Effectiveness and mechanisms of wearable Neiguan (P6) stimulation in preventing postoperative nausea and vomiting: A systematic review and meta-analysis

ANESTHESIA has become remarkably safe, and while death and permanent damage have become rare occurrences, other sequelae of anesthesia are gaining more importance. Postoperative nausea and vomiting (PONV) still is the most troublesome adverse event encountered in the recovery room, despite advances in prevention and treatment. The incidence of PONV has remained high and has a major negative impact on patient satisfaction about the overall surgical experience. Furthermore, the ongoing trend toward ambulatory procedures has increased the focus on PONV as its occurrence may delay discharge or cause unanticipated hospital admission. General anesthesia has long been considered as causing a greater frequency and severity of PONV than regional anesthetic techniques. Recent studies investigating this time-honored dictum in a controlled manner mostly, but not unanimously, confirmed it. Accordingly, considerable effort has been invested to examine etiology, define patients at risk, and outline preventive and therapeutic strategies in patients undergoing general anesthesia. Reviews dealing with PONV have discussed almost exclusively general anesthesia and largely ignored regional anesthesia. This contrasts with the increasing popularity of regional anesthesia. A survey in Europe showed that one third of patients are undergoing regional anesthesia for their operative procedure. In France, the proportion of regional anesthesia increased from 15 to 25% of all anesthetics administered from 1980 to 1996. The number of local anesthetic and analgesic agents available for regional anesthesia has increased over the last two decades. Since the introduction of intrathecal and epidural morphine in 1979, a multitude of medications, such as synthetic opioids, 2-agonists, and cholinesterase inhibitors, have been introduced in an attempt to enhance the action of local anesthetics. The decision about their usefulness will not only rely on their effects on nerve blockade and pain relief, but also on their influence on side effects such as PONV. This review focuses on PONV in the setting of perioperative regional anesthesia. General aspects of PONV, such as physiology, patient, and perioperative factors involved are discussed. Few studies regarding these issues have been specifically devoted to regional anesthesia. Therefore, much information must be derived from investigations of general anesthesia. Specific regional anesthetic techniques and the influence of adjunctive medications on PONV are also presented. Combined general–regional anesthesia is purposefully excluded, avoiding the many variables introduced by general anesthesia. A final section is devoted to continuous peripheral nerve blocks and their possible impact on PONV.

The efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis

BackgroundPostoperative nausea and vomiting is a distressing complication of surgery, and 5-HT3 receptor antagonists are often prescribed to prevent it. Ondansetron is the agent typically administered to prevent postoperative nausea and vomiting. Although ramosetron has a longer duration of action than ondansetron, it remains unclear whether ramosetron is the more effective medication. We performed an updated meta-analysis on the comparative efficacy of ramosetron and ondansetron in preventing postoperative nausea and vomiting.MethodsWe searched six databases for all trials that randomly assigned patients to ramosetron or ondansetron groups. The primary outcome was postoperative nausea or vomiting in the early, late, and next-day periods. The secondary outcomes were side effects of the medications. We used the random-effects model to combine the results. Trial sequential analyses were performed to correct for repetitive testing in the updated meta-analysis.ResultsTwenty-seven randomized controlled trials with 3,811 patients were included in the meta-analysis. The combined results of ramosetron vs. ondansetron efficacy in preventing postoperative nausea and vomiting were as follows: Risk ratio [95% confidence interval] = 0.82 [0.69–0.98] for early postoperative nausea, 0.76 [0.65–0.89] for late postoperative nausea, 0.69 [0.57–0.84] for next-day postoperative nausea, 0.78 [0.63–0.98] for early postoperative vomiting, 0.57 [0.45–0.72] for late postoperative vomiting, and 0.61 [0.43–0.86] for next-day postoperative vomiting. Dizziness was significantly lower in ramosetron groups than in ondansetron groups (risk ratio [95% confidence interval] = 0.81 [0.66–0.98]). Trial sequential analysis revealed that the results for late postoperative nausea, late postoperative vomiting, and next-day postoperative nausea were conclusive.ConclusionsRamosetron is more effective in preventing late postoperative nausea, late postoperative vomiting, and next-day postoperative nausea than ondansetron. The incidence of dizziness may be lower in patients receiving ramosetron than in patients receiving ondansetron.Trial registrationUniversity hospital Medical Information Network Clinical Trials Registry: UMIN000022980

Postoperative nausea and vomiting are typical postsurgical complications. Drug therapy is only partially effective. The goal of our meta-analysis is to systematically evaluate the efficacy and safety of electrical acupoint stimulation for postoperative nausea and vomiting and to score the quality of evidence supporting this concept. PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 19, 2020. Twenty-six studies (2064 patients) were included. Compared with control treatment, electrical acupoint stimulation reduced the incidence of postoperative nausea and vomiting (RR 0.49, 95% CI 0.41 to 0.57, P < 0.001), postoperative nausea (RR 0.55, 95% CI 0.47 to 0.64, P < 0.001) and postoperative vomiting (RR 0.56, 95% CI 0.45 to 0.70, P < 0.001). Electrical acupoint stimulation also reduced the number of patients requiring antiemetic rescue (RR 0.60, 95% CI 0.43 to 0.85, P = 0.004). No differences in adverse events were observed. Subgroup analysis showed that both electroacupuncture (RR 0.58, 95% CI 0.46 to 0.74, P < 0.001) and transcutaneous electrical acupoint stimulation (RR 0.44, 95% CI 0.34 to 0.58, P < 0.001) had significant effects. Electrical acupoint stimulation was effective whether administered preoperatively (RR 0.40, 95% CI 0.27 to 0.60, P < 0.001), postoperatively (RR 0.59, 95% CI 0.46 to 0.76, P < 0.001), or perioperatively (RR 0.50, 95% CI 0.37 to 0.67, P < 0.001). The quality of evidence was moderate to low. Electrical acupoint stimulation probably reduce the incidence of postoperative nausea and vomiting, postoperative nausea, postoperative vomiting, and reduce the number of patients requiring antiemetic rescue, with few adverse events.

Background:Patients who experience postoperative nausea and vomiting are not happy with their surgical outcomes. Preventing this problem expedites the patients’ return to normal activities following surgery and significantly increases their satisfaction. There are no condensed results that show the prevalence and contributing variables of postoperative nausea and vomiting in Africa. Thus, the purpose of this meta-analysis and comprehensive review was to ascertain the prevalence and contributing variables of postoperative nausea and vomiting in Africa.Methods:Studies were retrieved from the PubMed, EMBASE, Cochrane Database, CINAHL, Scopus, Mednar, and Google Scholar databases using combinations of searching terms and Boolean operators. I-squared (I2) statistics is used for evaluating study heterogeneity. Every publication is assessed for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal criteria. Using a funnel plot, publication bias is visually assessed. Subgroup analyses investigate the source of heterogeneity. To determine whether publication bias exists, the Eggers weighted regression test is employed. STATA software version 14 was used to perform statistical analyses.Results:In Africa, the combined incidences of nausea 24.96 % (95% CI: 17.903-32.018), vomiting 23.655 % (95% CI: 17.542-29.769) and nausea with vomiting 15.27 % (95% CI: 9.118-21.424) . History of motion sickness (odds ratio [OR]: 3.19 (95% CI 1.08–9.42), P < 0.036) and history of postoperative nausea and vomiting (OR: 4.33 (95% CI 2.654–7.07), P < 0.001) were factors linked to postoperative nausea and vomiting. Compared to their counterparts, patients who underwent more risky surgical procedures had a 1.4-fold increased chance of developing postoperative nausea and vomiting. Patients who skipped the use of prophylactic medication for nausea and vomiting had a 59% higher risk of experiencing postoperative nausea and vomiting than those who did [OR: 1.39 (95% CI (1.074–1.769), P < 0.012) and OR: 0.194 (95% CI (0.04–0.935), P < 0.001)], respectively.Conclusion:Postoperative nausea and vomiting were more common in surgically treated African individuals. Clinical interventions are needed to prevent, diagnose, and treat postoperative nausea and vomiting (PONV), with a focus on patients who have experienced motion sickness, high-risk surgery, or PONV in the past. It is advisable to use whole intravenous anesthesia based on Propofol for surgery, if feasible.

This updated systematic review and meta-analysis with trial sequential analysis aimed to compare the efficacy of the perioperative administration of palonosetron with that of ramosetron in preventing postoperative nausea and vomiting (PONV). A total of 17 randomized controlled trials comparing the efficacy of the perioperative administration of palonosetron to that of ramosetron for preventing PONV were included. The primary outcomes were the incidences of postoperative nausea (PON), postoperative vomiting (POV), and PONV, which were measured in early, late, and overall phases. Subgroup analysis was performed on the basis of the administration time of the 5-HT3 receptor antagonist and divided into two phases: early phase and the end of surgery. A total of 17 studies with 1823 patients were included in the final analysis. The incidence of retching (relative risk [RR] = 0.525; 95% confidence interval [CI] = 0.390 to 0.707) and late POV (RR = 0.604; 95% CI = 0.404 to 0.903) was significantly lower in the palonosetron group than in the ramosetron group. No significant differences were demonstrated in the incidence of PON, PONV, complete response, use of antiemetics, and adverse effects. Subgroup analysis showed that palonosetron was superior to ramosetron in terms of early PON, late PON, overall POV, and use of rescue antiemetics when they were administered early; in terms of retching, regardless of the timing of administration. Ramosetron was superior to palonosetron in terms of early PON when they were administered late. The prophylactic administration of palonosetron was more effective than that of ramosetron in preventing the development of retching and late POV. In this meta-analysis, no significant differences in PONV prevention between the two drugs were demonstrated. Further studies are required to validate the outcomes of our study.

Side effect profiles of different opioids in the perioperative setting: are they different and can we reduce them?

Background: Bariatric surgery is associated with significant postoperative challenges, including pain and nausea. Dexmedetomidine (Dex), an alpha-2 adrenergic agonist, is commonly used to manage pain and postoperative nausea and vomiting (PONV) in various surgical settings. This meta-analysis evaluates the efficacy of Dex in bariatric surgery patients, focusing on postoperative pain intensity, opioid consumption, and PONV. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2010 and 2023, assessing Dex use during or after bariatric surgery. Studies comparing Dex to placebo or standard care were included. Data extraction was performed independently by two reviewers, and statistical analysis was conducted using a random-effects model. Study quality was assessed using the Cochrane Risk of Bias tool. Results: Six RCTs (485 participants) met the inclusion criteria. Dex significantly reduced intraoperative fentanyl use (SMD -1.33, 95% CI [-2.19, -0.47], p = 0.002). Pain scores showed mixed results, with some studies reporting lower pain intensity in the Dex group, while others found no significant difference compared to morphine or placebo. PONV scores were generally lower in the Dex group (p = 0.01) compared to placebo and morphine. No significant differences were found in morphine consumption (SMD -1.13, 95% CI [-2.24, 0.01], p = 0.05) or recovery time. Conclusions: Dexmedetomidine appears to reduce opioid requirements and postoperative nausea in bariatric surgery patients. However, the variability in pain management outcomes suggests that further well-designed RCTs are needed to confirm its overall efficacy. The findings are based on moderate-quality evidence, and further research should aim to standardize dosing protocols and patient populations.

ystematic reviews provide the best estimates ofthe true effects (both beneficial and adverse) ofmedical interventions (1). In this era of evidence-based medicine, clinicians are increasingly using sys-tematic reviews to keep up with new evidence and toguide their clinical decision-making. Yet the mainchallenges for clinicians are to translate the results ofsystematic reviews into clinical practice and to pro-vide optimal patient care. This concept is known as“applicability.” Applicability addresses whether aparticular treatment that showed an overall benefit ina study or systematic review can be expected to con-vey the same benefit to an individual patient (2).This paper outlines a framework for how quantita-tive systematic reviews (meta-analyses) should be re-ported and how they may be used to identify thoseindividuals in whom the treatment is likely to do moregood than harm. We illustrate the concepts by usingdata from systematic reviews of ondansetron for thetreatment and prevention of postoperative nausea andvomiting (PONV). Throughout this paper, we use theterms “baseline” and “underlying risk” interchange-ably. Underlying risk is defined as the risk of event fora patient under the control condition; it indicates theaverage risk of a patient if not treated (3).

Effectiveness of Music Intervention on Postoperative Nausea and Vomiting: A Systematic Review and Meta-analysis

The preventive and relieving effects of ginger on postoperative nausea and vomiting: A systematic review and meta-analysis of randomized controlled trials

Transdermal scopolamine for the prevention of postoperative nausea and vomiting: A systematic review and meta-analysis

To evaluate the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in relieving postoperative pain and reducing the incidence of postoperative nausea and vomiting (PONV) in patients undergoing cancer surgery. A systematic search was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, and Wanfang databases to identify randomized controlled trials (RCTs) published between January 2015 and May 2025. Postoperative pain scores at different time points, assessed using the visual analog scale (VAS) or numerical rating scale (NRS), as well as the incidence of PONV, postoperative nausea (PON), and postoperative vomiting (POV), were extracted. Subgroup analyses were performed according to the timing of TEAS intervention and pain assessment methods. The risk of bias was evaluated using the Cochrane Risk of Bias (RoB) tool, and the meta-analysis was conducted using RevMan 5.4 software. A total of 16 randomized controlled trials involving 2,017 postoperative cancer patients were included (1,125 in the TEAS group and 892 in the control group). Meta-analysis of 13 studies showed that TEAS significantly reduced postoperative pain scores (SMD = -1.19, 95% CI: -1.42 to -0.95, p < 0.00001). Eleven studies indicated that TEAS decreased the incidence of PONV (RR = 0.47.95% CI:0.37~0.61, P<0.00001). Four studies were included in the meta-analysis of postoperative nausea, showing a significant reduction in incidence in the TEAS group compared to controls (RR = 0.33, 95% CI: 0.22 to 0.49, p < 0.00001). Another four studies showed a downward trend in postoperative vomiting but without statistical significance (RR = 0.69, 95% CI: 0.44 to 1.09, p = 0.11). TEAS appears to be an effective adjunctive intervention for alleviating postoperative pain and nausea in patients undergoing cancer surgery, showing clear clinical advantages. Further high-quality, large-scale, and multicenter studies are warranted to confirm its long-term efficacy and to promote the standardization of TEAS protocols for broader clinical application. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038890.

To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Systematic review and network meta-analysis (NMA). MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. Randomized clinical trials that investigated the efficacy of pharmacologic interventions in preventing PONV in patients undergoing thyroidectomy were included. The primary endpoints were the incidences of postoperative nausea and vomiting (PONV), postoperative nausea (PON), postoperative vomiting (POV), use of rescue antiemetics, and incidence of complete response in the overall postoperative phases. The secondary endpoints were the same parameters assessed in the early, middle, and late postoperative phases. The surface under the cumulative ranking curve (SUCRA) values and rankograms were used to present the hierarchy of pharmacologic interventions. Twenty-six studies (n = 3,467 patients) that investigated 17 different pharmacologic interventions were included. According to the SUCRA values, the incidence of PONV among the overall postoperative phases was lowest with propofol alone (16.1%), followed by palonosetron (27.5%), and with tropisetron (28.7%). The incidence of PON among the overall postoperative phases was lowest with propofol alone (11.8%), followed by tropisetron and propofol combination (14%), and ramosetron and dexamethasone combination (18.0%). The incidence of POV among the overall postoperative phases was lowest with tropisetron and propofol combination (2.2%), followed by ramosetron and dexamethasone combination (23.2%), and tropisetron alone (37.3%). The least usage of rescue antiemetics among the overall postoperative phases and the highest complete response was observed with tropisetron and propofol combination (3.9% and 96.6%, respectively). Propofol and tropisetron alone and in combination, and the ramosetron and dexamethasone combination effectively prevented PONV, PON, POV in patients undergoing thyroidectomy, with some heterogeneity observed in this NMA of full-text reports. Their use minimized the need for rescue antiemetics and enhanced the complete response. CRD42018100002.

Ramosetron has been shown to have a very strong effect for preventing postoperative nausea and vomiting (PONV) in previous meta-analyses. However, these previous meta-analyses included a number of studies by Fujii et al. which have now been proven to have been fabricated. In the present meta-analysis, we reevaluated the effectiveness of ramosetron in preventing PONV after excluding Fujii et al.'s randomized controlled trials. We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. All double-blind randomized controlled trials that tested the efficacy of ramosetron compared with a placebo or other drugs as a control in the prophylaxis of PONV were considered to be eligible. The first postoperative 24 hours were divided into early (0-6 hours) and late (6-24 hours) time periods, and we collected these data separately. A total of 1372 patients were included in the final analysis. Compared with a placebo, ramosetron reduced the incidence of early postoperative nausea (PON) (relative risk [RR] [95% confidence interval] 0.59 [0.47-0.73]: number needed to treat [NNT] [95% confidence interval] 6.0 [4.3-9.7]), late PON (RR 0.65 [0.49-0.85]: NNT 7.2 [4.6-16.6]), early postoperative vomiting (POV) (RR 0.48 [0.31-0.74]: NNT 14.8 [8.3-70.4]), and late POV (RR 0.50 [0.35-0.73]: NNT 12.3 [7.1-47.6]). Compared with ondansetron, ramosetron reduces early POV (RR 0.50 [0.28-0.90]: NNT 24.1 [10.7-98.0]) and late POV (RR 0.53 [0.34-0.81]: NNT 27.2 [12.0-102.0]) but not PON. Ramosetron has a significant effect for preventing PONV compared with a placebo, but less than that reported in previous analyses. Ramosetron also has statistically significant differences in preventing early and late POV compared with ondansetron, but the clinical significance may be questioned because the NNTs are large.