Effects of Chinese acupuncture on nausea and vomiting after cholecystectomy: A retrospective study

Abstract

BACKGROUND

Post-operative nausea and vomiting (PONV) after cholecystectomy occurs in 40%-75% of patients, significantly affecting recovery and satisfaction.

AIM

To evaluate the effectiveness and safety of acupuncture at Hegu (LI4) and Zusanli (ST36) acupoints in preventing PONV in patients undergoing cholecystectomy.

METHODS

This retrospective study included 240 patients undergoing cholecystectomy (January 2022 to December 2023), randomized to acupuncture (n = 120) or control groups (n = 120). The acupuncture group received bilateral LI4 and ST36 acupuncture immediately post-surgery and 6 hours later; controls received routine care. Primary outcomes included PONV incidence, severity (visual analogue scale score), and time to first occurrence.

RESULTS

The total PONV incidence in the acupuncture group was significantly lower than in the control group (28.3% vs 47.5%, P < 0.01). Stratified analysis showed that in the laparoscopic group, the acupuncture group’s PONV incidence was 26.7%, significantly lower than the control group’s 45.6% (P < 0.01); in the open surgery group, the acupuncture group was 33.3%, lower than the control group’s 53.3% (P < 0.05). The acupuncture group showed significantly reduced symptom severity (visual analogue scale score 2.7 ± 1.4 vs 4.5 ± 1.8, P < 0.01), delayed time to first occurrence (8.4 ± 2.1 hours vs 4.2 ± 1.5 hours, P < 0.01), with the symptom-free period extended by 4.2 hours. The acupuncture group had a higher proportion of mild symptoms (76.5% vs 35.1%) and a significantly increased proportion of symptom-free patients within 6 hours post-surgery (67.6% vs 28.1%, P < 0.01). Rescue antiemetic medication usage was significantly reduced in the acupuncture group (18.3% vs 35.8%, P < 0.01). Patient satisfaction scores in the acupuncture group were significantly better than the control group (4.6 ± 0.7 vs 3.8 ± 0.9, P < 0.01), with hospital stay shortened by 0.5 days (2.1 ± 0.8 days vs 2.6 ± 1.1 days, P < 0.05). Subgroup analysis showed that acupuncture was more effective in patients ≤ 45 years (incidence reduction 23.5% vs > 45 years group 16.8%), with significant efficacy in high-risk patients (Apfel score ≥ 3) (36.2% vs 62.2%, P < 0.01). Safety analysis showed only 7 cases (5.8%) of mild adverse reactions in the acupuncture group, all self-resolved with no serious adverse events.

CONCLUSION

Acupuncture at LI4 and ST36 acupoints significantly reduces PONV incidence and severity after cholecystectomy, with an excellent safety profile. This non-pharmacological intervention offers particular value for high-risk patients and those with medication contraindications.

Keywords: Acupuncture; Cholecystectomy; Post-operative nausea and vomiting; Laparoscopic surgery; Hegu and Zusanli

Core Tip: This retrospective study found that acupuncture at Hegu and Zusanli significantly reduced post-operative nausea and vomiting incidence, severity, and antiemetic use after cholecystectomy. It delayed symptom onset, shortened duration, and improved patient satisfaction. Acupuncture showed better efficacy in younger and high-risk patients, with good safety. To evaluate the effect of acupuncture in traditional Chinese medicine on postoperative nausea and vomiting, acupuncture centered on acupoints such as Neiguan can significantly reduce the incidence and severity of postoperative nausea and vomiting, decrease the use of antiemetic drugs, shorten the length of hospital stay, and has good safety. Early intervention and standardized programs may yield greater benefits.