Key messages
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Both invasive (such as needle acupuncture) and noninvasive (such as acupressure wristbands) PC6 acupoint stimulation techniques, when used in combination with antiemetic (anti-sickness) drugs, may reduce the likelihood of nausea and vomiting after surgery compared to sham treatments (such as a device applied in a non-PC6 acupoint location, or any attempt to imitate (give the illusion of) PC6 acupoint stimulation, or the use of placebo (sham drug - saline) antiemetic drugs).
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Combining noninvasive PC6 acupoint stimulation techniques with antiemetic drugs probably reduces the need for additional drug therapy later on. However, we are uncertain about the minor side effects of PC6 acupoint stimulation techniques, as these were not frequently reported.
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More high-quality studies are needed to investigate the combined use of PC6 acupoint stimulation techniques and antiemetic drugs in children and in low-income countries.
What is postoperative nausea and vomiting, and how is it treated?
Nausea and vomiting are two of the most common unwanted effects (affecting up to 80% of patients) following surgery and general anaesthesia (medications that induce unconsciousness and unresponsiveness to pain during operations). Antiemetic medications are administered to help prevent these symptoms but are only partially effective. Some antiemetics may cause side effects, such as drowsiness, headaches, or wound infections. For some people, experiencing nausea or vomiting despite receiving antiemetic treatment may lead to unexpectedly longer hospital stays, potentially accompanied by other complications. Stimulating the wrist acupuncture point known as PC6 (Neiguan) is an alternative method that may help alleviate nausea and vomiting with fewer side effects than traditional antiemetics.
What did we want to find out?
We aimed to determine how many individuals receiving wrist PC6 acupoint stimulation experienced postoperative nausea and vomiting, and whether there were any unwanted effects. Additionally, we sought to find out if PC6 acupoint stimulation techniques, antiemetics, or both were more effective than sham treatments, and which technique proved most effective.
What did we do?
We searched for studies that randomly assigned participants to receive wrist PC6 acupoint stimulation with or without antiemetics while ensuring that participants were unaware whether they received active or inactive PC6 acupoint stimulation, another antiemetic, or a saline injection. Studies that investigated other acupoints in conjunction with wrist PC6 (Neiguan) were excluded. We compared direct results (from head-to-head comparisons) and indirect results (from comparisons linked to a common treatment) of various wrist PC6 acupoint stimulation techniques with or without antiemetics and rated our confidence in the evidence based on the quality of studies' methods and the numbers of participants.
What did we find?
We identified 77 studies involving 9847 participants at risk of postoperative nausea and vomiting from the time of awakening after surgery under local or general anaesthesia until discharge. Most studies focused on adults from middle- to high-income countries.
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Invasive PC6 techniques (such as needle acupuncture) and noninvasive PC6 techniques (such as acupressure bands) may reduce postoperative nausea and vomiting (135 to 247 fewer people per 1000).
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The combination of invasive PC6 techniques with antiemetics may result in moderate to large reductions in postoperative nausea and vomiting (203 to 383 fewer people per 1000).
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Noninvasive PC6 acupoint stimulation techniques combined with antiemetics probably decrease the need for additional drug therapy when initial prevention fails (180 fewer people per 1000).
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None of the included studies reported serious or long-term complications. Minor side effects that go away (such as skin irritation, blistering, redness, and pain) may occur with PC6 acupoint stimulation; however, we have very low confidence in these findings.
What are the limitations of the evidence?
Our confidence in the evidence is generally low due to several factors: variability in study quality, diversity amongst surgical populations, differences in treatment duration examined, and timing of assessments for postoperative nausea and vomiting. Many studies did not consistently collect or report unwanted side effects. Results from further well-designed research from low-income countries and in children could potentially alter the results of this review.
How up to date is this evidence?
This review updates our previous review published in 2015. The evidence is current as of June 2025.
อ่านบทคัดย่อฉบับเต็ม
Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Antiemetic drugs are only partially effective in preventing PONV. An alternative approach is to stimulate the PC6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004, updated in 2009 and now in 2015.
วัตถุประสงค์
To update and compare the effects and safety of PC6 acupoint stimulation with or without antiemetic drug(s) versus sham or antiemetic drug(s) for preventing postoperative nausea (PON) and postoperative vomiting (POV) in people undergoing surgery, and to identify the most effective techniques using network meta-analyses (NMAs).
