Acupuncture for Postoperative Nausea and Vomiting
PONV remains a significant problem that results in patient dissatisfaction,
delayed discharge, unanticipated hospital admission, and the use of resources (see
Chapter 68
). Pharmacologic
agents are the mainstay of management. However, they have limited effectiveness,
are associated with side effects, and can be costly. There is considerable interest
in acupuncture for its potential to prevent PONV with minimal side effects and expense.
Available evidence suggests that acupuncture prevents PONV compared
with placebo (e.g., sham acupuncture, no treatment).[133]
[134]
[135]
[136]
[137]
[138]
[139]
[140]
[141]
[142]
[143]
Acupuncture appears to prevent PONV to approximately
the same extent as pharmacologic agents, including metoclopramide, droperidol, prochlorperazine,
and ondansetron. A meta-analysis of studies published before 1998 reached the conclusion
that acupuncture and related techniques prevent PONV in adults with a calculated
absolute risk reduction of 20% to 25% (i.e., for every four or five patients treated,
one case of PONV is avoided).[144]
This meta-analysis
also concluded that acupuncture was not effective in children. Since the meta-analysis
was published, however, several randomized, controlled trials suggest that acupuncture
also may prevent PONV in the pediatric population.[139]
[140]
[141]
[142]
Most PONV acupuncture studies use the P6 (i.e., Nei-guan or pericardium)
acupuncture point, which is located between the palmaris longus and flexor carpi
radialis muscle tendons, 4 cm proximal to the distal wrist crease and 1 cm below
the skin ( Fig. 15-1
). Korean
hand acupuncture may be equally effective.[136]
Studies often differ on the acupuncture method: duration and timing of stimulation,
unilateral versus bilateral stimulation, and type of stimulation (i.e., needles with
or without additional stimulation, acupressure, transcutaneous electrical stimulation,
cutaneous laser stimulation, or injection of 50% dextrose solution). Data to compare
the effectiveness, safety, and costs of different methods of stimulation are inadequate.
It is recommended that stimulation of the acupuncture point be initiated before
induction of anesthesia,[145]
although in children,
stimulation immediately before emergence and in the recovery room has been effective.
Some anesthesiologists anecdotally report taping a small needle cap or other piece
of smooth plastic over the P6 point as an effective means of acupressure stimulation.
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