Based on the application practice of perioperative acupuncture in enhanced recovery after surgery (ERAS), this paper study explores the current limitations and clinical implementation bottlenecks of the ERAS pathways, and systematically reviews the unique clinical advantages of acupuncture in perioperative management—including alleviating preoperative anxiety, mitigating postoperative pain, accelerating gastrointestinal function recovery, preventing and treating perioperative neurocognitive disorders, and improving frailty and fatigue. Meanwhile, it analyzes the major challenges confronted by acupuncture in ERAS-related clinical research, such as the lack of unified operational standards for acupuncture, uneven quality of research methodologies, and insufficient interdisciplinary collaboration. On this basis, several targeted countermeasures and suggestions are put forward, emphasizing the need to strengthen multi-disciplinary team cooperation, upgrade the quality of clinical research design, and explore the integration of advanced technologies such as artificial intelligence in efficacy evaluation and protocol optimization. This work aims to collate empirical evidence for the perioperative treatment model integrating traditional Chinese and Western medicine, promote the rational allocation of medical resources, and ultimately achieve the optimization of patient-centered surgical outcomes.