{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:53:44Z","timestamp":1785423224410,"version":"3.56.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative delirium (POD) is an acute disorder of attention and cognition, frequently observed as a complication in elderly individuals undergoing major surgery. Patients undergoing laparoscopic radical prostatectomy (LRP) are particularly vulnerable due to advanced age and comorbidities. Electroacupuncture (EA), as a non-pharmacological intervention, may attenuate neuroinflammation and cerebral injury, potentially reducing the risk of POD. This study aims to evaluate the efficacy of EA in reducing the incidence of POD among elderly patients undergoing LRP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a double-center, prospective, randomized, patient- and assessor-blinded, sham-controlled trial. A total of 212 eligible participants will be enrolled and allocated in a 1:1 ratio to either the EA group or the sham EA (SEA) group. Participants in the EA group will receive intervention at the acupoints Zusanli (ST36) and Baihui (GV20), initiated 30\u202fmin prior to anesthesia induction and maintained for 25\u201330\u202fmin. The primary outcome is the incidence of POD assessed using the 3D-CAM during the first three postoperative days. Secondary endpoints include the duration and severity of delirium, delirium subtypes, pain scores, opioid consumption, catheter-related bladder discomfort, adverse events, and plasma levels of neuroinflammatory biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Currently, evidence regarding the efficacy of EA in preventing POD specifically in elderly patients undergoing LRP is limited. This randomized controlled trial is designed to address this research gap. If the hypothesis is confirmed, this study will provide evidence for a safe, non-pharmacological strategy to improve postoperative cognitive outcomes in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.chictr.org.cn\/showproj.html?proj=240562<\/jats:uri>\n                      , Identifier: ChiCTR2500097337.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1790084","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:43:23Z","timestamp":1775022203000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of electroacupuncture on postoperative delirium in elderly patients undergoing laparoscopic radical prostatectomy: study protocol for a double-center randomized controlled trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Shirong","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sitong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Zhi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yungong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaobo","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhangtian","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Jiaxing Hospital of Traditional Chinese Medicine","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesheng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Jiaxing Hospital of Traditional Chinese Medicine","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huadong","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"Itc49","DOI":"10.7326\/AITC202010060","article-title":"Delirium","volume":"173","author":"Mattison","year":"2020","journal-title":"Ann Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e103516","DOI":"10.1136\/bmjopen-2025-103516","article-title":"Correlation between middle cerebral artery flow parameters and postoperative delirium in older non-cardiac patients: study protocol for a single-Centre, prospective, observational study","volume":"15","author":"Tang","year":"2025","journal-title":"BMJ Open"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e0136071","DOI":"10.1371\/journal.pone.0136071","article-title":"Risk factors and outcomes for postoperative delirium after major surgery in elderly patients","volume":"10","author":"Raats","year":"2015","journal-title":"PLoS One"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-026-07125-2","article-title":"Development and multicenter validation of a dynamic nomogram for early postoperative neurocognitive disorder in older adults with hip fracture","author":"Wei","year":"2026","journal-title":"BMC Geriatr"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1007\/s00520-025-09289-w","article-title":"Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study","volume":"33","author":"Wang","year":"2025","journal-title":"Support Care Cancer"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e2094","DOI":"10.1002\/rcs.2094","article-title":"Postanesthesia care unit delirium following robot-assisted vs open retropubic radical prostatectomy: a prospective observational study","volume":"16","author":"Beck","year":"2020","journal-title":"Int J Med Robot"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13741-022-00253-4","article-title":"Effect of sedative premedication with oral midazolam on postanesthesia care unit delirium in older adults: a secondary analysis following an uncontrolled before-after design","volume":"11","author":"Stuff","year":"2022","journal-title":"Perioper Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1016\/j.jgo.2022.08.014","article-title":"Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery","volume":"13","author":"Yajima","year":"2022","journal-title":"J Geriatric Oncol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3322\/caac.20107","article-title":"Global cancer statistics","volume":"61","author":"Jemal","year":"2011","journal-title":"CA Cancer J Clin"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s12955-021-01705-z","article-title":"Health-related quality of life and self-reported cognitive function in patients