Background <p>This study investigated the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative recovery in patients undergoing internal spinal-fixation surgery.</p> Methods <p>Seventy-four patients scheduled for elective internal spinal fixation surgery at the First People's Hospital of Pinghu City between August 2024 and April 2025 were enrolled. Patients were aged 19–78 years, of either gender, with American Society of Anesthesiologists class II or III and a body mass index of 17–33 kg/m². They were randomly assigned to a TEAS-assisted general anaesthesia group (Group T) or a general anaesthesia-only group (Group G) using a random number table, with 37 patients per group. In Group T, TEAS was initiated 30 min before anaesthesia induction. The Neiguan, Hegu, and Ashansanli acupoints were electrically stimulated at a frequency of 2 Hz/100 Hz and an intensity of 8–12 mA, continuing until completion of incision suturing. In Group G, electrode pads were placed at the same acupoints, but no electrical stimulation was administered. The primary outcome was Quality of Recovery-15 (QoR-15) scores at 24 h postoperatively. The secondary outcomes were intraoperative remifentanil and propofol dosages, QoR-15 scores at 72 h postoperatively, time to first postoperative analgesic pump use, and total opioid consumption during the 72 h postoperative period. Other outcomes were length of hospitalization, satisfaction scores at discharge, and incidence of adverse events during hospitalization.</p> Results <p>Group T had significantly higher QoR-15 scores at both 24 h and 3 d postoperatively, lower intraoperative remifentanil consumption, longer time to first postoperative use of the analgesic pump, lower opioid consumption during the 72 h postoperative period, and higher satisfaction scores at discharge (<i>P</i> &lt; 0.05), than Group G.</p> Conclusions <p>TEAS improves the quality of postoperative recovery in patients undergoing internal spinal-fixation surgery.</p> Trial registration <p>ITMCTR2025000399. <a href="http://itmctr.ccebtcm.org.cn">http://itmctr.ccebtcm.org.cn</a></p>