วิธีการสืบค้น
We searched CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, WHO Global Index Medicus, major trial registries, and reference lists of articles for studies up to 6 June 2025, with no language restrictions.
เกณฑ์การคัดเลือก
All randomized trials of techniques that stimulated the PC6 acupoint compared with sham treatment or drug therapy, or combined PC6 acupoint and drug therapy compared to drug therapy, for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous electrical acupoint stimulation, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, acu-stimulation device, and acupressure in people undergoing surgery. Primary outcomes were the incidences of nausea and vomiting after surgery. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.
การรวบรวมและวิเคราะห์ข้อมูล
Two review authors independently extracted the data and assessed the risk of bias domains for each trial. We used a random-effects model and reported risk ratio (RR) with associated 95% confidence interval (95% CI). We used trial sequential analyses to help provide information on when we had reached firm evidence in cumulative meta-analyses of the primary outcomes, based on a 30% risk ratio reduction in PONV.
ผลการวิจัย
We included 59 trials involving 7667 participants. We rated two trials at low risk of bias in all domains (selection, attrition, reporting, blinding and other). We rated 25 trials at high risk in one or more risk-of-bias domains. Compared with sham treatment, PC6 acupoint stimulation significantly reduced the incidence of nausea (RR 0.68, 95% CI 0.60 to 0.77; 40 trials, 4742 participants), vomiting (RR 0.60, 95% CI 0.51 to 0.71; 45 trials, 5147 participants) and the need for rescue antiemetics (RR 0.64, 95% CI 0.55 to 0.73; 39 trials, 4622 participants). As heterogeneity among trials was substantial and there were study limitations, we rated the quality of evidence as low. Using trial sequential analysis, the required information size and boundary for benefit were reached for both primary outcomes.
PC6 acupoint stimulation was compared with six different types of antiemetic drugs (metoclopramide, cyclizine, prochlorperazine, droperidol. ondansetron and dexamethasone). There was no difference between PC6 acupoint stimulation and antiemetic drugs in the incidence of nausea (RR 0.91, 95% CI 0.75 to 1.10; 14 trials, 1332 participants), vomiting (RR 0.93, 95% CI 0.74 to 1.17; 19 trials, 1708 participants), or the need for rescue antiemetics (RR 0.87, 95% CI 0.65 to 1.16; 9 trials, 895 participants). We rated the quality of evidence as moderate, due to the study limitations. Using trial sequential analyses, the futility boundary was crossed before the required information size was surpassed for both primary outcomes.
Compared to antiemetic drugs, the combination of PC6 acupoint stimulation and antiemetic therapy reduced the incidence of vomiting (RR 0.56, 95% CI 0.35 to 0.91; 9 trials, 687 participants) but not nausea (RR 0.79, 95% CI 0.55 to 1.13; 8 trials, 642 participants). We rated the quality of evidence as very low, due to substantial heterogeneity among trials, study limitations and imprecision. Using trial sequential analysis, none of the boundaries for benefit, harm or futility were crossed for PONV. The need for rescue antiemetic was lower in the combination PC6 acupoint stimulation and antiemetic group than the antiemetic group (RR 0.61, 95% CI 0.44 to 0.86; 5 trials, 419 participants).
The side effects associated with PC6 acupoint stimulation were minor, transient and self-limiting (e.g. skin irritation, blistering, redness and pain) in 14 trials. Publication bias was not apparent in the contour-enhanced funnel plots.
ข้อสรุปของผู้วิจัย
NMAs suggest that both invasive and noninvasive PC6 acupoint stimulation combined with antiemetics may reduce PON and POV, compared to sham, and likely lower rescue antiemetic use. PC6 acupoint stimulation may cause minor side effects, but the evidence is very uncertain.
แหล่งทุน
This updated Cochrane review was partially funded by the Cochrane Complementary Medicine Field Bursary 2020 from the National Center for Complementary and Alternative Medicine, National Institutes of Health (Grant Number R24 AT001293).
การลงทะเบียน
Protocol (2001): doi.org/10.1002/14651858.CD003281
Original review (2004): doi.org/10.1002/14651858.CD003281.pub2
Update review (2009): doi.org/10.1002/14651858.CD003281.pub3
Update review (2015): doi.org/10.1002/14651858.CD003281.pub4
