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

NCT07771751 | Not Yet Recruiting

• 1 other identifier: 23.2026fbu
• Study Type: interventional
• Target: 114
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Postoperative Pain; Postoperative Complications; Cardiac Surgery

Keywords

Respiratory Performance; Pain Management; Nursing Care; acupressure; cardiac surgery

Outcome Measures

Primary Outcomes (2)

• 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 Outcomes (2)

• State and Trait Anxiety Levels

  State and Trait anxiety is evaluated right before and 20 minutes after the intervention.

• Chest Tube Removal Time

  Up to hospital discharge, an average of 7 days.

Study Arms (3)

Acupressure Group

EXPERIMENTAL

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; Behavioral: Incentive spirometry

Placebo Acupressure Group

SHAM COMPARATOR

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: Placebo Acuprresure; Behavioral: Incentive spirometry

control group

ACTIVE COMPARATOR

Patients in this group will receive only standard postoperative nursing care and routine incentive spirometry exercises.

Behavioral: Incentive spirometry

Interventions

Acupressure BEHAVIORAL

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).

Acupressure Group

Placebo Acuprresure BEHAVIORAL

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.

Placebo Acupressure Group

Incentive spirometry BEHAVIORAL

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).

Acupressure Group; Placebo Acupressure Group; control group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Fenerbahce University: lead

Study Sites (1)

Şehit Prof. Dr. İlhan Varank Sancaktepe Eğitim ve Araştırma Hastanesi

Istanbul, Sancaktepe, 34785, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pain, Postoperative; Postoperative Complications; Agnosia

Interventions

Acupressure

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

Intervention Hierarchy (Ancestors)

Therapy, Soft Tissue; Musculoskeletal Manipulations; Complementary Therapies; Therapeutics; Physical Therapy Modalities; Rehabilitation

Study Officials

• Ayda Kebapçı, Assc. Prof.

  Koç University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ruhat Tilki, PhD Candidate

CONTACT

+90 553 514 98 10; ruhat.tilki@fbu.edu.tr

Ayda Kebapçı, Assc. Prof.

CONTACT

+90 536 858 91 14; akebapci@ku.edu:tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: In the study, patient blinding will be achieved by using placebo acupressure. However, since the same researcher will both administer the intervention and monitor the patients, blinding of the researcher cannot be achieved. Therefore, the study has been designed as a single-blind trial.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Assistant

Study Record Dates

• First Submitted: August 11, 2026
• First Posted: August 18, 2026
• Study Start (Estimated): September 21, 2026
• Primary Completion (Estimated): September 21, 2027
• Study Completion (Estimated): September 21, 2027
• Last Updated: August 18, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: Data will be available beginning 6 months and ending 36 months following article publication.
• 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.

Locations

TU (1)