Clinical Role of Acupressure in Preventing Postoperative Nausea and Vomiting: A Scoping Review

Abstract

Background: Postoperative nausea and vomiting (PONV) remain one of the most distressing and prevalent complications following anaesthesia and surgery, affecting approximately 30% of unselected surgical patients and up to 80% of individuals with multiple Apfel risk factors. Despite significant advances in pharmacological prophylaxis, residual risk persists, particularly among high-risk groups, and the side-effect profiles and costs of conventional antiemetics limit their universal applicability. Acupressure at the Pericardium 6 (PC6, Neiguan) point offers a non-invasive, low-cost, and nursing-friendly adjunctive intervention that warrants systematic evaluation. Objective: To map and synthesise current evidence on PC6 acupressure for the prevention of PONV, appraise proposed neurophysiological mechanisms, compare efficacy with standard antiemetic agents, and propose evidence-informed implementation strategies relevant to diverse resource settings, with particular emphasis on sub-Saharan Africa. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and reported following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Five electronic databases—MEDLINE (PubMed), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and African Journals Online (AJOL)—were systematically searched from inception to 31 December 2023. Eligible studies included peer-reviewed randomised controlled trials (RCTs), systematic reviews, and meta-analyses evaluating PC6 stimulation for PONV prevention in adults aged 18 years or older. Two independent reviewers screened records, extracted data, and assessed methodological quality. Narrative synthesis prioritised Cochrane reviews and recent network meta-analyses. Results: The search yielded 1,247 records, of which 42 sources met inclusion criteria (12 systematic reviews/meta-analyses and 30 landmark RCTs). The 2015 Cochrane review comprising 59 RCTs (n=7,667) demonstrated that PC6 stimulation significantly reduced nausea (RR 0.68, 95% CI 0.60–0.77) and vomiting (RR 0.60, 95% CI 0.51–0.71) versus sham, with a number needed to treat for an additional benefit (NNTB) of 5 for nausea at 60% baseline risk. No significant difference was found between PC6 and single-agent antiemetics (ondansetron, dexamethasone, droperidol). The 2025 Cochrane network meta-analysis of 77 trials confirmed an additive benefit when PC6 was combined with antiemetics, yielding 135–247 fewer PONV events per 1,000 patients compared with sham. African data show pooled PONV incidence of 25.0% for nausea and 23.7% for vomiting, with lower rates reported in Nigerian obstetric cohorts using regional anaesthesia. Adverse events were minor (skin irritation 1–3%). Conclusions: PC6 acupressure is safe, inexpensive, and supported by moderate-quality evidence. It is non-inferior to single pharmacologic agents and provides incremental benefit in multimodal regimens. Integration into perioperative pathways is warranted, especially in high-risk patients and resource-constrained settings.