Background: Preoperative anxiety causes a profound psychological and physiological reactions, that may lead to a worse postoperative recovery, higher intensity of acute and persistent postsurgical pain and impaired quality of life in the postoperative period. Previous randomized controlled trials (RCTs) suggest that auricular acupuncture (AA) is safe and effective in treatment of preoperative anxiety; a systematic evidence on this topic is missing. Therefore, this protocol was developed following the PRISMA guidelines to adequately evaluate the existing literature regarding the value of AA for the reduction of anxiety in patients in a preoperative setting, compared to other forms of acupuncture or pharmacological or no control interventions and measured with questionnaires regarding anxiety and fear. Methods and analysis: The following databases will be searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, Scopus Database and Google search. RCTs will be included if an abstract is available in English. Data collection and analysis will be conducted by 2 reviewers independently. Quality and risk assessment of included studies will be done using the Cochrane 5.1.0 handbook criteria and meta-analysis of effectiveness and symptom scores will be conducted using the statistical software RevMan V.5.3.Ethics and dissemination: This systematic review will evaluate the efficacy and safety of AA for preoperative anxiety. Since all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. The results may be published in a peer-reviewed journal or be presented in relevant conferences.Registration number: PROSPERO ID CRD42020184795