Perioperative pain management remains challenging, as inadequate analgesia may delay recovery and increase opioid exposure. Multidisciplinary pain management (MPM) emphasizes multimodal and collaborative strategies, creating opportunities for integrating non-pharmacological interventions. Acupuncture anesthesia (AA), derived from traditional Chinese medicine, has re-emerged as a potential adjunct in perioperative care through modulation of nociceptive transmission, stress responses, and opioid requirements. This review summarizes the historical development, proposed neuroimmune mechanisms, and current clinical applications of AA in modern perioperative settings. Evidence from randomized controlled trials and meta-analyses suggests that AA may reduce postoperative pain scores, opioid consumption, and postoperative nausea and vomiting, and facilitate recovery in selected procedures. Moderate-level evidence supports its adjunctive role in gastrointestinal, orthopedic, and gynecological surgeries, whereas evidence in thoracic, cardiac, and highly invasive procedures remains limited and inconsistent. Critically, current evidence is constrained by small sample sizes, heterogeneous acupuncture protocols, inadequate blinding, regional concentration of studies, and insufficient long-term outcome reporting. These limitations reduce external validity and hinder guideline-level recommendations. Overall, AA shows promise as part of MPM pathways, particularly in enhanced recovery protocols, but standardized intervention protocols and large multicenter high-quality trials are needed before broader implementation in perioperative anesthesia practice.

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