Effect of acupuncture on postoperative nausea and vomiting in lumbar disc herniation surgery

Nausea, vomiting and pain are common postoperative complications. The aim of this study was to evaluate the effects of ondansetron combined with acupuncture at bilateral PC6 during the intraoperative period on the incidence of postoperative nausea and vomiting (PONV), severity of nausea/pain and the need for rescue antiemetics in patients undergoing elective one- or two-level lumbar disc herniation (LDH) surgery.

In this double-blind randomized controlled trial, 92 patients with American Society of Anesthesiologists (ASA) physical status I-II who were scheduled for elective LDH surgery under general anesthesia were randomized into two groups: the acupuncture group (group A) and the control group (group C). Group A received PC6 acupuncture bilaterally plus ondansetron; group C received ondansetron only. PONV was defined as nausea with a visual analog scale (VAS) score ⩾4, vomiting or need for rescue medication. Persistent nausea (>20 min), unchanged score or repeated vomiting prompted administration of 4 mg intravenous (IV) ondansetron. Pain scores ⩾4 were treated with IV dexketoprofen.

Data on 79 patients (n = 40 in group A and n = 39 in group C) were analyzed. The incidence of PONV within 24 h (primary outcome) did not significantly differ in group A versus group C (15.0% vs 33.3%, p = 0.057). However, nausea incidence at 0-24 h, as well as PONV incidence and rescue antiemetic use at 0-2 h, were significantly lower in group A (p < 0.05). Nausea and pain severity were also significantly lower in group A at 0-2 and 2-4 h (p < 0.05). A moderate positive correlation was found between pain and nausea severity over 24 h (p < 0.001).

Although this study was negative in its primary endpoint, multiple significant secondary findings suggest that acupuncture with standard antiemetic therapy was associated with lower early PONV and reduced rescue antiemetic use.

NCT06669676 (ClinicalTrials.gov).