This prospective, randomized controlled study aims to evaluate the efficacy and safety of electroacupuncture combined with 5-HT3 receptor inhibitor for preventing postoperative nausea and vomiting (PONV) in high-risk patients undergoing thoracoscopic lung cancer surgery. The primary outcome is the incidence of PONV within 24 hours after surgery.

Postoperative nausea and vomiting (PONV) is a common complication after thoracic surgery, especially in high-risk patients, which seriously affects postoperative recovery and quality of life. 5-HT3 receptor inhibitors are commonly used for PONV prophylaxis, but their efficacy is limited in some high-risk populations. Electroacupuncture has been shown to reduce PONV in clinical settings.

This study aims to investigate the safety and efficacy of electroacupuncture (EA) combined with 5-HT3 receptor inhibitor dolasetron in preventing nausea and vomiting in high-risk patients after video-assisted thoracoscopic (VATS) surgery. This is a prospective, randomized, sham-controlled, blinded study designed to enroll perioperative patients at high risk of postoperative nausea and vomiting (PONV) (with an Apfel score ≥ 3) who are scheduled to undergo video-assisted thoracoscopic surgery (VATS) for lung resection. Eligible patients will be randomly assigned to 2 sessions of EA or sham electroacupuncture (SA) during the perioperative time. All patients will receive prophylactic antiemetic medication of dolasetron and dexamethasone. The primary outcome will be the incidence of PONV within 24 hours after surgery. The secondary outcomes include the incidence of postoperative nausea (PON), postoperative vomiting (POV), or PONV at different time intervals within 48 hours after surgery (upon awakening, 6, 24, 48 hours postoperatively), severity of PON (assessed by Visual Analogue Scale, VAS score), frequency of POV, usage rate of rescue antiemetic drugs, average dosage intensity of opioids administered during and after surgery, average exhaust time and average defecation time; average length of hospital stay, and recording of adverse events related to acupuncture.

Inclusion Criteria:

• Age ≥ 18 years;
• American Society of Anesthesiologists (ASA) physical status I-III;
• Body mass index (BMI) 18-30 kg/m²;
• Scheduled for elective video-assisted thoracoscopic surgery (VATS) lobectomy, segmentectomy, or wedge resection;
• Expected to receive postoperative opioid analgesia, with an Apfel risk score ≥ 3;
• Normal pulmonary function, without severe cardiovascular, hepatic, or renal abnormalities;
• No infection around the acupuncture sites;
• Voluntary written informed consent provided by the subject.

Exclusion Criteria:

• Severe systemic diseases, such as cardiovascular, hepatic, or renal abnormalities, or poor pulmonary function;
• Subjects with cognitive dysfunction or psychological disorders;
• History of previous esophageal or gastric surgery;
• Hypersensitivity to acupuncture or any study medications;
• Severe infection or history of surgery around the acupuncture sites;
• Pregnant or lactating women;
• Long-term opioid use;
• Conversion to open surgery;
• Acupuncture treatment received within 1 month prior to enrollment.

Brief explanation for not sharing IPD: This study does not plan to share Individual Participant Data (IPD) primarily to protect the privacy and confidentiality of study participants, in line with the ethical requirements of clinical trials and the relevant policies of the Chinese Clinical Trial Registry. All participant-related data, including demographic data, baseline clinical data, intervention-related data, outcome measure data and follow-up data, are strictly managed and kept confidential.

The clinical trial coordinators and acupuncturists are aware of the treatment assignments; while the subjects, anesthesiologists, perioperative management physicians, baseline and efficacy assessors, and statistical analysts are all blinded.