Identifying the optimal timing of preoperative electroacupuncture for postoperative nausea and vomiting and pain in patients undergoing laparoscopic gynecologic surgery: Study protocol for a randomized controlled trial

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.

Preoperative electroacupuncture for postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial

Objective:

We aimed to evaluate the effectiveness and safety of preoperative electroacupuncture (EA) on the incidence of postoperative nausea and vomiting (PONV), and severity of postoperative pain, in gynecological patients undergoing laparoscopic surgery. The effects of EA administered at different preoperative time points were compared.

Methods:

A total of 413 patients undergoing elective laparoscopic gynecological surgery were randomly allocated into 4 groups receiving EA the day before surgery (Group Pre, n = 103), 30 min before (Group 30, n = 104) or both (Group Comb, n = 103), or usual care alone (Group Usual, n = 103). All acupuncture groups had usual care. The incidence of PONV and pain at 24 h were primary outcomes. Secondary outcomes included the severity of postoperative nausea, vomiting and pain, requirement for antiemetic medication and quality of recovery (QoR)-15 scores after surgery.

Results:

There were significant differences between the four groups in nausea and vomiting incidence (0–24 h), postoperative antiemetic use (0–48 h), and postoperative pain (0–6 h), with the EA groups recording the lowest levels. Regarding primary outcomes, incidence of nausea and vomiting at 6-24 h was 28/11/18/11% (p = 0.003) 23/5/8/9% (p < 0.001), respectively, for Groups Usual/Pre/30/Comb. Accordingly, EA reduced the incidence of nausea and vomiting at 6-24 h by 61/34/60% and 79/65/61% for Groups Pre/30/Comb, respectively. Regarding secondary outcomes, incidence of nausea and vomiting at 0-6 h was 20/9/11/7% (p = 0.013) and 17/7/9/6% (p = 0.021), respectively, for Groups Usual/Pre/30/Comb. Rescue antiemetics at 0–6 h were required by 18/4/11/4% (p = 0.001) in Groups Usual/Pre/30/Comb. The mean numerical rating scale (NRS) pain score (0–10) at 0–6 h was significantly different between groups (2.45/1.89/2.01/1.97 for Groups Usual/Pre/30/Comb, p = 0.024). There were no significant differences between the three EA-treated groups.

Conclusion:

In gynecological patients undergoing laparoscopic surgery and treated with multimodal antiemetic methods, one session of preoperative EA may be a safe adjunctive treatment for PONV prophylaxis. Optimal timing of EA requires further verification.

Trial registration number:

ChiCTR-INR-16010035 (Chinese Clinical Trial Registry).