Comparison Between Effects of Acupuncture and Metoclopramide on Postoperative Nausea and Vomiting after Gynaecological Laparoscopy: A Randomized Controlled Trial

Masoumeh Albooghobeish, Ahmadreza Mohtadi, Vahid Saidkhani, Habib Fallah, Kaveh Behaein, Sholeh Nesionpour, Roshan Nikbakht, Masoumeh Albooghobeish, Ahmadreza Mohtadi, Vahid Saidkhani, Habib Fallah, Kaveh Behaein, Sholeh Nesionpour, Roshan Nikbakht

Abstract

Background: Gynaecological laparoscopy one ofthe most common operations thatis accompanied by postoperative nausea and vomiting (PONV). A non-pharmacological method of preventing PONV is acupuncture therapy.

Objectives: This study is conducted to compare the effects of acupuncture and metoclopramide on post-operative nausea and vomiting (PONV) after gynaecological laparoscopy.

Methods: In this double-blind, randomized, clinical trial study,122female, ASA I, aged 19 - 46, who had been referred to the Imam Khomini Hospital (Ahvaz, Iran) and were candidates for gynaecological laparoscopy were enrolled. Eligible patients were randomly allocated into three groups group I (acupuncture; n = 40), group II (metoclopramide 0.2 mg/kg IV; n = 41), and group III (control; n = 41). In group I, acupuncture was done by inserting a special needle at point P6 in front of the elbow immediately after induction of anaesthesia and removing it before extubation and transfer of the patient to the recovery room. The occurrences of nausea and vomiting during the period of stay in the recovery room (one and two hours after surgery) were recorded through questions or clinical observation. Statistical analysis was conducted using SPSS V. 19, descriptive statistics, and the Chi-square test.

Results: The acupuncture group (11.1%) showed a significant decrease in the incidence of nausea one hour after surgery compared to the metoclopramide group (33.3%) (P = 0.02), but there was no significant difference between the acupuncture and metoclopramide groups in terms of postoperative vomiting (POV) incidence one and two hours after surgery. Incidence of PONV in the acupuncture group (2.7%) was statistically significantly lower than that in the control group (28.5%), two hours after surgery (P < 0.01).

Conclusions: Acupuncture is better for controlling nausea after laparoscopic surgery, compared to metoclopramide. Acupuncture is an effective method for reduction of PONV in gynaecological laparoscopy.

Keywords: Acupuncture; Gynaecological; Laparoscopy; Metoclopramide; Nausea; PONV; Vomiting.

Figures

Figure 1.. p6 Point
Figure 1.. p6 Point
Figure 2.. Flow chart of patients in…
Figure 2.. Flow chart of patients in trial
Figure 3.. Nausea 1 h After Surgery
Figure 3.. Nausea 1 h After Surgery
Figure 4.. Nausea 2 h After Surgery
Figure 4.. Nausea 2 h After Surgery
Figure 5.. Vomiting 1 h After Surgery
Figure 5.. Vomiting 1 h After Surgery
Figure 6.. Vomiting 2 h After Surgery
Figure 6.. Vomiting 2 h After Surgery

