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Abstract
Introduction: Successful antiemesis contributes significantly to quality, safety, and patient satisfaction. Patients undergoing general anesthesia often experience postoperative nausea and vomiting (PONV). Acupressure offers a side effect-free alternative to common first-line antiemetics. Because the patient may perceive needle acupuncture as uncomfortable, acupressure is a desirable alternative for the prevention of PONV.
Methods: This study was a randomized, prospective, double-blinded clinical trial investigating the effect of acupressure in patients with a history of PONV and motion sickness. The three auricular acupressure points chosen were shen men, point zero, and the subcortex point. Rescue treatment for PONV with 4 mg intravenous ondansetron was used if the patient reported persistent nausea. A blinded observer recorded antiemetic rescue data, and postoperative analgesic use was recorded over 24 hours. Nausea, vomiting, and retching were assessed in the post-anesthesia care unit (PACU).
Results: Using univariate analysis, we ruled out the null hypothesis of equal means as afunction of intervention group (p = 0.001). Pair-wise comparisons revealed a difference between placebo and test groups (p = 0.000) and also sham and test groups (p = 0.033) where age (p = 0.048) and gender (p = 0.003) were significant covariates.
Discussion: Our data reveal that auricular acupressure significantly decreases nausea during the PACU stay and within the 24 hours postoperatively. It is not clear whether the intervention decreases nausea as a primary effect or as a secondary result by decreasing narcotic requirements. Also, perception of nausea may be in part subjective. This is evidenced by our results in which subjects who received sham points fared better than the placebo subjects.
Patients undergoing general anesthesia often experience postoperative nausea and vomiting (PONV). Despite the utilization of newer anesthetic agents and antiemetics, such as 5-HT3 antagonists, the incidence of PONV remains between 20% and 70%.1 PONV causes undue distress on patients and can lead to increased costs in the ambulatory surgery setting by increasing lengths of stay and unplanned admissions. Protracted retching and vomiting can lead to more severe sequelae, including wound tension, pulmonary aspiration, and fluid and electrolyte imbalances. PONV negatively affects the patient experience. In multiple surveys, patients have named the avoidance of nausea and vomiting as their number one concern, outranking pain, death, myocardial infarction, and stroke.2,3 Stimulation of acupuncture...