with delayed neurocognitive recovery after radical prostatectomy: a prospective follow-up study","volume":"19","author":"Kahl","year":"2021","journal-title":"Health Qual Life Outcomes"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e2565","DOI":"10.1002\/rcs.2565","article-title":"Deep neuromuscular block attenuates intra-abdominal pressure and inflammation and improves post-operative cognition in prostate cancer patients following robotic-assisted radical prostatectomy","volume":"20","author":"Hu","year":"2023","journal-title":"Int J Med Robot Comput Assist Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"104239","DOI":"10.1016\/j.ijnurstu.2022.104239","article-title":"Comparative effectiveness of non-pharmacological interventions for preventing delirium in critically ill adults: a systematic review and network meta-analysis","volume":"131","author":"Chen","year":"2022","journal-title":"Int J Nurs Stud"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"afae248","DOI":"10.1093\/ageing\/afae248","article-title":"World delirium awareness and quality survey in 2023-a worldwide point prevalence study","volume":"53","author":"Lindroth","year":"2024","journal-title":"Age Ageing"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e71242","DOI":"10.1002\/brb3.71242","article-title":"Efficacy of repetitive transcranial magnetic stimulation on postoperative delirium in elderly patients undergoing non-cardiac major surgery: a randomized controlled trial","volume":"16","author":"Gao","year":"2026","journal-title":"Brain Behav"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1111\/anae.16757","article-title":"Effect of peri-operative pharmacological interventions on postoperative delirium in patients having cardiac surgery: a systematic review and Bayesian network meta-analysis","volume":"81","author":"Queiroz","year":"2025","journal-title":"Anaesthesia"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s13063-025-08828-4","article-title":"Effects of opioid-free anesthesia combined with iliofascial nerve block on perioperative neurocognitive deficits in elderly patients undergoing hip fracture surgery: study protocol for a prospective, multicenter, parallel-group, randomized controlled trial","volume":"26","author":"Zhi","year":"2025","journal-title":"Trials"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e0309605","DOI":"10.1371\/journal.pone.0309605","article-title":"Comparative effectiveness of non-pharmacological therapies for postoperative cognitive dysfunction: protocol for a systematic review and network meta-analysis","volume":"19","author":"Wu","year":"2024","journal-title":"PLoS One"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"103114","DOI":"10.1016\/j.ctim.2024.103114","article-title":"Clinical evidence of acupuncture for amnestic mild cognitive impairment: a systematic review and meta-analysis of randomized controlled trials","volume":"88","author":"Lin","year":"2025","journal-title":"Complement Ther Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1111\/anae.70061","article-title":"Interventions to prevent postoperative neurocognitive complications: an umbrella review of meta-analyses of randomised controlled trials","volume":"81","author":"D\u2019Amico","year":"2025","journal-title":"Anaesthesia"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e14373","DOI":"10.1111\/cns.14373","article-title":"Electroacupuncture pretreatment preserves telomerase reverse transcriptase function and alleviates postoperative cognitive dysfunction by suppressing oxidative stress and neuroinflammation in aged mice","volume":"30","author":"Wang","year":"2024","journal-title":"CNS Neurosci Ther"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2669","DOI":"10.1002\/alz.12756","article-title":"The Alzheimer's Association appropriate use recommendations for blood biomarkers in Alzheimer's disease","volume":"18","author":"Hansson","year":"2022","journal-title":"Alzheimers Dement"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"778474","DOI":"10.3389\/fmed.2021.778474","article-title":"Electroacupuncture for the prevention of postoperative cognitive dysfunction among older adults undergoing hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials","volume":"8","author":"Ou","year":"2021","journal-title":"Front Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e23891","DOI":"10.1097\/MD.0000000000023891","article-title":"Effect of electroacupuncture on postoperative cognitive dysfunction for patients undergoing total knee arthroplasty: a protocol for systematic review and meta-analysis of randomized controlled trials","volume":"100","author":"Ye","year":"2021","journal-title":"Medicine"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1007\/s11684-025-1192-9","article-title":"A phase 1\/2 pilot study of acupuncture and moxibustion at Zusanli (ST36) as a prophylactic treatment in middle-aged and elderly individuals","volume":"19","author":"Liang","year":"2025","journal-title":"Med Sci (Paris)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e081660","DOI":"10.1136\/bmj-2024-081660","article-title":"Spirit 2025 explanation and elaboration: updated guideline for protocols of randomised trials","volume":"389","author":"Hr\u00f3bjartsson","year":"2025","journal-title":"BMJ"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1111\/j.1756-5391.2010.01086.x","article-title":"Revised STandards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement","volume":"3","author":"MacPherson","year":"2010","journal-title":"J Evid Based Med"},{"key":"ref28","volume-title":"WHO Standard Acupuncture point Locations in the Western Pacific Region","year":"2008"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1136\/bmj.39339.610000.BE","article-title":"The