Integrating acupoint stimulation in postoperative nausea and vomiting management: a path to enhanced recovery

Postoperative nausea and vomiting (PONV) is among the most common complications following general anesthesia, affecting approximately 30% of all surgical patients and up to 60–80% of high-risk individuals1. The occurrence of PONV not only impairs patient comfort but also increases the risk of severe complications, such as aspiration, wound dehiscence, and delayed recovery2. Traditional pharmacological treatments, such as antiemetic drugs, are commonly used to manage PONV but often have side effects such as headaches, dizziness, and dry mouth3,4. Therefore, non-pharmacological interventions, particularly acupoint stimulation techniques, have gained attention as an effective alternative for preventing PONV. A recent network meta-analysis by Zhou et al. systematically evaluated the effectiveness of different acupoint stimulation techniques, including acupuncture, acupressure, transcutaneous electrical acupoint stimulation (TEAS), and electroacupuncture, in preventing PONV after general anesthesia5. The study analyzed data from 50 randomized controlled trials involving 7,372 participants, with a median age of 43.5 years, 73.3% of whom were female. The results revealed that both TEAS and electroacupuncture significantly reduced the incidence of PONV, PON (postoperative nausea), and POV (postoperative vomiting), either alone or in combination with antiemetic drugs. Notably, the combination of TEAS with antiemetics showed the highest effectiveness in reducing PONV, with a relative risk (RR) of 0.53 compared to the control group. Electroacupuncture alone had an RR of 0.43, indicating its substantial efficacy in preventing PONV. These findings highlight the potential of acupoint stimulation techniques, especially TEAS and electroacupuncture, as valuable adjuncts in PONV management. Acupoint stimulation techniques, rooted in traditional Chinese medicine (TCM), have been used for centuries to regulate the flow of energy (Qi) and maintain bodily balance6. The most commonly targeted acupoints for preventing PONV include PC6 (Neiguan), LI4, ST36, and SP6, which are believed to modulate the autonomic nervous system and influence gastrointestinal motility.7-9 Acupoint stimulation can be categorized into physical stimulation methods, such as acupuncture and acupressure, and electrical stimulation methods, including TEAS and electroacupuncture10. Physical stimulation techniques, like acupuncture and acupressure, involve inserting fine needles into specific acupoints or applying pressure to stimulate them. Although these methods have demonstrated efficacy in reducing PONV, they are often limited by their invasiveness and the need for trained practitioners11. In contrast, electrical stimulation techniques like TEAS and electroacupuncture offer a more convenient and less invasive alternative, delivering electrical impulses to acupoints through electrodes placed on the skin. Studies have shown that electrical stimulation techniques, particularly TEAS and electroacupuncture, are more effective than physical stimulation methods in reducing the incidence of PONV7,12,13. TEAS in particular, has been demonstrated to modulate the autonomic nervous system and enhance the body’s endogenous production of endorphins and serotonin, contributing to its antiemetic effects14. This non-invasive approach offers a practical solution for perioperative management, reducing reliance on pharmacological interventions. Electroacupuncture, which combines the principles of acupuncture with electrical stimulation, provides a more robust activation of the acupoints and has been shown to be highly effective in preventing PONV7. By regulating neurotransmitter release and modulating the vagal nerve, electroacupuncture can significantly reduce the occurrence of nausea and vomiting following surgery, offering a promising alternative to conventional treatments. Growing evidence supporting the efficacy of acupoint stimulation techniques in preventing PONV has important clinical implications. These techniques, particularly TEAS and electroacupuncture, offer a non-pharmacological approach that can be easily integrated into perioperative care, reducing reliance on antiemetic medications and their associated side effects. Moreover, their use can be tailored to individual patient needs, providing a personalized approach for PONV management. Future research should focus on optimizing the application protocols for acupoint stimulation, including the timing, duration, and intensity of stimulation, to maximize therapeutic benefits. Additionally, exploring the mechanisms underlying the antiemetic effects of acupoint stimulation could provide valuable insights into the development of targeted interventions for PONV. In conclusion, acupoint stimulation techniques, especially TEAS and electroacupuncture, have demonstrated significant potential in preventing postoperative nausea and vomiting, either alone or in combination with antiemetic drugs. These non-pharmacological interventions represent a valuable addition to perioperative care, offering an effective and patient-centered approach for reducing PONV. As research continues to explore the integration of acupoint stimulation into standard clinical practice, its role in enhancing patient outcomes and reducing the burden of PONV is likely to expand.