Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy

Abstract

P Pu ur rp po os se e: : To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV).M Me et th ho od ds s: : 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 50. Group I was the control; Group II received ondansetron 4 mg iv 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 ondansetron iv as the rescue antiemetic. Results were analyzed by Z test. A P value of < 0.05 was taken as significant. R Re es su ul lt ts s: : 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.C Co on nc cl lu us si io on n: : 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 mg iv. 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

Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting

“…There was no difference in the risk of requiring rescue antiemetics for P6 acupoint stimulation compared to pooled antiemetic drugs (RR 0.82, 95% CI 0.59 to 1.13) (Agarwal 2002;Butkovic 2005;Gan 2004;Misra 2005;Sharma 2007;Wang 2002;White 2002). Trial results were homogeneous (I 2 = 0%) ( Figure 13).…”

“…There was no difference in the risk of postoperative nausea for P6 acupoint stimulation compared to pooled antiemetic drugs (Analysis 2.1.6: RR 0.82, 95% CI 0.60 to 1.13) (Agarwal 2002;Dundee 1989;Gan 2004;Misra 2005;Schultz 2003;Sharma 2007;Tavlan 1996;Wang 2002;White 2002). There was minor heterogeneity between the trials (I 2 = 37%) ( Figure 9).…”

“…There were 10 types of P6 acupoint stimulation: needle acupuncture (Dundee 1986;Dundee 1989;Sharma 2007;Streitberger 2004;Yentis 1992); infiltration of dextrose (Tavlan 1996;Wang 2002;Yang 1993); semipermanent needles (Andrzejowski 1996); electrical stimulation of needles (Amir 2007;Dundee 1989;Ho 1989;Rusy 2002); transcutaneous electrical nerve stimulation (Fassoulaki 1993;Gan 2004;Habib 2006;Ho 1989); laser stimulation (Butkovic 2005;Schlager 1998); an acu-stimulation device (White 2002;Zarate 2001); and acupressure (Agarwal 2000;Agarwal 2002;Alkaissi 1999;Alkaissi 2002;Allen 1994;Barsoum 1990;Duggal 1998;Ferrara-Love 1996;Gieron 1993;Harmon 1999;Harmon 2000;Ho 1996;Klein 2004;Lewis 1991;Samad 2003;Schultz 2003;Turgut 2007). Two studies used conventional peripheral nerve stimulation (Arnberger 2007;Liu 2008).…”

“…P6 stimulation was compared with five antiemetic drugs: metoclopramide (Butkovic 2005;Dundee 1989); cyclizine (Dundee 1989); prochlorperazine (Barsoum 1990;Ho 1989); droperidol (Schultz 2003;Wang 2002;Yang 1993;Yentis 1992); and ondansetron (Agarwal 2002;Gan 2004;Misra 2005;Sharma 2007;Tavlan 1996;White 2002).…”

“…Allocation sequence was generated using a computer-generated random numbers table (Agarwal 2000;Arnberger 2007;Gan 2004;Harmon 1999;Ho 1996;Klein 2004;Misra 2005;White 2002;Zarate 2001), a table of random numbers (Agarwal 2002;Duggal 1998;Liu 2008;Samad 2003;Schultz 2003), a block design procedure (Rusy 2002), and a yoking randomization based on a computer-generated list (Wang 2002). Four of the 40 trials reported adequate allocation concealment (Arnberger 2007;Gan 2004;Schultz 2003;Streitberger 2004).…”