The Effect of Acupressure Application on Respiratory Performance and Pain Levels in Adult Patients Undergoing Cardiac Surgery

The Effect of Acupressure Application on Respiratory Performance and Pain Levels in Adult Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial

The purpose of this randomized controlled trial is to evaluate the effect of acupressure on respiratory performance and pain levels in adult patients who have undergone open-heart surgery. Pulmonary complications and severe pain are common after cardiac surgery, often limiting the effectiveness of standard deep breathing exercises such as incentive spirometry. This study investigates whether applying acupressure-a non-invasive complementary therapy-can help manage postoperative pain and improve respiratory capacity. By potentially reducing pain without the respiratory side effects associated with pharmacological medications, acupressure may enable patients to perform their breathing exercises more effectively and support their overall recovery.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Complications; Postoperative Pain; Cardiac Surgery
• Intervention / Treatment: Behavioral: Acupressure; Behavioral: Incentive spirometry; Behavioral: Placebo Acuprresure

Detailed Description

Cardiovascular diseases remain a major global health burden. While open-heart surgery is a vital treatment for many cardiac conditions, it is characterized by a high risk of complications and a long recovery period. Postoperative pulmonary complications, including hypoxemia, pneumonia, atelectasis, and respiratory failure, are prevalent among these patients. To prevent these issues and restore lung expansion, the regular use of an incentive spirometer is a standard and essential component of nursing care in the cardiovascular surgical intensive care unit.

However, severe postoperative pain restricts patients' ability to take deep breaths, which significantly reduces the effectiveness of incentive spirometry and increases the risk of lung complications. Furthermore, pharmacological agents commonly used for pain management can cause adverse effects like respiratory depression. This has directed nursing practice toward non-pharmacological, complementary symptom management strategies.

Acupressure is a non-invasive complementary therapy rooted in traditional medicine, involving the application of physical pressure to specific acupoints. Current literature indicates that stimulating specific points, such as LU7 (Lieque) and PC6 (Neiguan), can regulate autonomic nervous system activities, increase parasympathetic tone, and improve overall respiratory function. Although its potential in general symptom management is recognized, clinical evidence regarding the direct impact of acupressure on respiratory performance in post-cardiac surgery intensive care patients remains highly limited. This study aims to address this gap by determining the physiological and clinical effects of acupressure on both pain levels and respiratory capacity in this specific patient population.

• Study Type: Interventional
• Enrollment (Estimated): 114
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ruhat Tilki, PhD Candidate; Phone Number: +90 553 514 98 10; Email: ruhat.tilki@fbu.edu.tr
• Study Contact Backup: Name: Ayda Kebapçı, Assc. Prof.; Phone Number: +90 536 858 91 14; Email: akebapci@ku.edu:tr

Study Locations

• Turkey (Türkiye)
  • Sancaktepe
    • Istanbul, Sancaktepe, Turkey (Türkiye), 34785
      • Şehit Prof. Dr. İlhan Varank Sancaktepe Eğitim ve Araştırma Hastanesi
      • Contact: Ruhat Tilki, Ph.D. Candidate; Phone Number: +90 553 514 98 10; Email: ruhat.tilki@fbu.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 18 years and older.
• Undergoing cardiac surgery for the first time.
• Extubated and hemodynamically stable in the postoperative period.
• A Glasgow Coma Scale (GCS) score of 15.
• Absence of arterial or venous catheters, incisions, hematomas, ecchymoses, or any skin lesions/deformities at the acupressure application sites.
• No analgesic medication administered within the last four hours.
• No known neuromuscular diseases that could affect respiratory muscle strength or performance.
• Ability to speak Turkish and absence of any communication barriers.

