Acupressure for Pain and Anxiety After Cesarean Section

This randomized, single-blind, controlled clinical trial aims to evaluate the effectiveness and safety of acupressure combined with standard modern care in postpartum women with pain and anxiety following cesarean delivery under spinal anesthesia.

Participants who meet the eligibility criteria will be randomly assigned to either the intervention group ( acupressure plus standard modern care) or the control group (sham acupressure plus standard modern care).

In the intervention group, participants will receive manual acupressure (using xoa, day, and an techniques) on three bilateral therapeutic points: Hegu (LI4), Neiguan (PC6), and Sanyinjiao (SP6). Before applying pressure, the surrounding tissue is rubbed (xoa) with the palm for 20-30 seconds. Then, the points are pressed (an) for 5 seconds at a depth of 1-1.5 cm, kneaded (day) for 5 seconds, and rested for 5 seconds, repeating this cycle for 2 minutes per point. The total duration is 15 minutes for 6 points, performed once daily for 3 consecutive days.

In the control group, participants will receive sham acupressure (xoa, day, an) at identical frequencies and durations on 3 non-therapeutic sham points: Sham Hegu, Sham Neiguan, and Sham Sanyinjiao.

Both groups will receive standard post-operative modern pain management as prescribed by the hospital's obstetricians, which includes:

• Post-op Day 1: Paracetamol 1g IV q6-8h ± Diclofenac 100mg rectally q12h;
• Post-op Day 2 onwards: Paracetamol 1g PO q8h ± Diclofenac 100mg rectally q12h or other NSAIDs (such as Diclofenac 50mg, Ibuprofen 600-1200mg/day, Paracetamol + Ibuprofen, or Paracetamol + Tramadol) as prescribed by the hospital.

Outcomes including pain (VAS-P), anxiety (VAS-A, STAI-Y1), and any adverse events will be assessed at baseline (T1, pre-intervention) and after 3 days of intervention (T2).

Inclusion criteria

• Postpartum women aged 18 years or older who have undergone cesarean delivery with spinal anesthesia.
• Gestational age >= 37 weeks.
• Willing to participate and signing the written informed consent form.

Exclusion criteria

• General anesthesia or methods other than spinal anesthesia.
• Hearing, vision, or speech impairment.
• History of chronic diseases such as uncontrolled diabetes, severe hypertension, cardiovascular disease, or psychiatric disorders.
• Diagnosed with chronic pain before surgery, or regular use of pain medications.
• Opioid, alcohol addiction or dependence.
• Pathological cesarean deliveries (placenta praevia, placental abruption, placenta accreta).
• Multiple pregnancies (twins, triplets, etc.).
• Post-operative complications (wound infection, hemorrhage, coagulation disorders, or loss of the child).
• Severe postpartum urinary retention requiring urinary catheterization.
• Refusing to participate.