Risk of Postoperative Nausea and Vomiting After Total Hip or Knee Arthroplasty Under Spinal Anesthesia: Randomized Trial Comparing Conventional Antiemetics with or without the EmeTerm Bracelet.

Summary

In a Level I RCT of 348 arthroplasty patients under spinal anesthesia, adding a transcutaneous acupoint-stimulation bracelet to standard antiemetics halved PONV (16.0% vs 31.2%) and reduced severe PONV and rescue antiemetic use. Benefits emerged within the first 6 postoperative hours and improved 24-hour recovery scores.

Key Findings

• PONV incidence reduced from 31.2% to 16.0% (p=0.001) with bracelet plus antiemetics.
• Severe PONV reduced from 8.1% to 1.1% (p=0.002); rescue antiemetic use reduced from 13.9% to 3.4% (p=0.001).
• Adjusted hazard ratio for 24-hour PONV was 0.39 (95% CI 0.24–0.63); benefits evident at 0–3 and 3–6 hours post-op.
• Complete response higher with bracelet (84.0% vs 68.8%; p=0.001) and 24-hour quality of recovery improved.

Clinical Implications

Consider adding a transcutaneous acupoint-stimulation bracelet to standard prophylaxis for moderate/high-risk PONV patients undergoing THA/TKA under spinal anesthesia to reduce PONV and rescue medication use and to enhance early recovery.

Limitations

• Single surgical context (THA/TKA under spinal anesthesia); generalizability to other surgeries/anesthetic techniques unknown.
• Follow-up limited to 24 hours; longer-term outcomes not assessed; potential for unblinded device effects.

Future Directions

Evaluate efficacy in general anesthesia settings, other surgeries, and in enhanced recovery protocols; assess cost-effectiveness and patient-reported outcomes beyond 24 hours.