Acupuncture and PC6 stimulation for the prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic resection of colorectal cancer: a study protocol for a three-arm randomised pilot trial

Abstract

IntroductionThis study aims to assess the feasibility of acupuncture and a Pericardium 6 (PC6) wristband as an add-on intervention of antiemetic medication for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing elective laparoscopic colorectal cancer resection.Methods and analysisA total of 60 participants who are scheduled to undergo elective laparoscopic resection of colorectal cancer will be recruited. An enhanced recovery after surgery protocol using standardised antiemetic medication will be provided for all participants. Participants will be equally randomised into acupuncture plus PC6 wristband (Acupuncture), PC6 wristband alone (Wristband), or no acupuncture or wristband (Control) groups using computer-generated random numbers concealed in opaque, sealed, sequentially numbered envelopes. For the acupuncture combined with PC6 wristband group, the embedded auricular acupuncture technique for preoperative anxiolysis and up to three sessions of acupuncture treatments with manual and electrical stimulation within 48 hours after surgery will be provided by qualified Korean medicine doctors. The PC6 wristband will be applied in the Acupuncture and Wristband groups, beginning 1 hour before surgery and lasting 48 hours postoperatively. The primary outcome will be the number of participants who experience moderate or severe nausea, defined as nausea at least 4 out of 10 on a severity numeric rating scale or vomiting at 24 hours after surgery. Secondary outcomes, including symptom severity, participant global assessments and satisfaction, quality of life, physiological recovery, use of medication and length of hospital stay, will be assessed. Adverse events and postoperative complications will be measured for 1 month after surgery.Ethics and disseminationAll participants will provide written informed consent. The study has been approved by the institutional review board (IRB). This pilot trial will inform a full-scale randomised trial of acupuncture combined with PC6 stimulation for the prevention of PONV in patients undergoing elective laparoscopic colorectal cancer surgery.Trial registration numberNCT02509143.

Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting

“…PONV is a frequent complication, and there are a lot of factors influencing it. 14,17 Many studies have shown that drugs such as metoclopramide, dexamethasone, and ondansetron can reduce PONV. Although potency of these drugs is different, they have a limited effect on PONV and they also have adverse effects such as sedation, headache, and extrapyramidal side effects in addition to high costs.…”

“…14 Studies concerning the timing of acupuncture in anesthetized patients have no clear evidence. 5,15,17 Although administering acupuncture before induction of anesthesia has been found useful in some of the studies, there are other studies that showed no difference in PONV among preoperative, intraoperative, and postoperative application of acupuncture. 15 The results of the updated Cochrane review 18 for the effectiveness of PC6 acupoint stimulation in prevention of PONV showed that there is inconclusive evidence supporting the use of a combined strategy of PC6 acupoint stimulation with antiemetic drug prophylaxis, and further, high quality trials are needed for this purpose.…”

Targeting TRPV1 to relieve motion sickness symptoms in mice by electroacupuncture and gene deletion

“…Evidence-based studies have suggested that electroacupuncture (EA) can be used to treat learning and memory impairments in rats with cerebral ischemia-reperfusion injury 26 or epilepsy 27 and to control body weight 28 and pain 29 – 32 . Nei Guan, also known as acupoint pericardium 6 (PC6), is the most commonly important acupressure point, especially for nausea and vomiting 33 , and can extend the time to onset of nausea, even though its function remains unknown 34 . In the present study, we hypothesized that the EA treatment would reduce the symptoms of MS through the TRPV1 pathway.…”

A novel taping therapy for pain after arthroscopic shoulder surgery: study protocol for a randomised controlled pilot trial

“…Electroacupuncture treatment also reduces postoperative thoracic pain [ 11 ]. Studies regarding indirect stimulation of acupoints, such as the PC6 (pericardium-6: Neiguan) point stimulation band, made up of a wrist band and a bead to stimulate the acupoint, which is effective for postoperative nausea, have been published as study protocols [ 12 ], while the effectiveness of indirect acupoint-stimulating therapies to relieve postoperative pain is still unknown.…”