Traditional Chinese medicine acupuncture for postoperative nausea and vomiting after cholecystectomy: Mechanistic insights and clinical evidence

Abstract

Postoperative nausea and vomiting (PONV) remain a frequent and distressing complication following cholecystectomy, impairing recovery and patient satisfaction. Despite the availability of pharmacologic therapies, PONV continues to occur at a substantial rate. While conventional pharmacologic antiemetics are widely used, their efficacy is limited by incomplete symptom control and potential adverse effects. In recent years, traditional Chinese medicine acupuncture has emerged as a promising non-pharmacological adjunct with both preventive and therapeutic value in PONV management. This review synthesizes current evidence on the mechanisms and clinical efficacy of acupuncture for PONV after cholecystectomy. Acupuncture modulates the autonomic nervous system, enhances gastrointestinal motility, and regulates key neurotransmitters such as serotonin and dopamine, collectively restoring neuro-humoral balance and suppressing emetic pathways. Clinical trials and meta-analyses consistently demonstrate that acupuncture, particularly stimulation of the Neiguan point, significantly reduces PONV incidence and severity with minimal adverse effects. Various acupuncture modalities, including manual acupuncture, electroacupuncture, and transcutaneous electrical acupoint stimulation, have shown similar antiemetic potential in perioperative settings. Based on accumulating evidence, integrating Neiguan-focused acupuncture into multimodal antiemetic regimens may provide added benefit, although further research is needed to standardize implementation protocols. Future research should focus on standardizing acupuncture protocols and elucidating molecular mechanisms to strengthen evidence-based application in surgical practice.

Keywords: Traditional Chinese medicine acupuncture; Cholecystectomy; Nausea and vomiting; Perioperative management; Non-pharmacological treatment

Core Tip: Postoperative nausea and vomiting frequently complicates recovery after cholecystectomy despite advances in pharmacologic prophylaxis. This review summarizes recent mechanistic and clinical evidence supporting traditional Chinese medicine acupuncture as a safe, effective adjunctive therapy. Acupuncture modulates autonomic function, enhances gastrointestinal motility, and balances neurotransmitter signaling to reduce postoperative nausea and vomiting severity. Stimulation at Neiguan demonstrates consistent antiemetic benefits, suggesting that acupuncture may be integrated into multimodal perioperative management to optimize recovery and improve patient satisfaction.