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March 1998
Accupressure Treatment for Prevention of Postoperative Nausea and Vomiting
Fan CF, Tanhui E, Joshi S, Trivedi S, Hong Y, Shevde K; Anesth Analg 1997: 821-5
[ see abstract below ]
Nausea and vomiting provide substantial contributions to patients' suffering in a variety of circumstances: the postoperative period, cancer chemotherapy, opioid-related side effects to name but a few. Rational administration of anti-emetics to target each of the physiologic systems involved in nausea and vomiting (dopaminergic, cholinergic, histamine and serotonin) can help a great deal, however, some of these medications are very costly and have side effects of their own. The availability of complementary or alternative strategies could provide comfort to many.
Dr. Fan and colleagues from the Maimonides Medical Center in Brooklyn NY describe their evaluation of acupressure at the P.6 (Nei-Guan) point for prophylaxis for post-surgical nausea and vomiting. In this randomized, double blind study of 200 healthy patients, they found a 50% reduction in these symptoms in the group treated with P.6 acupressure. The bands were placed preoperatively, compressed to activate the P.6 meridian, and then left in place until 6 hours postoperatively. No patient reported side effects or complications from the acupressure band.
In a previous paper on the successful use of acupuncture for prophylaxis of perioperative nausea and vomiting, J.W. Dundee (Br Med J 1986; 293:583-4) describes the sensation of P.6 activation: "the occurrence of a non-anatomically distributed feeling of heaviness,
numbness, or tightness verified the correct positioning of the needle."
The results of other studies of the anti-emetic efficacy of acupuncture or acupressure at P.6 are varied. Possible explanations for the results in studies which did not show anti-emetic efficacy include poor localization or timing of the P.6 stimulus. Attention to placement
(details are available in both papers and in the instructions which accompany commercially available acupressure bands (AcuBand, SeaBand) and activation to elicit the sensations described above are key to the success of this technique. Also, application of the bands prior to the emetic stimulus seems to be very important.
Sounds as though this inexpensive, non-invasive approach to a common and unpleasant problem is worth a try!
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
Postoperative nausea and vomiting are still common problems after general anesthesia, especially in ambulatory surgery. Drug therapy is often complicated with central nervous system symptoms.
We studied a nonpharmacological method of therapy--acupressure--at the Pericardium 6 (P.6) (Nei-Guan) meridian point. Two hundred consecutive healthy patients undergoing a variety of short surgical procedures were included in a randomized, double-blind study:108 patients were in the acupressure group (Group 1) and 92 patients were in the control group (Group 2). Spherical beads of acupressure bands were placed at the P.6 points in the anterior surface of both forearms in Group 1 patients, while in Group 2 they were placed inappropriately on the posterior surface. The acupressure bands were placed before induction of anesthesia and were removed 6 h postoperatively. They were covered with a soft cotton wrapping to conceal them from the blinded observer who evaluated the patients for presence of nausea and vomiting and checked the order sheet for any antiemetics prescribed. In both groups, the age, gender, height, weight, and type and duration of surgical procedures were all comparable without significant statistical difference.
In Group 1, only 25 of 108 patients (23%) had nausea and vomiting as compared to Group 2, in which 38 of 92 patients (41%) had nausea and vomiting (P = 0.0058).
We concluded that acupressure at the P.6 (Nei-Guan) point is an effective prophylaxis for postsurgical nausea and vomiting and therefore a good alternative to conventional antiemetic treatment.
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