Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section

doi:10.1016/S0959-289X(98)80044-7

International Journal of Obstetric Anesthesia

Volume 7, Issue 4, October 1998, Pages 231-236

https://doi.org/10.1016/S0959-289X(98)80044-7 Get rights and content

Abstract

In this randomized double-blind trial we investigated the effect of acupressure on the incidence of nausea and vomiting after caesarean section under spinal anaesthesia with added intrathecal morphine. Parturients wore either acupressure or placebo wristbands during surgery and postoperatively for at least 10 h. There was no significant difference overall betweeen the two groups in the incidence of intra- or postoperative nausea or vomiting/retching. Demand for antiemetic medication was also similar in the two groups. However, in the sub-group of parturients who gave a previous history of postoperative nausea or vomiting, there was a statistically significant reduction in both postoperative nausea and vomiting/retching in the acupressure group. Further investigations are needed to see whether acupressure may be an effective non-pharmacological, non-invasive treatment for a common problem in this sub-group of patients.

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Cited by (23)

The Use of Short-Term Acupressure to Prevent Long-Term PONV: Was This a Case of Too Little, Too Late?
2017, Journal of Perianesthesia Nursing
Postoperative nausea and vomiting (PONV) is a common surgical complication that contributes to poor patient outcomes. The purpose of this study was to determine if acupressure to the P6 pressure point during the immediate postoperative period decreased PONV for the first 24 postoperative hours.
This was a double-blind, randomized study.
Experimental group participants wore a wristband, which administered acupressure to the P6 pressure point of one wrist. Control group wristbands were malpositioned. Bands remained on until patients were discharged from the postanesthesia care unit or up to a maximum of 2 hours. Data on nausea, vomiting, and antiemetic use were tracked for the first 24 postoperative hours.
There were no statistically significant between-group differences in PONV or antiemetic use.
Short-term postoperative acupressure to one wrist did not lead to a 24-hour decrease in nausea, vomiting, or antiemetic use.
Acupuncture in the Management of Intraoperative Nausea and Vomiting
2016, JAMS Journal of Acupuncture and Meridian Studies
Intraoperative and postoperative nausea and vomiting (IONV and PONV, respectively) are common complications of anesthesia with significant associated morbidity. Strategies for their prevention and treatment have been organized in pharmacological and nonpharmacological measures. Acupuncture at PC6 has demonstrated efficacy in randomized trials, although evidence regarding its efficacy in treating IONV and PONV has not yet been fully established. We present the case of a patient who underwent peripheral vascular surgery on a limb under a subarachnoid block and who developed IONV refractory to conventional pharmacological therapy. Acupuncture at the PC6 and the TF4 points proved to be an effective alternative treatment to conventional pharmacological treatment and resulted in almost immediate cessation of IONV.
Integrating Tuina Acupressure and Traditional Chinese Medicine Concepts Into a Holistic Nursing Practice
2006, Explore: The Journal of Science and Healing
Metaanalyses of Acustimulations: Effects on Nausea and Vomiting in Postoperative Adult Patients
2006, Explore: The Journal of Science and Healing
Using metaanalysis to examine the effects of acustimulations on nausea and vomiting symptoms (NVS) in postoperative adult populations.
Metaanalyses of effects of various acupoints stimulations (AS) (including acupuncture, acupressure, and electrical stimulation) on NVS in postoperative adult populations were performed. Thirty-three quality randomized controlled trials (RCT) published over the past three decades were identified by evaluating the quality of randomization and treatment methods, and results were pooled using a fixed effects model.
Twenty-four trials were pooled for nausea, 29 trials for vomiting, and 19 trials for rescue antiemetics, with AS compared with placebo or controls. Two additional trials did not have control groups but compared AS to medication groups. Compared with the controls, AS (all modalities) reduced nausea (relative risk [RR] = 0.60, 95% confidence interval [CI]: 0.54-0.67, P < .0001), vomiting (RR = 0.51, 95% CI: 0.45-0.57, P < .0001), and use of rescue antiemetics (RR = 0.63, 95% CI: 0.54-0.74, P < 0001). All AS modalities were effective in reducing NVS. Korean hand acupressure stimulations (two trials) had the best impact on reducing vomiting. There were no significant differences on pooled RRs for nausea (five trials) and vomiting (eight trials) between medication and AS groups, but medication groups had increased use of rescue antiemetics (two trials, RR = 2.27, 95% CI: 1.48-3.49, P = .0002). There was a placebo effect when compared with controls in reducing nausea (four trials, RR = 0.67, 95% CI: 0.50-0.90, P = .0069) and vomiting (three trials, RR = 0.39, 95% CI: 0.19-0.80, P = .0106).
