Abstract
Purpose
To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV).
Methods
One hundred and fifty ASA I–II, patients undergoing elective laparoscopic cholecystectomy were included in a randomized, prospective, double-blind and placebo-controlled study. Patients were divided into three groups of SO. Group I was the control; Group II received ondansetron 4 mgiv just prior to induction of anesthesia; in Group III acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I and II. The acupressure wrist bands were applied 30 min prior to induction of anesthesia and removed six hours following surgery. Anesthesia was standardized. PONV were evaluated separately as none, mild, moderate or severe within six hours of patients’ arrival in the postanesthesia care unit and then at 24 hr after surgery by a blinded observer. If patients vomited more than once, they were given 4 mg ondansetroniv as the rescue antiemetic. Results were analyzed by Ztest. AP value of < 0.05 was taken as significant.
Results
The incidence of PONV and the requirement of rescue medication were significantly lower in both the acupressure and ondansetron groups during the first six hours.
Conclusion
Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy, similar to that of ondansetron 4 mgiv.
Résumé
Objectif
Comparer l’efficacité des bandes d’acupression et de l’ondansétron comme prévention des nausées et vomissements postopératoires (NVPO).
Méthode
Cent cinquante patients d’état physique ASA I– II devant subir une cholécystectomie laparoscopique ont été recrutés pour une étude prospective, randomisée et à double insu contre placebo. Ils ont été répartis en trois groupes de 50. Le groupe I a été le groupe témoin; les patients du groupe II ont reçu 4 mg iv d’ondansétron juste avant l’induction de l’anesthésie; chez les patients du groupe III, on a appliqué des bandes d’acupression aux point P6. Des bandes d’acupression ont été placées de façon inappropriée chez les patients des groupes I et II. Les bandes ont été appliquées 30 min avant l’induction et enlevées six heures après l’opération. Lanesthésie a été normalisée. Les NVPO ont été évalués séparément comme inexistants, légers, modérés ou sévères pendant les six premières heures en salle de réveil, puis 24 h après l’opération par un observateur impartial. Si les patients vomissaient plus d’une fois, ils recevaient 4 mg d’ondansétron iv comme antiémétique de secours. Les résultats ont été analysés avec le test Z. Une valeur de P < 0,05 était considérée significative.
Résultats
L’incidence de NVPO et les besoins de médication de secours ont été significativement plus faibles autant avec l’acupression qu’avec l’ondansétron pendant les six premières heures.
Conclusion
Lacupression en Pô réduit de façon significative l’incidence de NVPO et la nécessité d’antiémétique de secours pendant les six premières heures suivant la cholécystectomie laparoscopique. Son effet est donc similaire à celui de 4 mg iv d’ondansétron.
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References
Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992;77: 162–84.
Korttila K. The study of postoperative nausea and vomiting. Br J Anaesth 1992; 69(Suppl. 1): 20S-3S.
Haley S, Edelist G, Urbach G. Comparison of alfentanil, fentanyl and enflurane as supplements to general anaesthesia for outpatient gynaecologic surgery. Can J Anaesth 1988; 35: 570–5.
Harmon D, Gardiner J, Harrison R, Kelly A. Acupressure and the prevention of nausea and vomiting after laparoscopy. Br J Anaesth 1999; 82: 387–90.
Watcha MF, Simeon RM, White PF, Stevens JL. Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients. Anesthesiology 1991; 75: 204–9.
Dundee JW, Sourial FBR, Ghaly RG, Bell PF. P6 acupressure reduces morning sickness. J R Soc Med 1988; 81: 456–7.
Dundee JW, Ghaly RG, Fitzpatrick KTJ, Lynch G, Abram P. Optimising antiemesis in cancer chemotherapy (Letter). Br Med J (Clin Res Ed) 1987; 294: 179.
Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KTJ, Lynas AGA. Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Br J Anaesth 1989; 63: 612–8.
Ho CM, Hseu SS, Tsai SK, Lee TY. Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief. Acta Anaesthesiol Scand 1996; 40: 372–5.
Vincent CA, Richardson PH. The evaluation of therapeutic acupuncture: concepts and methods. Pain 1986; 24: 1–13.
Allen DL, Kitching AJ, Nagle C. P6 acupressure and nausea and vomiting after gynaecological surgery. Anaesth Intensive Care 1994; 22: 691–3.
