Auricular Acupressure for Managing Nausea–Vomiting, Pain and Fatigue After Liver Arterial Chemoembolization and Hepatic Arterial Infusion Chemotherapy

Summary

A standardized auricular acupressure protocol integrated into peri–interventional nursing care may help relieve nausea, vomiting, pain, fatigue, sleep disturbance, and appetite loss after liver arterial chemoembolization and hepatic arterial infusion chemotherapy while providing a practical and reproducible supportive care workflow for routine clinical implementation and symptom management during hospitalization.

Abstract

Patients undergoing transarterial chemoembolization or hepatic arterial infusion chemotherapy frequently experience nausea, vomiting, pain, fatigue, sleep disturbance, and appetite loss during hospitalization, yet standardized nonpharmacologic supportive care protocols remain limited. This study aimed to describe a standardized auricular acupressure protocol integrated into peri–interventional nursing care and to evaluate its feasibility, tolerability, and symptom–related outcomes. In this single–center, prospective, nonrandomized, quasi-experimental study, 102 consecutive eligible patients treated between January 2022 and December 2024 received either auricular acupressure plus routine nursing care (n = 52) or routine nursing care alone (n = 50). After receiving standardized information about both nursing care pathways, patients selected their preferred pathway. No random sequence or allocation concealment was used. Because the auricular patches were visible and the intervention required active nursing instruction, neither the participants nor the intervention nurses were blinded. The protocol included standardized acupoint selection, vaccaria seed application, nurse–guided self–acupressure training, fidelity monitoring, and symptom assessment before intervention, at 24 h and 48 h after treatment, and before discharge. Auricular acupressure was associated with lower nausea scores at 24 h (3.9 ± 1.2 vs. 4.8 ± 1.4, p = 0.002), 48 h (2.8 ± 1.1 vs. 4.1 ± 1.3, p < 0.001), and before discharge (1.9 ± 0.9 vs. 3.2 ± 1.2, p < 0.001). Vomiting occurrence at 48 h was also lower (26.9% vs. 52.0%, p = 0.009). Patients receiving auricular acupressure additionally showed lower pain and fatigue scores, earlier oral intake, less rescue antiemetic use, and higher satisfaction. No severe intervention–related adverse events occurred. These findings support the feasibility of this nursing protocol but should be interpreted as associations, given the nonrandomized allocation of treatment.

Introduction

Primary liver cancer remains a major cause of cancer–related morbidity and mortality worldwide, and hepatocellular carcinoma accounts for most cases encountered in clinical practice. Many patients are diagnosed at an intermediate or advanced stage, when surgical resection, liver transplantation, or local ablation is no longer feasible. Liver–directed interventional treatments have therefore become an important component of multidisciplinary management. Recent clinical studies have demonstrated the expanding role of transarterial chemoembolization (TACE) in patients with large or unresectable tumors¹. Hepatic arterial infusion chemot....

Protocol

This study was conducted in accordance with the Declaration of Helsinki and institutional guidelines for research involving human participants. The Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University approved the study before participant enrollment (approval no. 2026YS462). Written informed consent was obtained from each participant before assigning participants to groups and initiating the nursing intervention. All clinical records, nursing forms, and statistical datasets were de-identified before analysis. The standardized auricular acupressure protocol was developed with reference to published studies on auricular acupressure for n....

Results

Between January 2022 and December 2024, 118 consecutive patients scheduled to undergo TACE or HAIC were screened for eligibility. Sixteen patients were excluded due to incomplete symptom assessment data, refusal to participate, active auricular skin lesions, or inability to complete the peri-interventional nursing evaluation. The final analytic sample comprised 102 patients. After receiving standardized information regarding both nursing care pathways, 52 patients selected auricular acupressure plus routine nursing care,.......

