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

Summary

In a multicenter, randomized, double-dummy, patient- and observer-blinded trial of 232 women with moderate to severe PONV after thyroid or anterior cervical surgery, wearable PC6-TEAS yielded a higher 2-hour remission rate and a markedly lower 24-hour relapse rate than intravenous metoclopramide. No adverse events occurred. Findings support TEAS as an effective nonpharmacologic rescue strategy that may improve recovery.

Key Findings

• PC6-TEAS increased 2-hour PONV remission vs metoclopramide (77.6% vs 55.2%, P<.001).
• TEAS reduced 24-hour relapse vs control (12.2% vs 56.3%, P<.001).
• No adverse events were reported; trial was double-dummy, patient- and observer-blinded, and registered (ChiCTR2400084329).

Clinical Implications

Consider incorporating PC6-targeted TEAS as a second-line or adjunctive therapy for moderate to severe PONV, especially when antiemetic escalation is undesirable. Protocolization within ERAS pathways may reduce relapse and improve patient satisfaction without added adverse events.

Limitations

• All participants were women undergoing thyroid/anterior cervical surgery, limiting generalizability to other populations/surgeries.
• Per-protocol analysis and cross-over rerandomization may affect ITT interpretability.

Future Directions

Replicate in broader surgical populations with both sexes, compare against 5-HT3 antagonists or multimodal antiemetic regimens, and evaluate cost-effectiveness, adherence, and mechanistic biomarkers.