Tigerstedt I, Salmela L, Aromaa U. Double-blind comparison of transdermal scopolamine, droperidol and placebo against postoperative nausea and vomiting. Acta Anaesthesiol Scand 1988: 32: 454–7.
Liberman MA, Howe S, Lane M. Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 2000; 179: 60–2.
Goll V, Akça O, Greif R, et al. Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesth Analg 2001; 92: 112–7.
Wang JJ, Ho ST, Liu YH, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth 1999; 83: 772–5.
Parlow JL, Meikle AT, van Vlymen J, Avery N. Post discharge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis. Can J Anesth 1999; 46: 719–24.
Naguib M, El Bakry AKE, Khoshim MHB, et al. Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth 1996; 43: 226–31.
Tang J, Watcha MF, White PF. A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg 1996; 83: 304–13.
Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78: 7–16.
Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A. Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 1994; 79: 152–4.
Stein DJ, Birnbach DJ, Danzer BL, Kuroda MM, Grunebaum A, Thys DM. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1997; 84: 342–5.
Bailey PL, Streisand JB, Pace NL, et al. Transdermal scopolamine reduces nausea and vomiting after outpatient laparoscopy. Anesthesiology 1990; 72: 977–80.
Ferrari LR, Donlon JV. Metoclopramide reduces the incidence of vomiting after tonsillectomy in children. Anesth Analg 1992; 75: 351–4.
Heffernan AM, Rowbotham DJ. Postoperative nausea and vomiting—time for balanced antiemesis? (Editorial). Br J Anaesth 2000; 85: 675–7.
Kapur PA. Pharmacy acquisition costs: responsible choices versus overutilization of costly pharmaceuticals (Editorial). Anesth Analg 1994; 78: 617–8.
White PF. Are nonpharmacologic techniques useful alternatives to antiemetic drugs for the prevention of nausea and vomiting? Anesth Analg 1997; 84: 712–4.
Dundee JW. Belfast experience with P6 acupuncture antiemesis. Ulster Med J 1990; 59: 63–70.
Clement-Jones V, McLoughlin L, Tomlin S, Besser GM, Rees LH, Wen HL. Increased ß-endorphin but not metenkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Lancet 1980; 1: 946–8.
Lin X, Liang J, Ren J, Mu F, Zhang M, Chen JDZ. Electrical stimulation of acupuncture points enhances gastric myoelectrical activity in humans. Am J Gastroenterol 1997; 92: 1527–30.
Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M. Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy. Anesth Analg 1993; 76: 1012–4.
Fan CF, Tanhui E, Joshi S, Trivedi S, Hong Y, Shevde K. Acupressure treatment for prevention of postoperative nausea and vomiting. Anesth Analg 1997; 84: 821–5.
Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res 1990; 15:211–5.
Dundee JW, Ghaly G. Local anesthesia blocks the antiemetic action of P6 acupuncture. Clin Pharmacol Ther 1991; 50: 78–80.
Dundee JW, Ghaly RG. Does the timing of P6 acupuncture influence it’s efficacy as a postoperative antiemetic? Br J Anaesth 1989; 63: 630P.
Fitzpatrick KTJ, Dundee JW, Ghaly RG, Patterson CC. Is it necessary always to use the right forearm for acupuncture antiemesis? Br J Anaesth 1988; 61: 117–8P.
Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88: 1362–9.
Shenkman Z, Holzman RS, Kim C, et al. Acupressure-acupuncture antiemetic prophylaxis in children undergoing tonsillectomy. Anesthesiology 1999; 90: 1311–6.
Yentis SM, Bissonnette B. P6 acupuncture and postoperative vomiting after tonsillectomy in children. Br J Anaesth 1991; 67: 779–80.
Lewis LH, Pryn SJ, Reynolds PL, Pandit VA, Wilton NCT. Effect of P6 acupressure on postoperative vomiting in children undergoing outpatient strabismus correction. Br J Anaesth 1991; 67: 73–8.
Agarwal A, Pathak A, Gaur A. Acupressure wristbands do not prevent postoperative nausea and vomiting after urological endoscopic surgery. Can J Anesth 2000; 47: 319–24.
O’Brien B, Relyea MJ, Taerum T. Efficacy of P6 acupressure in the treatment of nausea and vomiting during pregnancy. Am J Obstet Gynecol 1996; 174: 708–15.
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Agarwal, A., Bose, N., Gaur, A. et al. Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anesth 49, 554–560 (2002). https://doi.org/10.1007/BF03017380
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DOI: https://doi.org/10.1007/BF03017380