Risk of Postoperative Nausea and Vomiting After Total Hip or Knee Arthroplasty Under Spinal Anesthesia: Randomized Trial Comparing Conventional Antiemetics with or without the EmeTerm Bracelet.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-03-28 DOI:10.2106/JBJS.24.00773

Yidan Yang, Chunping Wang, Guorui Cao, Hongjun Li, Lanbo Yang, Jianing Xi, Chaojun Sun, Huamei Lu, Youwen Liu, Jiayi Guo, Chen Yue

{"title":"Risk of Postoperative Nausea and Vomiting After Total Hip or Knee Arthroplasty Under Spinal Anesthesia: Randomized Trial Comparing Conventional Antiemetics with or without the EmeTerm Bracelet.","authors":"Yidan Yang, Chunping Wang, Guorui Cao, Hongjun Li, Lanbo Yang, Jianing Xi, Chaojun Sun, Huamei Lu, Youwen Liu, Jiayi Guo, Chen Yue","doi":"10.2106/JBJS.24.00773","DOIUrl":null,"url":null,"abstract":"Background: Acupoint stimulation has been shown to reduce the risk of postoperative nausea and vomiting (PONV) after various types of surgeries involving general anesthesia, but whether the same is true after orthopaedic surgery involving spinal anesthesia is unclear. The purpose of this study was to compare PONV rates and the quality of recovery between patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) under spinal anesthesia receiving conventional antiemetics alone and those receiving antiemetics combined with use of a transcutaneous electrical acupoint stimulation bracelet (EmeTerm; WAT Medical Enterprise).Methods: Patients at moderate or high risk for PONV, including 195 patients undergoing THA and 153 patients undergoing TKA, were randomized to receive routine antiemetics (dexamethasone and ondansetron) alone or with use of the EmeTerm bracelet. The primary outcome was the PONV incidence within 24 hours postoperatively; secondary outcomes included the rates of severe PONV, antiemetic rescue, adverse events, and Quality of Recovery scores.Results: Combining antiemetics with the EmeTerm bracelet significantly reduced PONV (16.0% compared with 31.2%; p = 0.001), severe PONV (1.1% compared with 8.1%; p = 0.002), and antiemetic rescue (3.4% compared with 13.9%; p = 0.001). Use of the bracelet reduced the risk of PONV within 24 hours by 61% (adjusted hazard ratio, 0.39; 95% confidence interval [CI], 0.24 to 0.63), and its benefit became significant at 0 to 3 and 3 to 6-hour intervals after surgery. The complete response rate was higher for the bracelet + antiemetics group compared with the group with antiemetics alone (84.0% compared with 68.8%; p = 0.001), with better Quality of Recovery scores at 24 hours in the bracelet + antiemetics group.Conclusions: The EmeTerm bracelet enhanced the efficacy of antiemetics in reducing PONV after THA and TKA under spinal anesthesia and may improve short-term recovery.Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone and Joint Surgery, American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2106/JBJS.24.00773","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Acupoint stimulation has been shown to reduce the risk of postoperative nausea and vomiting (PONV) after various types of surgeries involving general anesthesia, but whether the same is true after orthopaedic surgery involving spinal anesthesia is unclear. The purpose of this study was to compare PONV rates and the quality of recovery between patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) under spinal anesthesia receiving conventional antiemetics alone and those receiving antiemetics combined with use of a transcutaneous electrical acupoint stimulation bracelet (EmeTerm; WAT Medical Enterprise).

Methods: Patients at moderate or high risk for PONV, including 195 patients undergoing THA and 153 patients undergoing TKA, were randomized to receive routine antiemetics (dexamethasone and ondansetron) alone or with use of the EmeTerm bracelet. The primary outcome was the PONV incidence within 24 hours postoperatively; secondary outcomes included the rates of severe PONV, antiemetic rescue, adverse events, and Quality of Recovery scores.

Results: Combining antiemetics with the EmeTerm bracelet significantly reduced PONV (16.0% compared with 31.2%; p = 0.001), severe PONV (1.1% compared with 8.1%; p = 0.002), and antiemetic rescue (3.4% compared with 13.9%; p = 0.001). Use of the bracelet reduced the risk of PONV within 24 hours by 61% (adjusted hazard ratio, 0.39; 95% confidence interval [CI], 0.24 to 0.63), and its benefit became significant at 0 to 3 and 3 to 6-hour intervals after surgery. The complete response rate was higher for the bracelet + antiemetics group compared with the group with antiemetics alone (84.0% compared with 68.8%; p = 0.001), with better Quality of Recovery scores at 24 hours in the bracelet + antiemetics group.

Conclusions: The EmeTerm bracelet enhanced the efficacy of antiemetics in reducing PONV after THA and TKA under spinal anesthesia and may improve short-term recovery.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

查看原文本刊更多论文

脊髓麻醉下全髋关节或膝关节置换术后恶心和呕吐的风险：比较常规止吐药与 EmeTerm 手环的随机试验。

背景：有研究表明，穴位刺激可降低各类全身麻醉手术后恶心和呕吐（PONV）的风险，但脊髓麻醉骨科手术后是否也有同样的效果尚不清楚。本研究的目的是比较在脊柱麻醉下接受全髋关节置换术（THA）或全膝关节置换术（TKA）的患者仅接受常规止吐药与接受止吐药并同时使用经皮穴位电刺激手环（EmeTerm；WAT Medical Enterprise）的患者之间的 PONV 发生率和恢复质量：中度或高度PONV风险患者（包括195名接受THA手术的患者和153名接受TKA手术的患者）被随机分配为单独接受常规止吐药（地塞米松和昂丹司琼）或同时使用EmeTerm手环。主要结果是术后 24 小时内的 PONV 发生率；次要结果包括严重 PONV 发生率、止吐药抢救、不良事件和恢复质量评分：结果：将止吐药与 EmeTerm 手环结合使用可显著降低 PONV（16.0%，31.2%；p = 0.001）、严重 PONV（1.1%，8.1%；p = 0.002）和止吐抢救率（3.4%，13.9%；p = 0.001）。使用该手环可将24小时内发生PONV的风险降低61%（调整后的危险比为0.39；95%置信区间[CI]为0.24至0.63），其益处在术后0至3小时和3至6小时间隔内变得显著。与单独使用止吐药组相比，手环+止吐药组的完全反应率更高（84.0%对68.8%；P = 0.001），手环+止吐药组在24小时内的恢复质量评分更高：结论：EmeTerm 手环增强了止吐药在减少脊髓麻醉下 THA 和 TKA 术后 PONV 的疗效，并可改善短期恢复：有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.