Transcutaneous Electrical Acupoint Stimulation vs Metoclopramide for Moderate to Severe Postoperative Nausea and Vomiting

Importance: Moderate to severe postoperative nausea and vomiting (PONV) significantly impedes recovery and is inadequately managed by current pharmacotherapy. Objective: To evaluate the clinical efficacy of a novel wearable transcutaneous electrical acupoint stimulation (TEAS) device targeting the PC6 (Neiguan) acupoint in managing moderate to severe PONV. Design, Setting, and Participants: This randomized, double-dummy, patient-blinded and observer-blinded, parallel-group, and active-controlled clinical trial was conducted at 4 hospitals in Shanghai and Tianjin, China, from May 2024 through May 2025. Eligible participants were female patients aged 25 to 55 years scheduled for thyroidectomy or anterior cervical surgery undergoing general anesthesia who developed moderate to severe PONV (numerical rating score [NRS] ≥4). These data were analyzed during June 2025. Interventions: Participants were randomized 1:1 to receive either active TEAS via the EmeTerm wristband applied for 2 hours with a saline placebo injection or an identical inactive TEAS device (model stimulator) with intravenous metoclopramide, 10 mg. Participants not achieving symptom relief (NRS ≥4) at 2 hours underwent rerandomization to cross-intervention. Main outcome and measure: The primary outcome was the 2-hour PONV remission rate following initial intervention defined as a significant relief in symptoms (NRS ≤3). Results: A total of 310 patients were screened for eligibility and 232 (74.8%) were randomized into either TEAS group (n = 116) or control group (n = 116). All participants completed the trial and a per-protocol analysis was conducted. Among 232 total patients, mean (SD) age was 43.5 (5.1) years and 100% were female. The TEAS group demonstrated a significantly higher 2-hour remission rate (77.6%; 95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P < .001) and a lower 24-hour relapse rate (12.2%; 95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < .001) compared with controls. No adverse events were reported. Conclusion and relevance: In this study, wearable TEAS significantly outperformed metoclopramide for moderate to severe PONV, representing an effective nonpharmacological alternative that enhances postanesthesia recovery. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2400084329.