Exclusion Criteria:

• Development of postoperative complications (e.g., severe arrhythmia, need for re-intubation, active bleeding).
• Receiving sedation in the intensive care unit.
• Presence of chronic pain syndrome or regular use of opioids/analgesics.
• Known psychiatric disorders.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Acupressure Group; Acupressure will be applied to the LI4 (Hegu) (on the dorsum of the hand, between the 1st and 2nd metacarpal bones), LU7 (Lieque) (on the radial side of the forearm, approximately 3.75 cm [1.5 cun] above the wrist crease), and PC6 (Neiguan) (on the palmar aspect of the forearm, approximately 5 cm [2 cun] above the wrist crease) acupoints (Appendix-4), which are reported in the literature to positively affect pain and the respiratory system. The intervention will be performed by a researcher holding an acupressure certification. Using the thumb, index finger, or middle finger, pressure will be applied to the identified LI4, LU7, and PC6 points to a depth of 1 to 1.5 cm for 10 seconds. After a 2-second release, the pressure will be continued for 2 minutes (Düzel et al., 2023; Vanzini et al., 2021; Narimani et al., 2018).	Behavioral: Acupressure; Acupressure will be applied to the LI4 (Hegu) (on the dorsum of the hand, between the 1st and 2nd metacarpal bones), LU7 (Lieque) (on the radial side of the forearm, approximately 3.75 cm [1.5 cun] above the wrist crease), and PC6 (Neiguan) (on the palmar aspect of the forearm, approximately 5 cm [2 cun] above the wrist crease) acupoints (Appendix-4), which are reported in the literature to positively affect pain and the respiratory system. The intervention will be performed by a researcher holding an acupressure certification. Using the thumb, index finger, or middle finger, pressure will be applied to the identified LI4, LU7, and PC6 points to a depth of 1 to 1.5 cm for 10 seconds. After a 2-second release, the pressure will be continued for 2 minutes (Düzel et al., 2023; Vanzini et al., 2021; Narimani et al., 2018).; Behavioral: Incentive spirometry; The study will use a triflow device, which consists of three separate chambers and a breathing tube with a mouthpiece. The chambers contain colored balls corresponding to flow volumes of 600, 900, and 1200 mL/sec, respectively. An inspiratory flow of 600 mL/sec raises the ball in the first chamber, an inspiratory flow of 900 mL/sec raises the ball in the second chamber, and an inspiratory flow of 1200 mL/sec raises the ball in the third chamber (Amin et al., 2021). To measure inspiratory flow rate and volume, patients will be instructed to seal their lips tightly around the triflow mouthpiece, ensuring no gaps remain. Patients will be asked to take a deep and slow breath to raise the balls. Subsequently, to measure expiratory flow rate and volume, they will be asked to remove the mouthpiece, hold their breath for 3 to 5 seconds, and then exhale normally (Gökçe et al., 2025).
Sham Comparator: Placebo Acupressure Group; In the placebo acupressure group, all procedural steps will be performed in the exact same manner as in the true acupressure group. However, very light pressure will be applied to sham areas located 1.5 cm away from the LI4, LU7, and PC6 acupoints that do not fall on any meridian. Using the thumb, index finger, or middle finger, this very light pressure will be applied to each point for 10 seconds, followed by a 2-second rest, continuing for 2 minutes per point. The application will be performed bilaterally and will take an average of 15 minutes. Following the procedure, a 20-minute resting period will be provided.	Behavioral: Incentive spirometry; The study will use a triflow device, which consists of three separate chambers and a breathing tube with a mouthpiece. The chambers contain colored balls corresponding to flow volumes of 600, 900, and 1200 mL/sec, respectively. An inspiratory flow of 600 mL/sec raises the ball in the first chamber, an inspiratory flow of 900 mL/sec raises the ball in the second chamber, and an inspiratory flow of 1200 mL/sec raises the ball in the third chamber (Amin et al., 2021). To measure inspiratory flow rate and volume, patients will be instructed to seal their lips tightly around the triflow mouthpiece, ensuring no gaps remain. Patients will be asked to take a deep and slow breath to raise the balls. Subsequently, to measure expiratory flow rate and volume, they will be asked to remove the mouthpiece, hold their breath for 3 to 5 seconds, and then exhale normally (Gökçe et al., 2025).; Behavioral: Placebo Acuprresure; In the placebo acupressure group, all procedural steps will be performed in the exact same manner as in the true acupressure group. However, very light pressure will be applied to sham areas located 1.5 cm away from the LI4, LU7, and PC6 acupoints that do not fall on any meridian. Using the thumb, index finger, or middle finger, this very light pressure will be applied to each point for 10 seconds, followed by a 2-second rest, continuing for 2 minutes per point. The application will be performed bilaterally and will take an average of 15 minutes. Following the procedure, a 20-minute resting period will be provided.
