Acupressure for Nausea and Vomiting
Clinical Briefs
With Comments from John La Puma, MD, FACP
Acupressure for Nausea and Vomiting
August 2000; Volume 3; 95-96
Source: Harmon D, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Br J Anaesth 2000;84:463-467.
"The efficacy of acupressure at the P6 point in the prevention of nausea and vomiting during and after Caesarean section was studied. A double-blind, randomized controlled study of acupressure vs. placebo was designed. Ninety-four patients scheduled for Caesarean section were included. The anaesthetic technique and postoperative analgesia were standardized. The use of acupressure reduced the incidence of nausea or vomiting from 53% to 23% compared with placebo (95% confidence interval [CI] 0.34-0.25; P = 0.002) during the operation and from 66% to 36% compared with placebo (95% CI 0.34-0.19; P = 0.003) after the operation. Other variables were similar between the groups."
COMMENT
These Irish investigators, sympathetic to the request to avoid nausea and vomiting during and after cesarean and the use of routine antiemetics, briefly reviewed the data for acupressure’s effect on nausea generally. They utilized bupivacaine/morphine spinal anesthesia instead of fentanyl, because of the latter’s too-short duration of action. They excluded women who had had acupuncture previously, were severely obese (BMI > 35), or had diabetes: Most of the women were primiparous, without (apparently) significant differences in their obstetric and anesthetic histories.
Using acupressure bands (Sea Band), an anesthetist placed the plastic bead of the Sea Band at the treatment point P6 (it is the number 6 meridian point in the pericardium channel, meaning on the anterior forearm, approximately 3 cm proximal to the distal wrist crease) for the acupressure group. The control group got the plastic bead on the dorsal forearm. The bands were removed six hours after "discharge to ward," and nausea and vomiting were assessed using a visual analogue scale after 6 and 24 hours.
Controls in acupuncture have had problems, but the investigators’ approach seemed as careful as possible. The economy and ease of the procedure are strong arguments for it, and for prospective assessment of nausea well before anesthesia and delivery. A mechanism of action would be good to understand as well—is it peripheral nerve stimulation? A redirection of chi? Distraction wrought from a slightly sore wrist? Results this good are hard to argue with, except that they need duplication.
Recommendation
Pregnant women who want to reduce their need for medication to prevent nausea and vomiting during and after a cesarean should try a Sea Band. Apply as directed prior to operation.
August 2000; Volume 3; 95-96
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