Wearable transcutaneous electrical acupoint stimulation bracelet for prevention of postoperative nausea and vomiting in patients undergoing hysteroscopic surgery: a randomised controlled trial

Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after laparoscopic surgery: A meta-analysis

BACKGROUND

Postoperative nausea and vomiting (PONV) is a common adverse event after general surgery. This study aimed to examine the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) for the prevention of nausea and vomiting after laparoscopic surgery.

METHOD

The Cochrane Library, Pubmed, Embase, and Web of Science databases were accessed from inception to 23 January 2024. The incidence of PONV was the primary outcome measure. The required information size (RIS) of each outcome was estimated by Trial sequential analysis (TSA). The RoB 2.0 tool was used to assess the risk of bias and GRADE to assess the quality of evidence.

RESULTS

Seventeen RCTs including 3698 participants were included. In comparison to the control group, TEAS reduced the incidence of PONV (13 trials, n = 3310; RR, 0.56; 95% CI, 0.46-0.67; I2 = 64%; p < 0.01; RIS = 1100), with the level of evidence graded as low. TEAS reduced the incidence of PON (9 trials, n = 2762; RR, 0.64; 95% CI, 0.52-0.79; I2 = 57%, p < 0.01; RIS = 1595), and was also associated with a lower incidence of POV (9 trials, n = 2797; RR, 0.53; 95% CI, 0.45-0.63; I2 = 0%, p < 0.01; RIS = 773).

CONCLUSION

The current meta-analysis and TSA provide reliable evidence that TEAS is an effective and safe method to prevent PONV. It may reduce the workload of nursing professionals, alleviate emotional stress, and decrease exposure risk. Adverse events related to TEAS were mild.

CLINICAL RELEVANCE

Nurses can incorporate TEAS into the rehabilitation nursing of patients experiencing PONV.

Effect of single or multi-period use of transcutaneous acupoint electrical stimulation on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a prospective randomized double-blind trial

OBJECTIVE

To evaluate the efficacy of different periods for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopy with transcutaneous electrical acupoint stimulation (TEAS).

DESIGN

Prospective, randomized, double-blind trial.

SETTING

An academic medical canter specializing in the care of women and children.

POPULATION OR SAMPLE

A total of 120 women were enrolled.

METHODS

Patients were randomly allocated to three groups: a single-period TEAS group (Group S, n = 40), a multi-period TEAS group (Group M, n = 40) and a non-stimulation control group (Group C, n = 40). TEAS was applied at specific acupuncture points preoperatively and postoperatively.

MAIN OUTCOME MEASURES

The primary outcome was the incidence and severity of PONV during the 48 h after surgery and the secondary outcomes included pain, early recovery after surgery, and complication.

RESULTS

Within postoperative 0-2 h, 4-12 h, group M had less frequency and lower scores for nausea compared with group C and group S had only less frequency of nausea compared with group C at 4-12 h postoperatively. The frequency and severity of vomiting for group M were less than group S in the postoperative 2-4 h. Group M mitigated pain and reduced the rescue antiemetic compared to group S.

CONCLUSION

Multiple-period TEAS provides greater efficacy and a longer duration of action than single-period TEAS. It effectively reduces PONV in patients undergoing gynecological laparoscopic surgery which could be a new option in multimodal prophylactic antiemetic regimes for perioperative undergoing gynecological laparoscopic surgery.

TRIAL REGISTRATION

Chinese Clinical Trials Registry, No. ChiCTR2200065802, Registered 15/11/2022. https//www.chictr.org.cn/bin/project/edit? pid=175,377.

Efficacy of wearable transcutaneous electrical acupoint stimulation bracelet on moderate-to-severe postoperative nausea and vomiting in patients after general anesthesia: a study protocol for a multicenter randomized controlled trial

BACKGROUND

Postoperative nausea and vomiting (PONV) is the most common complication following general anesthesia. Currently, pharmaceutical therapy is the primary method of treatment, but it has reached a plateau, and it is accompanied by inherent adverse reactions and high costs. Stimulation of the wrist acupuncture point PC6 is recommended as an effective means of preventing PONV. Our previous study suggests that the wearable transcutaneous electrical acupoint stimulation (TEAS) bracelet can prevent PONV, but its effectiveness in treating moderate-to-severe PONV that has already occurred remains unknown. This trial aims to include female patients who have suffered from PONV after general anesthesia in real-world settings to investigate the therapeutic effect of the TEAS bracelet.

