Journal of Anesthesia

, 25:698

Effect of acupuncture on nausea and/or vomiting during and after cesarean section in comparison with ondansetron

Original Article

Abstract

Purpose

Acupuncture has been used for the management of postoperative nausea and vomiting (PONV). This study compared the effect of electrical acustimulation with ondansetron for preventing intraoperative and postoperative emetic symptoms and improving patient satisfaction.

Methods

After gaining ethical approval, 450 parturients scheduled for elective cesarean delivery were randomly allocated to receive either electrical stimulation using P6 acupoint (pericardium 6) bilaterally for 30 min before spinal anesthesia (group III; n = 150), or 4 mg ondansetron 30 min before spinal anesthesia (group II; n = 150), or placebo (group II; n = 150). Nausea and vomiting were evaluated and recorded intraoperatively and postoperative for 24 h by an independent anesthetist.

Results

The three groups were not significantly different with respect to intraoperative ephedrine dose and duration of surgery. Nausea and vomiting occurred statistically significantly less often in the active treatment groups (II, III) during operation and for 6 h postoperatively. There was no statistically significant difference between the groups in the incidence of nausea and vomiting from 6 to 24 h postoperatively. Patient satisfaction with PONV control was higher with the active treatment groups compared with group I.

Conclusion

Electrical acustimulation is comparable to ondansetron in prevention of PONV during and after cesarean delivery under spinal anesthesia and in improving patient satisfaction.

Keywords

Acupuncture Nausea Vomiting Ondansetron 

References

  1. 1.
    Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology. 1992;77:162–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology. 2003;98:530–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso AR, Berrisford SB, Thornton KC. Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Anesthesiology. 2002;96:1346–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Al-Sadi M, Newman B, Julious SA. Acupuncture in the prevention of postoperative nausea and vomiting. Anesthesia. 1997;52:658–61.CrossRefGoogle Scholar
  5. 5.
    Chernyak GV, Sessler DI. Preoperative acupuncture and related techniques. Anesthesiology. 2005;102:1031–49.PubMedCrossRefGoogle Scholar
  6. 6.
    Somri M, Vaida SJ, Sabo E, Yassain G, Gankin I, Gaitini LA. Acupuncture versus ondansetron in the prevention of postoperative vomiting: a study of children undergoing dental surgery. Anesthesia. 2001;56:927–32.CrossRefGoogle Scholar
  7. 7.
    Rusy LM, Hoffman GM, Weismzn SJ. Electroacupuncture prophylaxis of postoperative nausea and vomiting following pediatric tonsillectomy with or without adenoidectomy. Anesthesiology. 2002;96:300–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anesth. 1998;81:529–32.Google Scholar
  9. 9.
    Zarate E, Mingus M, White PF, Chiu W, Scuderi P, Loskota W, Daneshgari V. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg. 2001;92:629–35.PubMedCrossRefGoogle Scholar
  10. 10.
    Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M. Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy. Anesth Analg. 1993;76:1012–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Ulett GA, Han S, Han JS. Electroacupuncture: mechanisms and clinical application. Biol Psychiatry. 1998;44:129–38.PubMedCrossRefGoogle Scholar
  12. 12.
    Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85:355–75.PubMedCrossRefGoogle Scholar
  13. 13.
    Habib SS, Allen TK. P6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: a systematic review of randomized controlled trials. Anesth Analg. 2008;107:1308–12.Google Scholar
  14. 14.
    Gan TJ, Jiao KR, Zenn M, Georgiade G. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesth Analg. 2004;99:1070–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–51.PubMedCrossRefGoogle Scholar
  16. 16.
    Streitberger K, Ezzo J, Schneider A. Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Auton Neurosci. 2006;129:107–17.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg. 1999;88:1362–9.PubMedGoogle Scholar
  18. 18.
    Zou D, Chen WH, Iwakiri K, Rigda R, Tippett M, Holloway RH. Inhibition of transient lower esophageal sphincter relaxations by electrical acupoint stimulation. Am J Physiol Gastrointest Liver Physiol. 2005;289:G197–201.PubMedCrossRefGoogle Scholar
  19. 19.
    Balki M, Carvalho CA. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. 2005;14:230–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KT, Lynas AG. Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Br J Anaesth. 1989;63:612–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Liu WC, Feldman SC, Cook DB, Hung DL, Xu T, Kalnin AJ, Komisaruk BR. Study of acupuncture-induced periaqueductal gray activity in humans. Neuroreport. 2004;15:1937–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Ho CM, Tsai HG, Chan KH, Tsai SK. P6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery. Anesth Analg. 2006;102:900–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Stein DJ, Birnbach DJ, Danzer BI, Kuroda MM, Grunebaum A, Thys DM. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg. 1997;84:342–5.PubMedGoogle Scholar
  24. 24.
    Harmon D, Ryan M, Kelly A. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Br J Anaesth. 2000;84:463–7.PubMedGoogle Scholar
  25. 25.
    Frigerio C, Buchwalder PA, Spertini F. Ondansetron: reasons to be restrictive. Lancet. 1996;347:1484–5.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  1. 1.Department of Anesthesiology, Faculty of MedicineMansoura UniversityMansouraEgypt

Personalised recommendations