Wrist Acupuncture to Prevent Postoperative Nausea and Vomiting

Is stimulation of the wrist at the pericardium 6 (PC6; also known as Master of the Heart 6 or Neiguan) acupuncture point (acupoint) effective in preventing postoperative nausea and vomiting?

Invasive traditional percutaneous needling and noninvasive acupressure stimulation of acupoint PC6 reduce postoperative nausea compared with sham interventions.¹ (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) Invasive and noninvasive PC6 acupoint stimulation reduce postoperative vomiting compared with sham interventions. (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

Invasive and noninvasive PC6 acupoint stimulation also reduce the need for rescue drug therapy to treat postoperative nausea and vomiting compared with sham interventions.¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.) No serious adverse events were reported with PC6 acupoint stimulation. (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

Postoperative nausea and vomiting are common complications after general anesthesia, affecting up to 80% of patients.¹ These symptoms not only impair recovery and patient satisfaction but also contribute to prolonged postanesthesia care unit stays, unanticipated hospital admissions, and increased health care costs.² Antiemetics are only partially effective in preventing or treating postoperative nausea and vomiting.³

Among various nonpharmacologic approaches, PC6 acupoint stimulation has been evaluated in many clinical trials.^4–6 The PC6 acupoint lies between the tendons of palmaris longus and flexor carpi radialis muscles, 4 cm proximal (2–3 fingerbreadths) to the wrist crease. Stimulation using invasive percutaneous traditional acupuncture needling or noninvasive acupressure can be performed on this site. The authors of this Cochrane review sought to determine if PC6 acupoint stimulation is effective in preventing postoperative nausea and vomiting.¹

The review included 77 randomized controlled trials with 9,847 participants, mostly adults, across several countries (eg, United States, South Korea, India, China, Turkey, Iran).¹ The studies compared PC6 acupoint stimulation with sham treatment or antiemetic drugs. Sham treatment was defined as a device applied in a non-PC6 location, any attempt to imitate PC6 acupoint stimulation, or the use of placebo (saline) anti-emetic drugs. Antiemetics included serotonin (5-HT₃) receptor antagonists, D₂ dopamine receptor antagonists, corticosteroids, and antihistamines. The duration of follow-up was 0 to 24 hours after surgery.

Outcomes were measured as occurrence of nausea, vomiting, or the need for rescue medications (binary outcomes) rather than severity of symptoms. Risk ratios (RRs) with 95% CIs were reported with frequentist network meta-analysis, a statistical analysis that compares more than two treatments by combining direct and indirect evidence from multiple studies. A beneficial effect of treatment was defined as the upper end of the 95% CI being below an RR of 0.80 compared with sham treatment. The review was current as of June 2025.

In 63 studies (n = 7,534), five comparisons were analyzed regarding postoperative nausea: invasive PC6, noninvasive PC6, antiemetics, invasive PC6 plus antiemetics, and noninvasive PC6 plus antiemetics.¹ Each decreased the likelihood of nausea compared with sham (invasive PC6: RR = 0.49; 95% CI, 0.38–0.64; number needed to treat [NNT] to reduce incidence of nausea = 5; low-certainty evidence; noninvasive PC6: RR = 0.67; 95% CI, 0.58–0.76; NNT = 7; low-certainty evidence; antiemetics: RR = 0.73; 95% CI, 0.59–0.91; NNT = 8; very low-certainty evidence; invasive PC6 plus antiemetics: RR = 0.21; 95% CI, 0.10–0.45; NNT = 3; moderate-certainty evidence).