METHODS

This trial will be conducted in Shanghai and Tianjin, China, with a total of 232 participants recruited from four academic hospitals. Participants will be randomly allocated into the TEAS group or the control group in a 1:1 ratio. Participants in the TEAS group will wear an EmeTerm bracelet and be injected with normal saline, while participants in the control group will wear a model bracelet and be injected with 10 mg of metoclopramide. Follow-up will be conducted 2 h later, and participants who do not experience relief will be randomly allocated into two groups and given cross-intervention. The primary outcome of the trial is the response rate of moderate-to-severe PONV after 2 h of intervention. Secondary outcomes include the recurrence rate of moderate-to-severe PONV within 24 h after intervention and the response rate of moderate-to-severe PONV at 2 h after cross-intervention in a population insensitive to the initial intervention.

DISCUSSION

This multi-center randomized controlled trial aims to reveal the therapeutic effect of the wearable TEAS bracelet on PONV. It is expected that this bracelet will become an effective supplement for the clinical treatment of PONV, reducing medical expenditure and improving anesthesia quality and patient satisfaction.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400084329. Registered on May 14, 2024.

Acustimulation combined with pharmacological prophylaxis versus pharmacological prophylaxis alone in postoperative nausea and vomiting (PONV) prophylaxis among patients undergoing laparoscopy abdominal surgery: a research protocol for a randomised controlled trial

INTRODUCTION

This study evaluates the efficacy of integrating percutaneous electrical nerve stimulation at the pericardium 6 (PC6) acupuncture point through a wearable acustimulation device with standard pharmacological prophylaxis to prevent postoperative nausea and vomiting (PONV) compared with pharmacological prophylaxis alone in patients undergoing laparoscopic abdominal surgery.

METHOD AND ANALYSIS

This prospective study will enrol 302 patients scheduled for elective laparoscopic surgery. Participants will be randomly allocated to one of two groups: acustimulation combined with pharmacological prophylaxis or sham stimulation combined with pharmacological prophylaxis. Randomisation will involve a computer-generated sequence, with allocation concealment implemented through sealed envelopes. The acustimulation group will receive electrical stimulation at the PC6 point starting 30 min before surgery and continuing until discharge from the postanaesthesia care unit. Sham group will wear a wristband that does not provide stimulation. The primary outcome is the incidence of PONV. Secondary outcomes include the severity of PONV, incidence rates of nausea and vomiting at different postoperative intervals and indices of gastrointestinal functional recovery. Exploratory outcomes will assess haemodynamic parameters, baroreflex sensitivity, hospital stay duration, costs and both short-term and long-term postoperative recovery.

ETHICS AND DISSEMINATION

All participants will provide written informed consent. The study has been approved by the Ethics Committee of Peking Union Medical Hospital (approval number: I-23PJ1712). Results will be published open access.

TRIAL REGISTRATION NUMBER

NCT06241547.

Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

Purpose

Postoperative nausea and vomiting (PONV) frequently occur in patients after surgery. In this study, the authors investigated whether perioperative S-ketamine infusion could decrease the incidence of PONV in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.

Patients and Methods

This prospective, randomized, double-blinded, controlled study was conducted a total of 420 patients from September 2021 to May 2023 at Xuzhou Central Hospital in China, who underwent elective VATS lobectomy under general anesthesia with tracheal intubation. The patients were randomly assigned to either the S-ketamine group or the control group. The S-ketamine group received a bolus injection of 0.5 mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine at a rate of 0.25 mg/kg/h. The control group received an equivalent volume of saline. All patients were equipped with patient-controlled intravenous analgesia (PCIA), with a continuous infusion rate of 0.03 mg/kg/h S-ketamine in the S-ketamine group or 0.03 μg/kg/h sufentanil in the control group. The primary outcome was the incidence of PONV. Secondary outcomes included perioperative opioid consumption, hemodynamics, postoperative pain, and adverse events.

Results

The incidence of PONV in the S-ketamine group (9.7%) was significantly lower than in the control group (30.5%). Analysis of perioperative opioid usage revealed that remifentanil usage was 40.0% lower in the S-ketamine group compared to the control group (1414.8 μg vs 2358.2 μg), while sufentanil consumption was 75.2% lower (33.1 μg vs 133.6 μg). The S-ketamine group demonstrated better maintenance of hemodynamic stability. Additionally, the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and postoperative day 3 (POD-3) were significantly lower in the S-ketamine group. Finally, no statistically significant difference in other postoperative adverse reactions was observed between the two groups.

Conclusion

The results of this trial indicate that perioperative S-ketamine infusion can effectively reduce the incidence of PONV in patients undergoing VATS lobectomy.

Transcutaneous electrical acupoint stimulation for prevention of postoperative urinary retention: A systematic review

Introduction

Transcutaneous electrical acupoint stimulation (TEAS) has been proposed for postoperative urinary retention (POUR). This meta-analysis evaluated the effect of TEAS in preventing POUR.

Methods

Databases were searched until February 6, 2023. Randomized controlled trials (RCTs) about TEAS for preventing POUR were included. The primary concern was the incidence of POUR, with post-void residual urine volume as a secondary outcome.

