Electroacupuncture for Opioid-Sparing Analgesia and Enhanced Recovery after Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluates the efficacy of electroacupuncture (EA) for opioid-sparing analgesia and examines its role in facilitating enhanced recovery after surgery. Methods A comprehensive literature search was conducted across PubMed, the Cochrane Library, Web of Science, Embase, CNKI, Wangfang, and Cqvip. This search was aimed at identifying RCTs that evaluated the effects of EA versus sham acupuncture on opioid consumption and postoperative recovery outcomes in surgical patients. The literature search was finalized on July 20, 2025. Data extraction and subsequent meta-analysis were performed using Stata version 15.0. Result In a meta-analysis of 13 RCTs (n = 967), EA was associated with a significant reduction in total postoperative opioid use (weighted mean difference [WMD] = − 11.65 morphine milligram equivalents [MMEs], 95% confidence interval [CI]: −18.61 to − 4.70), and intraoperative opioid requirements (WMD = − 2.15 MME, 95% CI: −3.85 to − 0.46) compared to sham acupuncture. Furthermore, EA was associated with improved pain control, reduced postoperative nausea and vomiting (PONV), and attenuated inflammatory response, underscoring its role as an effective opioid-sparing strategy within enhanced recovery protocols. Conclusion Our study shows that EA does not compromise analgesic efficacy compared to sham acupuncture. Additionally, it exerts a pronounced opioid-sparing effect, significantly lowering postoperative opioid consumption while concurrently enhancing the overall recovery outcomes.