This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations.
P6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: A systematic review of randomized controlled trials
2008, Anesthesia and Analgesia
Citation Excerpt :
Vomiting: Of the five studies reporting on the incidence of intraoperative vomiting, none were able to demonstrate an improvement with P6 stimulation.5,8,9,11,18,19 Of the four studies reporting the incidence of postoperative vomiting,5,8,18,19 only two reported a significant reduction with P6 stimulation.8,18 Again Duggal et al.,5 in a subgroup analysis, reported a statistically significant reduction in the incidence of postoperative vomiting with P6 stimulation in women who had a history of PONV.
A number of studies investigated the use of P6 stimulation for the prevention of intraoperative and postoperative nausea and vomiting (IONV and PONV) in women having cesarean delivery under neuraxial anesthesia. We performed a systematic review to determine the overall efficacy of these techniques in preventing IONV and PONV in this patient population.
We performed a literature search of all randomized controlled trials (1966–2007) that compared different methods of P6 stimulation with placebo in women having cesarean delivery under neuraxial anesthesia. Data were extracted on the primary outcomes including the incidence of nausea, vomiting, and the need for rescue antiemetic therapy, both intraoperatively and postoperatively.
Six studies involving 649 patients were included in this review. Five studies reported on intraoperative outcomes. Of these, two studies reported a significant reduction in the incidence of intraoperative nausea with P6 stimulation, and one study reported a significant reduction in rescue antiemetic requirement. However, none of the studies reported any differences between the treatment and control groups with respect to vomiting. Four studies reported postoperative outcomes. Of these, one study reported a significant reduction in postoperative nausea, two studies reported a significant reduction in postoperative vomiting, and one study reported a significant reduction in the need for postoperative rescue antiemetic therapy.
While some studies showed a benefit of P6 stimulation, this finding was not consistent. The presence of heterogeneity and inconsistent results among the included trials prevents any definitive conclusions on the efficacy of P6 stimulation in reducing IONV and PONV associated with cesarean delivery performed under neuraxial anesthesia.
P6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery
2006, Anesthesia and Analgesia
Nausea and vomiting are major adverse effects during spinal anesthesia for cesarean delivery. Stimulation of the P6 (Neiguan) acupoint is a traditional Chinese acupuncture technique used for effective antiemetic purposes. In this study, we evaluated the antiemetic effect of P6 acupressure in parturients during spinal anesthesia for cesarean delivery. In a randomized, double-blind, controlled trial, 110 parturients scheduled for elective cesarean delivery were enrolled in the study. Thirty minutes before initiation of spinal anesthesia, parturients were randomized to acupressure bands or placebo bands bilaterally on the P6 acupoint and nausea and vomiting were observed over the study period. There were no statistically significant differences in maternal characteristics. Incidence rates for intraoperative nausea were 64% (acupressure group) and 71% (control group) (P = 0.416), with an incidence of intraoperative vomiting of 22% (acupressure group) and 27% (control group) (P = 0.506). The results suggest that prophylactic use of acupressure bands bilaterally on the P6 acupoint failed to prevent nausea and vomiting during spinal anesthesia for cesarean delivery.

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Original articleAcupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section

Abstract

Br J Anaesth

Acupressure in the prevention of postoperative nausea and vomiting

Anaesthesist

Postoperative nausea is relieved by acupressure

J Roy Soc Med

Acupressure and postoperative vomiting

Anaesthesia

Original article
Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section