declaration of Helsinki","volume":"335","author":"Goodyear","year":"2007","journal-title":"BMJ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"554","DOI":"10.7326\/M14-0865","article-title":"3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study","volume":"161","author":"Marcantonio","year":"2014","journal-title":"Ann Intern Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2600751","DOI":"10.1080\/07853890.2025.2600751","article-title":"Comparison of opioid-free versus opioid-based total intravenous anaesthesia in elderly patients undergoing short-duration surgery: a randomized controlled trial","volume":"58","author":"Wei","year":"2026","journal-title":"Ann Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"526","DOI":"10.7326\/M13-1927","article-title":"The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts","volume":"160","author":"Inouye","year":"2014","journal-title":"Ann Intern Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e246589","DOI":"10.1001\/jamanetworkopen.2024.6589","article-title":"Transcranial direct current stimulation for anxiety during laparoscopic colorectal cancer surgery: a randomized clinical trial","volume":"7","author":"Li","year":"2024","journal-title":"JAMA Netw Open"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"112660","DOI":"10.1016\/j.injury.2025.112660","article-title":"Effect of electroacupuncture intervention before and after operation on perioperative neurocognitive disorders in elderly patients with hip fractures: a randomized controlled trial","volume":"56","author":"Long","year":"2025","journal-title":"Injury"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e2337239","DOI":"10.1001\/jamanetworkopen.2023.37239","article-title":"Perioperative factors associated with postoperative delirium in patients undergoing noncardiac surgery: an individual patient data Meta-analysis","volume":"6","author":"Sadeghirad","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"103848","DOI":"10.1016\/j.ajp.2023.103848","article-title":"Evaluation of research trends in the incidence of postoperative neurocognitive disorders in patients undergoing cardiac surgery","volume":"91","author":"Sandeep","year":"2024","journal-title":"Asian J Psychiatr"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1097\/SLA.0b013e3181c1cfc9","article-title":"Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery","volume":"251","author":"Brouquet","year":"2010","journal-title":"Ann Surg"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1016\/j.jtcvs.2015.10.114","article-title":"Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality","volume":"151","author":"Maniar","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"984","DOI":"10.3390\/brainsci10120984","article-title":"Cognitive improvement effects of Electroacupuncture combined with computer-based cognitive rehabilitation in patients with mild cognitive impairment: a randomized controlled trial","volume":"10","author":"Kim","year":"2020","journal-title":"Brain Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.bbi.2020.04.035","article-title":"Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: an assessor-participant blinded, randomized controlled trial","volume":"88","author":"Zhang","year":"2020","journal-title":"Brain Behav Immun"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e7375","DOI":"10.1097\/MD.0000000000007375","article-title":"Effects of preconditioning of electro-acupuncture on postoperative cognitive dysfunction in elderly: a prospective, randomized, controlled trial","volume":"96","author":"Zhang","year":"2017","journal-title":"Medicine"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e97488","DOI":"10.1371\/journal.pone.0097488","article-title":"Effects of acupuncture at GV20 and ST36 on the expression of matrix metalloproteinase 2, aquaporin 4, and aquaporin 9 in rats subjected to cerebral ischemia\/reperfusion injury","volume":"9","author":"Xu","year":"2014","journal-title":"PLoS One"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"909512","DOI":"10.3389\/fnbeh.2022.909512","article-title":"Acupuncture at GV20 and ST36 improves the recovery of behavioral activity in rats subjected to cerebral ischemia\/reperfusion injury","volume":"16","author":"Yang","year":"2022","journal-title":"Front Behav Neurosci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e70696","DOI":"10.1002\/cns.70696","article-title":"Electroacupuncture prevents against AD-like phenotypes in APP\/PS1 mice: investigation of the mechanisms from cerebral Microangiopathy","volume":"31","author":"Yang","year":"2025","journal-title":"CNS Neurosci Ther"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"115637","DOI":"10.1016\/j.expneurol.2025.115637","article-title":"Electroacupuncture ameliorates tau-driven cognitive decline by modulating NF-\u03baB\/NLRP3 inflammasome signaling in P301S mice","volume":"398","author":"Zheng","year":"2025","journal-title":"Exp Neurol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e16755","DOI":"10.1016\/j.heliyon.2023.e16755","article-title":"Electroacupuncture at ST 36 ameliorates cognitive impairment and beta-amyloid pathology by inhibiting NLRP3 inflammasome activation in an Alzheimer's disease animal model","volume":"9","author":"Ni","year":"2023","journal-title":"Heliyon"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1790084\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:43:24Z","timestamp":1775022204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1790084\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":46,"alternative-id":["10.3389\/fmed.2026.1790084"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1790084","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1790084"}}