One hundred and twenty elderly patients undergoing elective orthopedic lower limb surgery were randomized to receive either perioperative buccal acupuncture (n=60) or no acupuncture (control group, n=60). The primary outcome was the incidence of postoperative delirium (POD) during the first 7 postoperative days. Secondary outcomes included delirium severity, duration, subtype; intraoperative total consumption of sufentanil and remifentanil; venous blood levels of IL-6, IL-8, and norepinephrine; the total number of electronic analgesia pump compressions; incidence of nausea and vomiting within 48 hours; postoperative pain scores; length of hospital stay; and postoperative adverse event rates. Overall, the results revealed a significantly lower incidence of POD in the intervention group compared to controls. The intervention group also showed lower opioid consumption, pain scores, and nausea and vomiting rates. The study suggests that perioperative buccal acupuncture may be a promising approach for reducing the risk of POD and postoperative pain.