated effect size of 0.55, alpha 0.05, power 0.80. Intention-to-treat analysis was used. Multivariate linear regression adjusted for age, previous abdominal surgery, laparoscopic surgery, anesthesia duration, nasogastric tube duration, water intake time interval, and time to first out of bed.
**Key Results:** Baseline characteristics were comparable between groups (mean age 58.89 vs 58.43 years; 51.8% male in both). Mean acupressure doses received were 8.89±2.07 vs 8.50±1.82 out of 10 (P>0.05). Univariate analysis showed no significant difference in time to first flatus (44.39±22.37 vs 50.16±20.11 h, P=0.15) or defecation (77.00±36.27 vs 80.08±28.88 h, P=0.62). After multivariate adjustment, acupressure significantly shortened time to first flatus by 11.08 h (95% CI: -19.36 to -2.81; P<0.01). Time to first defecation was not significantly different (β=-5.90, 95% CI: -19.34 to 7.55; P=0.39). For secondary outcomes, mean abdominal distention was 1.33±2.02 vs 1.68±1.77 (P=0.035 for total mean, but AUC 5.68±5.24 vs 5.92±4.03, P=0.35). Mean bowel motility was 3.04±1.97 vs 2.69±1.38 sounds/min (P=0.017 for total mean, but AUC 12.09±4.70 vs 11.51±3.00, P=0.45). Subgroup analysis by age (<60 vs ≥60 years) showed no statistically significant differences, though elderly patients had numerically greater improvement in bowel motility (AUC 11.84 vs 10.64, P=0.29). Missing data were 3.75% and comparable between groups.
**Clinical Implications:** This study provides evidence that nurse-delivered acupressure at ST36 can significantly shorten time to first flatus by about 11 hours after adjusting for confounders, suggesting a clinically meaningful benefit for early GI recovery. The intervention is noninvasive, simple, and feasible for bedside nursing practice. Although improvements in defecation time, abdominal distention, and bowel motility were not statistically significant, the trends favor acupressure, especially in elderly patients. The authors recommend incorporating acupressure into ERAS protocols for colorectal cancer surgery. Limitations include single-center design, subjective measurement of abdominal distention, and lack of long-term follow-up. Future multicenter trials with objective measures (e.g., abdominal X-ray) and qualitative stakeholder evaluations are needed.