Active Comparator: control group; Patients in this group will receive only standard postoperative nursing care and routine incentive spirometry exercises.	Behavioral: Incentive spirometry; The study will use a triflow device, which consists of three separate chambers and a breathing tube with a mouthpiece. The chambers contain colored balls corresponding to flow volumes of 600, 900, and 1200 mL/sec, respectively. An inspiratory flow of 600 mL/sec raises the ball in the first chamber, an inspiratory flow of 900 mL/sec raises the ball in the second chamber, and an inspiratory flow of 1200 mL/sec raises the ball in the third chamber (Amin et al., 2021). To measure inspiratory flow rate and volume, patients will be instructed to seal their lips tightly around the triflow mouthpiece, ensuring no gaps remain. Patients will be asked to take a deep and slow breath to raise the balls. Subsequently, to measure expiratory flow rate and volume, they will be asked to remove the mouthpiece, hold their breath for 3 to 5 seconds, and then exhale normally (Gökçe et al., 2025).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inspiratory and Expiratory Airflow Volume and Rate	Airflow rate (mL/sec) and volume (mL) will be measured using a three-chamber incentive spirometer (triflow). The average of the three highest values obtained during five inspirations and five expirations will be recorded.	Evaluated before and immediately after the intervention (acupressure, placebo acupressure, or standard triflow exercise).
Postoperative Pain Severity	Pain severity will be assessed using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (most severe pain).	Evaluated before and immediately after the intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State and Trait Anxiety Levels	Anxiety will be assessed using the State-Trait Anxiety Inventory (STAI), which consists of 40 items on a 4-point Likert scale. Scores range from 20 to 80, with higher scores indicating higher anxiety levels.	State and Trait anxiety is evaluated right before and 20 minutes after the intervention.
Chest Tube Removal Time	The duration from the end of the surgical procedure until the removal of the chest tube. This outcome will be measured and reported in hours.	Up to hospital discharge, an average of 7 days.

Collaborators and Investigators

• Sponsor: Fenerbahce University
• Investigators: Principal Investigator: Ayda Kebapçı, Assc. Prof., Koç University

Study record dates

Study Major Dates

• Study Start (Estimated): September 21, 2026
• Primary Completion (Estimated): September 21, 2027
• Study Completion (Estimated): September 21, 2027

Study Registration Dates

• First Submitted: August 11, 2026
• First Submitted That Met QC Criteria: August 14, 2026
• First Posted (Actual): August 18, 2026

Study Record Updates

• Last Update Posted (Actual): August 18, 2026
• Last Update Submitted That Met QC Criteria: August 14, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: cardiac surgery; Nursing Care; Pain Management; acupressure; Respiratory Performance
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Pathologic Processes; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Agnosia; Postoperative Complications; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Rehabilitation; Therapy, Soft Tissue; Musculoskeletal Manipulations; Acupressure
• Other Study ID Numbers: 23.2026fbu

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data that underlie the results reported in the published article will be shared.
• IPD Sharing Time Frame: Data will be available beginning 6 months and ending 36 months following article publication.
• IPD Sharing Access Criteria: Data will be shared with researchers who provide a methodologically sound proposal for secondary analyses. Requests should be directed to the central contact person via email.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No