References

    1. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's Anesthesia E-Book. Elsevier Health Sciences; 2014.
    1. Bready LL, Dillman D, Noorily SH. Decision making in anesthesiology: an algorithmic approach. Elsevier Health Sciences; 2007.
    1. Falk S. Post Anesthesia Care Unit, an Issue of Anesthesiology Clinics. Vol. 30. Elsevier Health Sciences; 2012.
    1. Farhadi K, Choubsaz M, Setayeshi K, Kameli M, Bazargan-Hejazi S, Heidari Zadie Z, et al. The effectiveness of dry-cupping in preventing post-operative nausea and vomiting by P6 acupoint stimulation: A randomized controlled trial. Medicine (Baltimore). 2016;95(38):e4770. doi: 10.1097/MD.0000000000004770.
    1. Nezhat C, Nezhat F, Nezhat C. Nezhat's operative gynecologic laparoscopy and hysteroscopy. Cambridge University Press; 2008.
    1. Arslan M, Cicek R, Kalender HU, Yilmaz H. Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, randomized, double-blind study. Curr Ther Res Clin Exp. 2011;72(1):1–12. doi: 10.1016/j.curtheres.2011.02.002.
    1. AOD . Anesthesia: A Very Short Introduction. United Kingdom: Oxford University Press; 2012.
    1. Vas J. Maciocia G. The Foundations of Chinese Medicine. A comprehensive Tex. Edimburgh: Elsevier; 2015. Elsevier; 2016.
    1. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010;7(6):e1000261. doi: 10.1371/journal.pmed.1000261.
    1. Geetika D, Kochhar SK. Comparative study of ondansetron and acupressure for postoperative nausea and vomiting after laparoscopic cholecystectomy. J Adv Res Biol Sci. 2012;4(4):330–6.
    1. Xinnong C. Chinese Acupuncture and Moxibustion. China: Foreign Languages Press; 2016.
    1. Wang HL, Zhu B. Basic theories of traditional Chinese medicine. Singing Dragon; 2011.
    1. Noroozinia H, Mahoori A, Hasani E, Gerami-Fahim M, Sepehrvand N. The effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia. Acta Med Iran. 2013;51(3):163–7.
    1. Saberi F, Sadat Z, Abedzadeh-Kalahroudi M, Taebi M. Acupressure and ginger to relieve nausea and vomiting in pregnancy: a randomized study. Iran Red Crescent Med J. 2013;15(9):854–61. doi: 10.5812/ircmj.12984.
    1. Gemma M, Nicelli E, Gioia L, Moizo E, Beretta L, Calvi MR. Acupuncture accelerates recovery after general anesthesia: a prospective randomized controlled trial. J Integr Med. 2015;13(2):99–104. doi: 10.1016/S2095-4964(15)60159-5.
    1. Van den Heuvel E, Goossens M, Vanderhaegen H, Sun HX, Buntinx F. Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature. BMC Complement Altern Med. 2016;16:13. doi: 10.1186/s12906-016-0985-4.
    1. Cheong KB, Zhang JP, Huang Y, Zhang ZJ. The effectiveness of acupuncture in prevention and treatment of postoperative nausea and vomiting--a systematic review and meta-analysis. PLoS One. 2013;8(12):e82474. doi: 10.1371/journal.pone.0082474.
    1. Cooke M, Rickard C, Rapchuk I, Shekar K, Marshall AP, Comans T, et al. PC6 acupoint stimulation for the prevention of postcardiac surgery nausea and vomiting: a protocol for a two-group, parallel, superiority randomised clinical trial. BMJ. 2014;4(11):e006179
    1. Naeimi Rad M, Lamyian M, Heshmat R, Jaafarabadi MA, Yazdani S. A Randomized Clinical Trial of the Efficacy of KID21 Point (Youmen) Acupressure on Nausea and Vomiting of Pregnancy. Iran Red Crescent Med J. 2012;14(11):697–701. doi: 10.5812/ircmj.2153.
    1. Soltanzadeh M, Behaeen K, Pourmehdi Z, Safarimohsenabadi A. Effects of acupressure on nausea and vomiting after gynecological laparoscopy surgery for infertility investigations. Life Sci J. 2012;9(3):871–5.
    1. Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2009;15(2):CD003281. doi: 10.1002/14651858.CD003281.
    1. Turgut S, Ozalp G, Dikmen S, Savli S, Tuncel G, Kadiogullari N. Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia. Eur J Anaesthesiol. 2007;24(1):87–91. doi: 10.1017/S0265021506001190.
    1. Streitberger K, Diefenbacher M, Bauer A, Conradi R, Bardenheuer H, Martin E, et al. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: a randomised placebo-controlled patient and observer blind trial. Anaesthesia. 2004;59(2):142–9.
    1. Ouyang MW, Qin ZS, Lin CS, Gu MN. [Prophylactic effect of acupuncture on nausea and vomiting after laparoscopic operation]. Zhongguo Zhen Jiu. 2009;29(11):915–8.
    1. Kim YH, Kim KS, Lee HJ, Shim JC, Yoon SW. The efficacy of several neuromuscular monitoring modes at the P6 acupuncture point in preventing postoperative nausea and vomiting. Anesth Analg. 2011;112(4):819–23. doi: 10.1213/ANE.0b013e31820f819e.
    1. Lee S, Lee MS, Choi DH, Lee SK. Electroacupuncture on PC6 prevents opioid-induced nausea and vomiting after laparoscopic surgery. Chin J Integr Med. 2013;19(4):277–81. doi: 10.1007/s11655-013-1425-7.
    1. Yang XY, Xiao J, Chen YH, Wang ZT, Wang HL, He DH, et al. Dexamethasone alone vs in combination with transcutaneous electrical acupoint stimulation or tropisetron for prevention of postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery. Br J Anaesth. 2015;115(6):883–9. doi: 10.1093/bja/aev352.
    1. Praveena Seevaunnamtum S, Bhojwani K, Abdullah N. Intraoperative electroacupuncture reduces postoperative pain, analgesic requirement and prevents postoperative nausea and vomiting in gynaecological surgery: A randomised controlled trial. Anesth Pain Med. 2016;6(6):e40106. doi: 10.5812/aapm.40106.
    1. Arnberger M, Stadelmann K, Alischer P, Ponert R, Melber A, Greif R. Monitoring of neuromuscular blockade at the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting. Anesthesiology. 2007;107(6):903–8. doi: 10.1097/01.anes.0000290617.98058.d9.
    1. Frey UH, Funk M, Lohlein C, Peters J. Effect of P6 acustimulation on post-operative nausea and vomiting in patients undergoing a laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2009;53(10):1341–7. doi: 10.1111/j.1399-6576.2009.02081.x.
    1. Butkovic D, Toljan S, Matolic M, Kralik S, Radesic L. Comparison of laser acupuncture and metoclopramide in PONV prevention in children. Paediatr Anaesth. 2005;15(1):37–40. doi: 10.1111/j.1460-9592.2004.01388.x.
    1. Lee A, Chan SK, Fan LT. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2015;(11):CD003281. doi: 10.1002/14651858.CD003281.pub4.
    1. Saleh RH. Efficacy of laser acupuncture in attenuating hemodynamic response to orotracheal intubation and postoperative nausea and vomiting in children undergoing strabismus surgery. Egypt J Anaesthesia. 2014;30(4):411–6. doi: 10.1016/j.egja.2014.05.005.
    1. Ebrahim Soltani AR, Mohammadinasab H, Goudarzi M, Arbabi S, Mohammadinasab A, Mohammadinasab F, et al. Comparing the efficacy of prophylactic p6 acupressure, ondansetron, metoclopramide and placebo in the prevention of vomiting and nausea after strabismus surgery. Acta Med Iran. 2011;49(4):208–12.
    1. White PF. Are Nonpharmacologic Techniques Useful Alternatives to Antiemetic Drugs for the Prevention of Nausea and Vomiting? Anesth Analg. 1997;84(4):712–4. doi: 10.1097/00000539-199704000-00002.
    1. Dundee JW. Belfast experience with P6 acupuncture antiemesis. Ulster Med J. 1990;59(1):63–70.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa