Transcutaneous Electrical Acupoint Stimulation Decreases the Incidence of Postoperative Nausea and Vomiting After Laparoscopic Non-gastrointestinal Surgery: A Multi-Center Randomized Controlled Trial.

Bingyu Liu,Xiaqing Zhang,Xinli Ni,Shanshan Zhang,Wenting Chen,Ge Wang,Ruini Du,Jiaqiang Zhang,Lan Yang,Jie Fang,Linzhong Zhang,Haiyun Wang,Chenggang Wang,Xuechang Han,Lai Wei,Qiang Wang,Yajuan Li,Wei Gao,Qi Zhou

doi:10.3389/fmed.2022.766244

Abstract

ImportancePostoperative nausea and vomiting (PONV) gives patients a bad experience and negates their good recovery from surgery.ObjectiveThis trial aims to assess the preventive effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on the incidence of PONV in high-risk surgical patients.DesignThe large sample size, multicenter, evaluator-blinded, and randomized controlled study was conducted between September 3, 2019 to February 6, 2021.SettingThe 12 hospitals were from different Chinese provinces.ParticipantsAfter obtaining ethics approval and written informed consent, 1,655 patients with Apfel score ≥ 3 points were enrolled for selective laparoscopic non-gastrointestinal surgery under general anesthesia.InterventionsPatients were randomly allocated into the TEAS and Sham group with a 1:1 ratio. The TEAS group was stimulated on bilateral Neiguan and Zusanli acupoints after recovery from anesthesia on the surgical day and the next morning for 30 min, while the Sham group received an identical setting as TEAS but without currents delivered. Electronic patient self-reported scale was used to evaluate and record the occurrence of PONV.Main Outcomes and MeasuresPrimary clinical end point is the incidence of PONV which was defined as at least one incidence of nausea, retching, or vomiting after operation within postoperative 24 h.ResultsCompared with the Sham treatment, the TEAS lowered the PONV incidence by 4.8% (29.4 vs. 34.2%, P = 0.036) and vomiting incidence by 7.4% (10.4 vs. 17.8%, P < 0.001). TEAS also lowered persistent nausea incidence and PONV scores and decreased PONV related complications and Quality of Recovery−40 scores (P < 0.05). TEAS lowered the 24 h PONV risk by 20% (OR, 0.80, 95% CI, 0.65 −0.98; P = 0.032), and lowered hazard ratio by 17% (HR, 0.83, 95% CI, 0.70–0.99; P = 0.035). Both TEAS and palonosetron were the independent PONV risk protective factors for 24 h PONV incidence and cumulative PONV incidence. The combination of TEAS and palonosetron was the most effective strategy to reduce the PONV incidence (P < 0.001).Conclusions and RelevanceTEAS attenuated the PONV incidence and severity in high-risk surgical patients and may be applied clinically as a complement therapy to prevent PONV.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04043247, identifier: NCT04043247.

Highlights

Postoperative nausea and vomiting (PONV), characterized as nausea, retching, or vomiting or any these symptoms in combination after surgery, is one of the most common complaints after surgery with an overall incidence of 30%, but its incidence can be as high as to be 60–80% in high-risk patients who have three or four PONV risk factors [1]
The anticholinergics, antiemetics, and multimode analgesics used during the perioperative period showed no significant differences between the two groups, except the parecoxib usage was more often higher in the Transcutaneous electrical acupoint stimulation (TEAS) group than in the Sham group (Table 2)
Our study found that the TEAS significantly decreased the 24 h PONV incidence and lowered persistent nausea incidence, PONV scores, and postoperative 24 h cumulative PONV incidences

Summary

Introduction

Postoperative nausea and vomiting (PONV), characterized as nausea, retching, or vomiting or any these symptoms in combination after surgery, is one of the most common complaints after surgery with an overall incidence of 30%, but its incidence can be as high as to be 60–80% in high-risk patients who have three or four PONV risk factors [1]. Even though the incidence of PONV can be decreased by using less opioids and inhalational anesthetics and even using antiemetic drugs, its occurrence is still high, with up to 20% of high-risk patients treated with three antiemetic prophylaxis [1, 3]. Owning to multiple mechanisms triggering PONV, several antiemetic drugs are often used clinically in high-risk PONV patients [4], but their effectiveness is still limited and include unwanted side effects such as headaches, xerostomia, abnormal liver function, and extrapyramidal reactions [5–8]. Non-pharmaceutical therapy including acupuncture has considerable advantages, for example, nontoxic effects, which has been widely used in postoperative pain analgesia and gastrointestinal function rehabilitation [9, 10]. The large sample size, multicenter, evaluator-blinded, and randomized controlled study was carried out to verify the effectiveness of TEAS on P6 and Zusanli (ST36) in reducing the incidence of PONV

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Discussion

Conclusion