From protocol to practice: enhancing the translational value of herbal patch studies through standardized assessment, robust blinding, and individualized dosing strategies

Dear Editor, We read with great interest the recent article by Yu et al titled “Effects of motion sickness patch on postoperative nausea and vomiting in female patients undergoing thyroid surgery: a randomized clinical trial”[1], published in the International Journal of Surgery. The authors conducted a meticulously designed randomized controlled trial to investigate a non-invasive herbal intervention for preventing postoperative nausea and vomiting (PONV) in high-risk female patients. Their work offers valuable insights into complementary strategies for PONV prophylaxis and represents a commendable contribution to perioperative medicine. While the study is methodologically sound, we wish to raise several considerations that may further refine the interpretation of the findings and enhance their translational potential for clinical practice. This study complies with the TITAN 2025 guidelines for transparent and ethical reporting of AI-assisted research[2]. First, in the “Participants” section, the investigator defined a “history of motion sickness” by asking patients if they had experienced dizziness, nausea, or vomiting while traveling through a “structured preoperative interview.” This definition relies on subjective recall and self-report and lacks objective, standardized diagnostic tools such as exercise testing or validated motion sickness scales. This may lead to a large heterogeneity in the severity and etiology of motion sickness in the selected patients, which may affect the uniformity of intervention effects and the universality of conclusions. Variability in the severity, frequency, and triggers of motion sickness among participants could influence both baseline PONV risk and response to the intervention[3]. To improve cohort homogeneity and reproducibility, future studies might consider employing validated tools such as the Motion Sickness Susceptibility Questionnaire or establishing more specific, operationally defined thresholds (e.g., symptoms occurring with certain modes of transportation or above a predefined frequency)[4]. Second, the blinding methodology, while well-intentioned, warrants closer attention. The authors noted that placebo patches were identical in size and scent to the active patches. However, for an herbal patch containing ingredients like peppermint – which often imparts a distinctive cooling sensation and aroma – sensory matching beyond visual appearance is crucial. If the active patch delivers perceptible local sensations (e.g., cooling, warmth, or a pronounced herbal odor) that are absent in the placebo, patients, particularly with patches applied behind the ears, may detect group assignment, potentially introducing expectation bias[5]. To strengthen blinding integrity, future trials should describe in detail the placebo formulation process, including the use of inert agents to replicate not only visual and olfactory but also tactile and thermal properties of the active patch. Additionally, evaluating blinding success through patient or assessor surveys at the trial’s conclusion could provide further methodological transparency[6]. Third, the study adopted a fixed 24-hour application period for the patch across all participants. While this ensures protocol uniformity, it does not account for individual variability in drug metabolism, symptom duration, or clinical response. In real-world practice, patients may experience complete relief well before 24 hours or may require extended antiemetic coverage beyond this timeframe. The current design leaves unanswered whether shorter or longer application durations could yield similar efficacy with improved convenience or safety. Future research could explore individualized or symptom-guided application strategies, such as patient-controlled removal upon symptom resolution or comparative studies assessing different wear durations (e.g., 12, 24, or 48 hours). Such approaches would better align with personalized medicine principles and inform more flexible, patient-centered usage guidelines[7]. In summary, the study provides promising evidence for the role of a herbal motion sickness patch in reducing PONV. Addressing the points above in subsequent investigations would not only enhance methodological rigor but also facilitate the integration of this non-invasive option into tailored, evidence-based PONV prevention pathways. We congratulate the authors on their important work and look forward to further advancements in this evolving field of perioperative care.