Clinical trial effects of acupuncture combined with different general anesthesia on postoperative nausea and vomiting and early recovery after thyroidectomy with intra-operative neuromonitoring: a randomized controlled trial.

BACKGROUND

Intraoperative neuromonitoring (IONM) is widely used to preserve recurrent laryngeal nerve (RLN) function during thyroid surgery. However, patients undergoing thyroidectomy with IONM may experience a higher incidence of postoperative nausea and vomiting (PONV) and poorer recovery quality. Both acupuncture and propofol anesthesia have been investigated as potential strategies to prevent PONV, but clinical evidence on their combined use in thyroidectomy is limited. This study aimed to evaluate the effects of propofol-based anesthesia combined with postoperative acupuncture on PONV and early recovery within 24 h after thyroidectomy with IONM.

METHODS

A total of 135 adult patients were randomly assigned to one of four groups: sevoflurane with sham acupuncture (n = 32), sevoflurane with active acupuncture (n = 33), propofol with sham acupuncture (n = 35), or propofol with active acupuncture (n = 35). The primary outcomes were the incidence and severity of PONV and early recovery quality within 24 h. Secondary outcomes included sore throat, headache, and dizziness.

RESULTS

Compared with sevoflurane, propofol anesthesia significantly reduced PONV severity (OR = 0.313; 95% CI, 0.123-0.797; p = 0.014) and the frequency of postoperative vomiting (OR = 0.329; 95% CI, 0.115-0.939; p = 0.038). Active acupuncture also significantly reduced PONV severity compared with sham acupuncture (p = 0.008). However, combining propofol anesthesia with active acupuncture did not provide additional benefits beyond each intervention alone.

CONCLUSION

Both propofol anesthesia and postoperative acupuncture independently reduced the incidence and severity of PONV after thyroidectomy with IONM. No synergistic effect was observed, possibly due to mechanistic differences or the limited intensity of the acupuncture protocol. Further research is warranted to optimize acupuncture parameters and clarify the clinical utility of combined approaches across broader surgical settings.

CLINICAL TRIAL REGISTRATION: The clinical trial was registered in the Chinese Clinical Trial Registry under the identifier ChiCTR2400082127.