Results

Fourteen studies with 2865 participants were identified. TEAS reduced the incidence of POUR (RR = 0.44, 95%CI = 0.33 to 0.58, P < 0.00001) and decreased the post-void residual urine volume (MD = -75.41 mL, 95%CI = -118.76 to -32.06, P = 0.0007). The preventive effect on POUR was found in patients receiving anorectal, gynecologic, orthopedic and biliary surgery, but not urinary surgery. Dilatational- and continuous-wave TEAS had a great outcome in preventing POUR. Intraoperative TEAS, preoperative and intraoperative TEAS, and postoperative TEAS were beneficial, and TEAS was more beneficial when compared with sham TEAS and blank control. It is nevertheless difficult to rule out publication bias.

Conclusions

TEAS could prevent POUR. Due to insufficient evidence, multicenter, large-sample and high-quality RCTs should be conducted. (Registration:INPLASY202320095).

Postoperative Nausea and Vomiting following Endoscopic Sinus Surgery under the Guidance of Adequacy of Anesthesia or Pupillometry with Intravenous Propofol/Remifentanil

Postoperative nausea and vomiting (PONV) constitutes an adverse event after endoscopic sinus surgery (ESS) under general anesthesia (GA) with intravenous opioids, such as remifentanil (RMF). Monitoring the nociception/antinociception balance using the surgical pleth index (SPI) or pupillary dilatation reflex (PRD) helps guide intravenous RMF infusion. We aimed to investigate whether their employment could help reduce the incidence of PONV in patients undergoing ESS. The data of 30 patients from the GA group, 31 from the SPI group, and 28 from the PRD group were analyzed. The initial RMF infusion rate of 0.25 µg/kg body weight/minute was increased by 50% when the SPI, PRD, or Boezaart Bleeding Scale (BBS) were elevated by >15, >5%, or >2 points, respectively, until they normalized. PONV was present in 7/89 patients (7.9%): 2/31 patients (6.5%) of the SPI group, 1/30 patients (3.3%) of the GA group, and 4/28 patients (14.3%) of the PRD group. Neither PRD nor SPI guidance for RMF administration reduced the incidence of PONV compared to standard practice. Further studies are required in order to investigate the possibility of PONV eradication in patients undergoing ESS under GA when it is possibly combined with paracetamol/metamizole preventive analgesia, as well as those using antiemetic prophylaxis based on the Apfel Score and premedication with midazolam.

Transcutaneous electrical acupoint stimulation versus dexamethasone for prophylaxis of postoperative nausea and vomiting in breast surgery: A non-inferiority randomized controlled trial

BACKGROUND

Transcutaneous electrical acupoint stimulation and dexamethasone can reduce postoperative nausea and/or vomiting. In this noninferiority study, we compared the effects of Neiguan acupoint (PC6) transcutaneous electrical acupoint stimulation with dexamethasone to prevent postoperative nausea and/or vomiting in female patients undergoing breast surgery.

METHODS

In total, 280 patients were randomized into the following 2 groups: transcutaneous electrical acupoint stimulation (n = 140) and dexamethasone (n = 140). Transcutaneous electrical acupoint stimulation was performed 0.5 hours before anesthesia induction, immediately after entering the post-anesthesia care unit, and every 3 hours after leaving the post-anesthesia care unit. In the postoperative ward, the anesthetist instructed the patient's family members to assist the patient with PC6 patient-controlled transcutaneous electrical acupoint stimulation. Patients in the dexamethasone group were given 8 mg dexamethasone (intravenously) at 0.5 hours before induction of anesthesia. The incidence of nausea, vomiting, need for rescue antiemetics, patient satisfaction score, and the feasibility results of PC6 patient-controlled transcutaneous electrical acupoint stimulation were recorded 24 hours after surgery.

RESULT

Within 0 to 24 hours after surgery, the incidence of postoperative nausea and/or vomiting in the transcutaneous electrical acupoint stimulation group was not inferior to the dexamethasone group (31.1% vs 27.9%, per protocol risk difference 3.2; 95% confidence interval -7.7 to 14.0). The results of the intention-to-treat analysis (30.7% vs 27.1%, risk difference 3.6; 95% confidence interval -7.0 to 14.2) agreed with the per protocol analysis. Patient satisfaction score in the transcutaneous electrical acupoint stimulation group was higher than that in the dexamethasone group (3.9 ± 0.1 vs 3.6 ± 0.1, P = .003). The scheme of preventing postoperative nausea and/or vomiting by PC6 patient-controlled transcutaneous electrical acupoint stimulation was feasible.

CONCLUSION

Transcutaneous electrical acupoint stimulation was noninferior to dexamethasone in preventing postoperative nausea and/or vomiting within 24 hours after breast surgery. Neiguan acupoint patient-controlled transcutaneous electrical acupoint stimulation was feasible to prevent postoperative nausea and/or vomiting.