Transcutaneous Electrical Acupoint Stimulation vs Metoclopramide for Moderate to Severe Postoperative Nausea and Vomiting: A Randomized Clinical Trial.

Summary

In a multicenter, double-dummy randomized trial of 232 women with moderate-to-severe PONV after thyroid or anterior cervical surgery, wearable TEAS at PC6 achieved higher 2-hour remission (77.6% vs 55.2%; P<.001) and lower 24-hour relapse (12.2% vs 56.3%; P<.001) than metoclopramide, with no adverse events. The design included rerandomization for nonresponders at 2 hours.

Key Findings

• Higher 2-hour PONV remission with TEAS vs metoclopramide (77.6% vs 55.2%; P<.001).
• Lower 24-hour relapse with TEAS vs control (12.2% vs 56.3%; P<.001).
• No adverse events were reported in either group; double-dummy, blinded design across 4 centers.
• Rerandomization of nonresponders at 2 hours allowed cross-intervention evaluation.

Clinical Implications

TEAS at PC6 can be considered as an effective, well-tolerated rescue or adjunct for moderate-to-severe PONV, potentially reducing reliance on antiemetics and their adverse effects in enhanced recovery pathways.

Limitations

• Per-protocol analysis (not clearly ITT) may introduce bias.
• All participants were female and limited to thyroid/anterior cervical procedures in China, limiting generalizability; comparator was metoclopramide only.

Future Directions

Replicate in mixed-sex, broader surgical populations, compare against 5-HT3 antagonists and multimodal regimens, and assess integration into ERAS with cost-effectiveness and long-term outcomes.