Discussion

The present study proposed a standardized auricular acupressure protocol as a supportive nursing intervention for patients undergoing TACE or HAIC. Unlike many previous studies that mainly focused on single symptoms or general oncology populations, the current protocol specifically targeted the combined symptom burden commonly observed after liver arterial interventional therapy, particularly nausea, vomiting, pain, and fatigue. The intervention integrated structured auricular acupoint selection, standardized stimulation.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
75% alcohol solution	Shandong Lircon Medical Technology Co., Ltd.	ALC-75-500	Used for routine cleaning of the auricular skin before patch application.
Adverse event record sheet	Participating hospital nursing department	AA-AE-2022	Used to document local redness, tenderness, allergy, patch detachment, dizziness, and other intervention-related events.
Auricular acupoint anatomical chart	Participating hospital nursing department	AA-Map-2022	Printed anatomical map used to standardize localization of Shenmen, Stomach, Sympathetic, Subcortex, Liver, Spleen, and Occiput points.
Auricular acupressure operation checklist	Participating hospital nursing department	AA-Checklist-2022	Checklist used by nursing staff to standardize skin inspection, cleaning, acupoint localization, patch placement, stimulation, replacement, and follow-up.
Auricular patch storage box	Participating hospital nursing department	AA-Storage-2022	Clean container used to store auricular patches before bedside use according to institutional nursing practice.
Blunt-ended auricular probe	Shanghai Acupuncture Instrument Factory	AP-102	Used to gently assess local tenderness and identify the most responsive area around each auricular acupoint before patch fixation.
Case report form	Participating hospital research office	CRF-AA-2022	Used to collect baseline characteristics, treatment details, symptom scores, medication use, safety outcomes, and recovery outcomes.
Clinical chemistry analyzer	Roche Diagnostics	cobas c 702	Used in the hospital laboratory for biochemical measurements, including alanine aminotransferase, aspartate aminotransferase, albumin, and total bilirubin.
Data management spreadsheet	Microsoft Corporation	Microsoft Excel 2021	Used for data entry, data checking, table preparation, and summary data management; RRID: SCR_016137.
Disposable medical gloves	Winner Medical Co., Ltd.	GL-2022	Used during auricular skin cleaning, patch placement, and patch replacement according to infection-control requirements.
Electronic medical record system	Participating hospital information center	EMR-2022	Used to retrieve demographic information, diagnosis, treatment regimen, hospitalization data, medication use, and laboratory results.
Electronic nursing documentation system	Participating hospital information center	Nursing-EMR-2022	Used to record nursing assessments, symptom observations, vomiting frequency, oral intake recovery, mobilization, and safety monitoring.
Hematology analyzer	Sysmex Corporation	XN-9000	Used in the hospital laboratory for routine blood tests, including hemoglobin measurement.
Hypoallergenic auricular adhesive patches	Shanghai Medical Materials Co., Ltd.	AP-118	Used to fix vaccaria seeds over selected auricular acupoints without skin penetration.
Intervention adherence record sheet	Participating hospital nursing department	AA-Adherence-2022	Used to record completion of self-acupressure training, daily pressing frequency, and scheduled patch replacement.
Laboratory information system	Participating hospital information center	LIS-2022	Used to retrieve validated laboratory values included in the baseline clinical characteristics table.
Medical waste container	Participating hospital central supply department	MWC-2022	Used for disposal of used cotton swabs, adhesive patches, and other single-use bedside materials.
Numeric Rating Scale form	Participating hospital nursing department	NRS-001	Used to assess pain intensity on a 0 to 10 scale, with higher scores indicating more severe pain.
Patch replacement record sheet	Participating hospital nursing department	AA-Replace-2022	Used to record 48 h patch replacement, ear alternation, skin findings, and temporary suspension when irritation occurred.
Patient education leaflet for auricular acupressure	Participating hospital nursing department	AA-Edu-2022	Used to explain expected sensations, self-acupressure technique, pressing frequency, patch protection, and when to report local discomfort.
Patient satisfaction scoring form	Participating hospital nursing department	SAT-AA-2022	Used to assess patient satisfaction with peri-interventional supportive care using a 10-point visual scoring system.
Routine antiseptic tray	Participating hospital central supply department	ANT-Tray-2022	Used to hold antiseptic materials and sterile accessories during bedside auricular preparation.
R statistical software	R Foundation for Statistical Computing	Version 4.3.2	Propensity-score weighting and sensitivity analyses
Self-acupressure instruction card	Participating hospital nursing department	AA-Card-2022	Bedside instruction card showing how to press each auricular point with thumb and index finger for about 1 min, three to five times daily.
Skin inspection flashlight	Shenzhen Mindray Bio-Medical Electronics Co., Ltd.	FL-01	Used during local ear skin inspection before application and during each patch replacement.
Standard hospital bed	Participating hospital equipment department	BED-2022	Used to position patients in a seated or semi-recumbent position during intervention.
Standard operating procedure manual	Participating hospital nursing department	SOP-AA-2022	Manual used for nurse training and procedural standardization before implementation.
Statistical analysis software	IBM Corp.	SPSS Statistics Version 27.0	Used for normality testing, t-tests, chi-square tests, Fisher exact tests, Wilcoxon signed-rank tests, and descriptive statistics; RRID: SCR_002865.
Sterile cotton swabs	Winner Medical Co., Ltd.	CS-210	Used for auricular skin cleaning with 75% alcohol solution before seed patch application.
Sterile gauze pads	Winner Medical Co., Ltd.	GZ-2022	Used for local skin drying or gentle cleaning when needed during patch replacement.
Sterile tweezers	Jiangsu Kangjian Medical Apparatus Co., Ltd.	TW-305	Used to pick up and place vaccaria seed patches onto selected auricular acupoints.
Stopwatch or timer	Casio Computer Co., Ltd.	HS-80TW	Used to standardize 15 to 20 s initial pressing by nurses and approximately 1 min self-acupressure per point.
Symptom assessment record sheet	Participating hospital nursing department	SYM-AA-2022	Used to record nausea, vomiting, pain, fatigue, sleep quality, appetite, treatment comfort, and adverse events at predefined time points.
Vaccaria seed auricular patches	Suzhou Medical Appliance Factory	VA-2022	Sterile vaccaria seeds mounted on adhesive patches and used to provide continuous mechanical stimulation of selected auricular acupoints.
Visual Analog Scale form	Participating hospital nursing department	VAS-001	Used to assess nausea severity on a 0 to 10 scale, with higher scores indicating more severe nausea.