Evidence Summaries

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 (Lee et al., 2025, Cochrane review update). Nausea was reduced from 47% in controls to 31% with treatment (RR 0.68, 95% CI 0.60–0.77). Vomiting was reduced from 33% to 19% (RR 0.60, 95% CI 0.51–0.71). Rescue antiemetic use fell from 33% to 20% (RR 0.64, 95% CI 0.55–0.73).

Evidence by Modality

The following summarises effectiveness data across individual modalities. Data sourced from Lee et al. (2025) and Cheong et al. (2013) unless otherwise noted.

• Manual acupressure: Evidence shows benefit for nausea and vomiting but varies across studies; direct comparative data are limited.
• Electroacupressure: Nausea reduced from 45% to 30% (RR 0.71, 95% CI 0.62–0.81); vomiting from 30% to 18% (RR 0.60, 95% CI 0.50–0.73).
• Auricular acupuncture: Effective for gynaecological surgery and laparoscopic cholecystectomy. Pooled vomiting data are limited.
• Body acupuncture (PC6 + other points): Nausea from 54% to 29% (RR 0.56, 95% CI 0.39–0.80); vomiting from 41% to 20% (RR 0.51, 95% CI 0.34–0.76). When combined with pharmacotherapy, PONV occurrence fell from 21% to 6% (RR 0.29, 95% CI 0.17–0.49).
• Electroacupuncture: Effectiveness equivalent to body acupuncture across nausea and vomiting outcomes.
• Acupressure wristbands: Broad PC6 acupressure data show nausea from 36% to 24% (RR 0.60, 95% CI 0.53–0.69) and vomiting from 20% to 15% (RR 0.54, 95% CI 0.45–0.64). Wristband-specific evidence is limited; these figures will be updated.

Modality Characteristics

• Manual acupressure: Non-invasive, no equipment needed, low training requirement. Effectiveness varies with practitioner skill.
• Electroacupressure: Non-invasive, equipment cost $40–$200, moderate training. Allows extended duration and adjustable stimulus intensity.
• Auricular acupuncture: Invasive (needle), cents per needle, high training requirement. Economical and individualisable but requires a qualified acupuncturist.
• Body acupuncture: Invasive, approximately $0.60–$1.20 per treatment, high training. Strongest effect size; requires credentialled practitioner and needle monitoring.
• Electroacupuncture: Invasive, equipment cost $200–$800, high training. Adjustable stimulus with reusable equipment; highest equipment cost.
• Acupressure wristbands: Non-invasive, approximately $8–$15 AUD per unit, low training. Reusable and suitable for home use; sizing may limit use alongside IV lines.

Understanding GRADE Ratings

Evidence quality is rated using the GRADE system. High means further research is very unlikely to change confidence in the effect estimate. Moderate means further research is likely to have an important impact and may change the estimate. Low means further research is very likely to change the estimate. Very Low means any estimate of effect is very uncertain.

Ratings based on published systematic reviews including Lee et al. (2025), 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.

1. 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.
2. 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.
3. 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.
4. Barwick, M. (2011). Checklist to Assess Readiness for Implementation (CARI). Hospital for Sick Children, Toronto, Ontario.
5. 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.
6. 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.
7. Faircloth, A. C. (2014). Perceptions of acupuncture/acupressure by anesthesia providers: a survey study. [Doctoral dissertation]. Available from ProQuest Dissertations.
8. 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.
9. 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.
10. Lee, A., Chan, S. K. & Fan, L. T. (2025). Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews, CD003281. [Updated review.]
11. Myles, P. S. (2016). Measuring quality of recovery and patient satisfaction. In P. S. Myles (Ed.), Perioperative Medicine — Current Controversies. Springer.
12. 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.
13. 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.
14. 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.
15. World Health Organization. (2002). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. WHO, Geneva.
16. Faircloth, A. C., Dubovoy, A., Biddle, C., Dodd-McCue, D. & Butterworth, J. F., 4th (2016). CME Article: Perceptions of Acupuncture and Acupressure by Anesthesia Providers: A Quantitative Descriptive Study. Medical Acupuncture, 28(2), 79–86. https://doi.org/10.1089/acu.2015.1161 [Original staff survey.]
17. Zhang, N. M., Daly, D., Terblanche, M., Joshi, S., Tacey, M., Vesty, G. & Zheng, Z. (2022). Doctors' and Nurses' Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey. Pain Management Nursing, 23(6), 800–810.
18. Zheng, Z., Stelmach, W. S., Ma, J., Briedis, J., Hau, R., Tacey, M., Atme, J., Bourne, D., Crabbe, J., Fletcher, C., Howat, P., Layton, J. & Xue, C. C. (2023). Health professionals' attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: a survey and implications for implementation. Acupuncture in Medicine, 41(1), 16–26. https://doi.org/10.1177/09645284221085282
19. Zheng, Z., Layton, J., Stelmach, W., Crabbe, J., Ma, J., Briedis, J., Atme, J., Bourne, D., Hau, R., Cleary, S. & Xue, C. C. (2020). Using patient self-checklist to improve the documentation of risk of postoperative nausea and vomiting: an implementation project. International Journal of Evidence-Based Healthcare, 18, 65–74. https://doi.org/10.1097/XEB.0000000000000213

Last reviewed: April 2026