Wrist-Ankle Acupuncture on Postoperative Nausea and Vomiting Prophylaxis in High-Risk Female Patients: A Pragmatic, Randomized, Single-Blind, Sham-Controlled Trial

Clinical Snapshot

Key Findings

• P Value: p = 0.002

• Effect Size: 28.8% absolute risk reduction

• Primary Outcome: 24-hour PONV incidence: 42.4% (WAA) vs 71.2% (sham)

• Nnt Or Sensitivity: Number needed to treat: approximately 3.5 patients

• Confidence Interval: RR 0.60 (95% CI 0.42-0.82)

Clinical Application

Requires trained acupuncturists and institutional support. May be challenging in centres without established acupuncture services Could complement existing PONV prevention strategies. Not currently covered by PBS but may be available in some public hospitals with integrative medicine programs. Would require training and credentialing of practitioners High-risk female surgical patients with previous PONV or motion sickness undergoing elective procedures

Abstract

BACKGROUND: Postoperative nausea and vomiting (PONV) affects up to 80% of high-risk patients, compromising Enhanced Recovery After Surgery (ERAS) outcomes and prolonging hospitalization. This randomized controlled trial evaluated wrist-ankle acupuncture (WAA) efficacy for PONV prevention in high-risk female surgical patients. METHODS: This single-center, randomized, patient- and assessor-blinded, sham-controlled trial enrolled female patients (aged 18-60 years, ASA I-II) scheduled for elective surgery under general anesthesia with documented motion sickness or previous PONV. Participants received either WAA (sterile needles at four standardized acupoints, 30-minute retention) or sham acupuncture postoperatively. The primary outcome was 24-h PONV incidence using the Rhodes Index of Nausea, Vomiting, and Retching (R-INVR). RESULTS: Among 132 patients (median age 41 years), WAA significantly reduced 24-h PONV incidence versus sham (42.4% vs. 71.2%; RR 0.60, 95% CI 0.42-0.82; p = 0.002). Median R-INVR scores were lower with WAA [0 (0-5) vs. 8 (0-11); p < 0.001]. WAA patients reported significantly reduced nausea/vomiting at 30 min, 6 h, and 24 h (all p ≤ 0.006) and higher satisfaction scores (p < 0.001). Antiemetic use was comparable (9.1% vs. 16.7%; p = 0.299). No adverse events occurred. CONCLUSIONS: WAA significantly reduced PONV incidence and severity with sustained effects and improved satisfaction, offering a promising non-pharmacological prevention strategy.

References

1. 1.Yu, L., Wang, X., Mei, L., Song, J., Song, W., Xue, H., Wu, S., Wang, J., Li, L., & Chen, W. (2026). Wrist-ankle acupuncture on postoperative nausea and vomiting prophylaxis in high-risk female patients: A pragmatic, randomized, single-blind, sham-controlled trial. Journal of Investigative Surgery, Article 2652778. https://doi.org/10.1080/08941939.2026.2652778