Acupuncture combined with ondansetron for prevention of postoperative nausea and vomiting in high-risk patients undergoing laparoscopic gynaecological surgery: A randomised controlled trial

Postoperative nausea and vomiting (PONV) are common problems that affect approximately 30% of surgical patients and may reach 80% in those considered high-risk. Although these symptoms may seem minor, they can cause significant complications such as wound dehiscence, dehydration, and aspiration of gastric contents, in addition to prolonging hospital stay and increasing healthcare costs. Women, nonsmokers, those with a history of PONV or motion sickness, and people who require opioids after surgery are at higher risk. Even with multiple antiemetic agents — as recommended by current guidelines for high-risk patients — PONV incidence remains high, between 60% and 70%.

Acupuncture has shown efficacy in PONV prevention, but few studies have investigated its effectiveness specifically in high-risk patients or when combined with antiemetic medications.

This study aimed to evaluate whether combining acupuncture with ondansetron would be more effective than the medication alone in preventing PONV in high-risk women. A randomized controlled trial was conducted at a tertiary hospital in China, enrolling 212 women aged 18–65 who were scheduled for laparoscopic gynecological surgery for benign conditions. All participants had three or four PONV risk factors according to the Apfel score (female sex, nonsmoking status, history of PONV or motion sickness, and expected postoperative opioid use). Patients were randomly allocated to two groups: the combination group received two acupuncture sessions (30–60 minutes before surgery and immediately after emergence from anesthesia) plus 8 mg of intravenous ondansetron, while the control group received ondansetron alone.

Acupuncture was performed bilaterally at specific points: Neiguan (PC-6), Hegu (LI-4), Zusanli (ST-36), and Sanyinjiao (SP-6), with needles retained for 30 minutes per session. The primary outcome was PONV incidence in the first 24 hours after surgery.

Results showed a significant difference between groups. During the 24 hours after surgery, 44% of patients in the combination group experienced nausea, vomiting, or both, compared with 60.2% in the ondansetron-alone group. This represents an absolute risk reduction of 16.3% for PONV. For every 6.2 patients treated with the combination, one would be spared a PONV episode.

When analyzed separately, the combination was effective at reducing nausea (same percentages as the primary outcome) but did not show a significant difference in vomiting alone. The benefit was most pronounced in the first 6 hours after surgery, suggesting that acupuncture is particularly effective in the early postoperative period. There were no differences between groups in rescue antiemetic use, patient satisfaction with symptom control, or postoperative pain intensity. Safety was similar between groups, with only one acupuncture-related adverse event (local pain at the insertion site), which was mild and self-limited.

For patients and clinicians, these findings suggest that acupuncture can be a valuable strategy as an adjunct to traditional antiemetics. The combination proved safe and effective, offering a non-pharmacologic option that may reduce reliance on multiple medications. This is particularly relevant given that some antiemetics can cause adverse effects such as hypotension, extrapyramidal symptoms, and QT-interval prolongation. For patients with four risk factors, the relative reduction reached 32.7%, suggesting that those at highest risk may benefit even more from the combined approach.

Acupuncture also has the advantage of being non-invasive compared with intravenous medications and of having minimal adverse effects.

The study has several important limitations that should be considered. First, no sham-acupuncture control group was used, meaning the placebo effect of acupuncture cannot be entirely excluded. The investigators chose this design because the benefit of real over sham acupuncture had already been well established, and they wanted to evaluate the practical effect of the combination in real-world clinical practice. Second, the sample-size calculation was based on prior studies with different designs, which may have produced imprecise effect-size estimates.

Third, follow-up was limited to 48 hours, the typical period for PONV studies, but may not capture longer-term effects. Finally, all participants underwent gynecological surgery, which may limit applicability to other surgical populations.

In conclusion, this study provides evidence that acupuncture combined with ondansetron represents a promising multimodal approach for PONV prevention in high-risk patients, particularly effective for nausea. The strategy proved safe and could be a valuable addition to the available therapeutic arsenal. Future research is needed to confirm these results in larger samples and to evaluate applicability in other patient populations, as well as to better understand the mechanisms by which acupuncture exerts its antiemetic effects.