Effect of Acupuncture-Assisted Anesthesia on Prevention of Postoperative Nausea and Vomiting: A Meta-Analysis

Abstract Background While conventional pharmacologic antiemetics have recognized limitations, the evidence regarding acupuncture-assisted anesthesia (AAA) for preventing postoperative nausea and vomiting (PONV) remains inconsistent. This study specifically evaluates AAA as a standardized perioperative protocol rather than isolated acupuncture interventions, aiming to quantitatively assess its efficacy in PONV prevention. Methods Major databases were systematically searched for all relevant studies published up to March 2025. Only trials implementing AAA as a structured component of anesthesia management were included. The meta-analysis was conducted using RevMan 5.3 software. Results A total of seven randomised controlled clinical trials with 775 patients were included, 389 in the AAA group and 386 in the control group. Acupuncture-assisted anesthesia reduced the incidence of postoperative nausea and vomiting (RR = 0.29, 95% CI 0.20–0.41; P < 0.00001; I 2 = 7%). Although the low I 2 value indicates good statistical homogeneity and strengthens the reliability of the pooled results, the relatively small number of included studies and large effect sizes compared to previous comprehensive reviews raise concerns. A more detailed and critical analysis is needed to explore potential sources of this discrepancy—such as differences in acupuncture techniques, surgical types, or patient populations. The finding of reduced cough incidence is noteworthy as it highlights the unique aspects of AAA in managing anesthesia-related complications during induction and recovery. This result distinguishes our study from other reviews that have not addressed this outcome. However, given that this finding is based on only two studies, the significance and limitations of this conclusion should be rigorously discussed. AAA lowered cough incidence (RR = 0.71, 95% CI 0.52–0.97; P = 0.03; 2 studies, n = 162; I 2 = 0%) and reduced postoperative pain (VAS score MD = − 1.20, 95% CI − 1.42 to − 0.98; P < 0.00001; 2 studies, n = 164; I 2 = 0%). For gastrointestinal recovery, AAA accelerated first flatus time (MD = − 1.71 h, 95% CI − 2.56 to − 0.86; P < 0.0001) and first defecation time (MD = − 4.32 h, 95% CI − 6.21 to − 2.43; P < 0.00001), both from 2 studies (n = 284; I 2 = 0% for both). Conclusion Acupuncture-assisted anesthesia as a standardized perioperative protocol can reduce postoperative nausea and vomiting, cough, and pain while accelerated gastrointestinal recovery. These findings provide specific guidance for integrating AAA into modern anesthesia practice. Graphical Abstract