Evidence Summaries
The Bottom Line
PC6 acupoint stimulation reduces post-operative nausea by 32%, vomiting by 40%,
and rescue antiemetic use by 36% compared with sham or no treatment. Evidence
quality ranges from high to moderate depending on modality. All modalities show
mild, transient side effects only.
PC6 Acupoint Stimulation (All Modalities Combined)
When all modes of PC6 stimulation are pooled, the evidence shows consistent benefit across nausea, vomiting, and rescue antiemetic outcomes. Source: Lee et al., 2015 (Cochrane Database of Systematic Reviews).
| Outcome | Control Rate | Intervention Rate | RR (95% CI) | GRADE |
|---|---|---|---|---|
| Nausea | 47% | 31% | 0.68 (0.60-0.77) | High |
| Vomiting | 33% | 19% | 0.60 (0.51-0.71) | High |
| Rescue antiemetics | 33% | 20% | 0.64 (0.55-0.73) | Moderate |
Evidence by Modality
The following table compares effectiveness data across individual modalities. Data sourced from Lee et al. (2015) and Cheong et al. (2013) unless otherwise noted.
| Modality | Outcome | Control | Intervention | RR (95% CI) | GRADE |
|---|---|---|---|---|---|
| Manual Acupressure | Nausea | Data variable by study | Varies | Low | |
| Vomiting | Data variable by study | Varies | Low | ||
| Electroacupressure (E-Stim) | Nausea | 45% | 30% | 0.71 (0.62-0.81) | Moderate |
| Vomiting | 30% | 18% | 0.60 (0.50-0.73) | Moderate | |
| Auricular Acupuncture | Nausea | Effective for gynaecological surgery and laparoscopic cholecystectomy | -- | Low | |
| Vomiting | Limited pooled data | -- | Low | ||
| Body Acupuncture (PC6 + Other Points) | Nausea | 54% | 29% | 0.56 (0.39-0.80) | Moderate |
| Vomiting | 41% | 20% | 0.51 (0.34-0.76) | Moderate | |
| PONV (combined therapy) | 21% | 6% | 0.29 (0.17-0.49) | Moderate | |
| Electroacupuncture (EA) | Nausea | Equivalent to body acupuncture | Similar to body acupuncture | Moderate | |
| Vomiting | Equivalent to body acupuncture | Similar to body acupuncture | Moderate | ||
| Acupressure Wristbands | Nausea | 36% | 24% | 0.60 (0.53-0.69) | High |
| Vomiting | 20% | 15% | 0.54 (0.45-0.64) | High | |
| Rescue antiemetics | 22% | 13% | 0.62 (0.52-0.74) | Moderate | |
Modality Characteristics Comparison
| Modality | Invasive? | Equipment Cost | Training Level | Key Advantage | Key Limitation |
|---|---|---|---|---|---|
| Manual Acupressure | No | None | Low | No equipment needed | Effectiveness varies by practitioner skill |
| Electroacupressure | No | $40-$200 | Moderate | Extended duration; adjustable intensity | Equipment cost and training |
| Auricular Acupuncture | Yes | Cents per needle | High | Individualised point selection; economical | Requires qualified acupuncturist |
| Body Acupuncture | Yes | ~$0.05/needle | High | Strongest effect size; individualised | Needle monitoring; credentialling |
| Electroacupuncture | Yes | $200-$800 | High | Adjustable stimulus; reusable equipment | Highest equipment cost; monitoring needed |
| Acupressure Wristbands | No | ~$5 AUD | Low | Reusable; minimal training; home use | Sizing limits; impractical with IV lines |
Understanding GRADE Ratings
| Rating | Meaning |
|---|---|
| High | Further research is very unlikely to change confidence in the effect estimate. |
| Moderate | Further research is likely to have an important impact on confidence and may change the estimate. |
| Low | Further research is very likely to have an important impact on confidence and is likely to change the estimate. |
| Very Low | Any estimate of effect is very uncertain. |
GRADE ratings assigned based on published systematic reviews including Lee et al. (2015), Cheong et al. (2013), and Cochrane methodology. See full reference list below.
References
The following references underpin the evidence and methodology used throughout the Hospital Acupuncture Implementation Framework. They are listed alphabetically by first author.
- Aarons, G. A., Hurlburt, M. & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4-23.
- Apfel, C. C., Heidrich, F. M., Jukar-Rao, S., Jalota, L., Hornuss, C., Whelan, R. P., Zhang, K. & Cakmakkaya, O. S. (2012). Evidence-based analysis of risk factors for postoperative nausea and vomiting. British Journal of Anaesthesia, 109(5), 742-753.
- Apfel, C. C., Laara, E., Koivuranta, M., Greim, C. A. & Roewer, N. (1999). A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology, 91(3), 693-700.
- Barwick, M. (2011). Checklist to Assess Readiness for Implementation (CARI). Hospital for Sick Children, Toronto, Ontario.
- Cheong, K. B., Zhang, J.-P., Huang, Y. & Zhang, Z.-J. (2013). The effectiveness of acupuncture in prevention and treatment of postoperative nausea and vomiting — a systematic review and meta-analysis. PLoS ONE, 8(12), e82474.
- Cohen, M. M., Penman, S., Pirotta, M. & Da Costa, C. (2005). The integration of complementary therapies in Australian general practice: results of a national survey. Journal of Alternative and Complementary Medicine, 11(6), 995-1004.
- Faircloth, A. C. (2014). Perceptions of acupuncture/acupressure by anesthesia providers: a survey study. [Doctoral dissertation]. Available from ProQuest Dissertations.
- Gan, T. J., Diemunsch, P., Habib, A. S., Kovac, A., Kranke, P., Meyer, T. A., Watcha, M., Chung, F., Angus, S., Apfel, C. C., Bergese, S. D., Candiotti, K. A., Chan, M. T. V., Davis, P. J., Hooper, V. D., Lagoo-Deenadayalan, S., Myles, P., Nezat, G., Philip, B. K. & Tramer, M. R. (2014). Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 118(1), 85-113.
- Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J. & Squires, J. E. (2012). Knowledge translation of research findings. Implementation Science, 7, 50.
- Lee, A., Chan, S. K. & Fan, L. T. (2015). Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews, (11), CD003281.
- Myles, P. S. (2016). Measuring quality of recovery and patient satisfaction. In P. S. Myles (Ed.), Perioperative Medicine — Current Controversies. Springer.
- Pearson, A., Wiechula, R., Court, A. & Lockwood, C. (2005). The JBI model of evidence-based healthcare. International Journal of Evidence-Based Healthcare, 3(8), 207-215.
- Wardle, J., Adams, J., Sibbritt, D. & Lauche, R. (2013). Referral to acupuncture by medical practitioners: a survey of 544 Australian general practitioners. Acupuncture in Medicine, 31(4), 363-367.
- Weeks, E. M., Zheng, Z. & Xue, C. C. L. (2017). Acupuncture for postoperative nausea and vomiting: a survey of patient preferences. [Unpublished manuscript]. RMIT University.
- World Health Organization. (2002). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. WHO, Geneva.
Last reviewed: April 2026