Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting

Nausea and vomiting after surgery are very common problems that affect patients' quality of life and can lead to serious complications. These symptoms, technically known as postoperative nausea and vomiting (PONV), occur in about 30% to 50% of patients undergoing surgical procedures, reaching up to 80% in higher-risk cases. In addition to the obvious discomfort, PONV can cause other complications such as bleeding, aspiration pneumonia, and electrolyte imbalance. Conventional treatments with antiemetic medications, although effective in many cases, have important limitations: they can cause side effects such as sedation, headache, and neurological problems, in addition to having high costs.

For this reason, researchers have sought nonpharmacological alternatives, such as acupuncture, which has already been shown to be effective in controlling these symptoms in previous studies.

This scientific study was conducted by Turkish researchers with the aim of evaluating whether combining laser acupuncture with antiemetic drugs would be more effective than using medications alone to prevent nausea and vomiting after surgery. The research focused specifically on patients undergoing laparoscopic cholecystectomy, which is the surgery to remove the gallbladder using a minimally invasive technique. The researchers used a technique called laser acupuncture, which is a noninvasive and painless way to stimulate specific points on the body, different from traditional acupuncture with needles. Two acupuncture points were chosen: PC-6, located on the wrist between the tendons of the forearm, and LI-4, located on the hand between the bones of the thumb and index finger.

The study was randomized, double-blinded, and prospective, involving 88 patients divided into two equal groups of 44 people each.

The study methodology was carefully planned to ensure reliable results. The first group received bilateral laser acupuncture at points PC-6 and LI-4 during surgery, in addition to the drug metoclopramide as prevention. The second group received only the preventive medication. Laser acupuncture was applied with specific equipment for 30 seconds at each point, using light with a wavelength of 904 nanometers.

To keep the study blinded, in patients of the second group the device was only placed against the same points but did not emit the laser. All patients received standardized general anesthesia and the same postoperative care protocol. The researchers assessed the presence of nausea and vomiting, as well as the need for rescue medications (ondansetron), at three time points: immediately after waking from anesthesia, 30 minutes later in the recovery room, and 6 hours later in the ward.

The results showed interesting differences between the groups, especially in the later period after surgery. In the early assessments, immediately after waking and at 30 minutes, there were no significant differences between the groups regarding nausea and vomiting. However, at the 6-hour assessment after surgery, the differences became evident. In the group that received laser acupuncture combined with medication, no patient experienced nausea, while in the group that received medication only, eight patients (18.2%) still experienced nausea.

This difference was statistically significant. As for vomiting, there were no important differences between the groups at any assessment time. Another relevant finding was that in the late period, no patient in the acupuncture group needed rescue medication, while eight patients in the control group required additional ondansetron.

The clinical implications of these results are promising for patients and health care professionals. For patients, combining laser acupuncture with medication may mean less discomfort in the postoperative period, especially in the first hours after surgery when they are already in the ward. The technique is completely painless and noninvasive, with none of the typical side effects of antiemetic medications. For professionals, especially anesthesiologists and surgeons, this approach offers an additional tool in the therapeutic arsenal against PONV, potentially reducing hospital costs and increasing patient satisfaction.

Laser acupuncture is practical to apply during surgery, when the patient is anesthetized, requiring no cooperation and causing no anxiety related to the use of needles. In addition, the reduction in the need for rescue medications may decrease the risks of adverse effects and the costs of treatment.

The study has some important limitations that must be considered. The number of patients evaluated, although adequate for statistical analysis, is relatively small, and the results apply specifically to patients undergoing laparoscopic cholecystectomy. It would be necessary to evaluate whether the same benefits extend to other types of surgery. In addition, follow-up was limited to the first 6 hours after surgery, providing no information on longer-term effects.

The exact mechanism by which acupuncture prevents nausea and vomiting is still not fully understood, although it is believed to involve the release of endorphins and changes in serotonin transmission in the nervous system. Despite these limitations, the study contributes to the growing body of evidence on the efficacy of acupuncture as a complementary therapy in medicine, especially when used in combination with conventional treatments, suggesting that integrative approaches may offer superior benefits to isolated treatments.