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P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women
Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
Department of Anaesthesiology and Intensive Care, Västervik Hospital .
Department of Anaesthesiology and Intensive Care, Eksjö Hospital, Linköping, Sweden.
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2002 (English)In: Canadian Journal of Anesthesia, ISSN 0832-610X, Vol. 49, no 10, 1034-1039 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the effect of sensory stimulation of the P6 point on postoperative nausea and vomiting (PONV) after gynecological surgery in the everyday clinical setting (effectiveness study).

Methods: Four hundred and ten women undergoing general anesthesia for elective gynecological surgery were included in a prospective, consecutive, randomized, multicentre, placebo-controlled, double-blind clinical trial with a reference group. One group was given bilateral P6 acupressure (n = 135), a second group similar pressure on bilateral non-acupressure points (n = 139), and a third group (n = 136) served as reference group. Nausea (scale 0–6), vomiting, pain, and satisfaction with the treatment were recorded. Primary outcome was complete response, i.e., no nausea, vomiting or rescue medication for 24 hr. Results were analyzed by applying logistic regression with indicators of treatments, type of operation and risk score for PONV as explanatory variables.

Results: Complete response was more frequent in the P6 acupressure group than in the reference group (P = 0.0194) Conversely, the incidence of PONV was 46% in the reference group, 38% after pressure on a non-acupoint and 33% after P6 acupressure. The decrease from 46% to 33% was statistically significant. When considering vaginal cases separately, the decrease in PONV was from 36% to 20% (P = 0.0168). The corresponding decrease from 59% to 55% in the laparoscopic surgery group was not statistically significant.

Conclusion: P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynecological surgery.

Place, publisher, year, edition, pages
2002. Vol. 49, no 10, 1034-1039 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13649OAI: oai:DiVA.org:liu-13649DiVA: diva2:21110
Available from: 2004-05-20 Created: 2004-05-20 Last updated: 2009-08-17
In thesis
1. Postoperative Symptoms After Gynaecological Surgery: How They Are Influenced by Prophylactic Antiemetics Sensory Stimulation (P6-Acupressure)
Open this publication in new window or tab >>Postoperative Symptoms After Gynaecological Surgery: How They Are Influenced by Prophylactic Antiemetics Sensory Stimulation (P6-Acupressure)
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness.

Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III).

Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p <0.009).

Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (>30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (>30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2004
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 851
Keyword
Acupuncture, P6-acupressure, droperidol, antiemetics, PONV, gynaecological surgery, motion sickness, eccentric rotation, coriolis effect, antiemetic prophylaxis, granisetron
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-5196 (URN)91-7373-822-0 (ISBN)
Public defence
2004-05-27, Elsa-Brändström salen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Note
On the day of the public defence the status of article IV was: Submitted.Available from: 2004-05-20 Created: 2004-05-20 Last updated: 2009-08-17

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Alkaissi, AidahKalman, Sigga

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