Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting

Abstract

Background: Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004.

Objectives: To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV.

Search strategy: We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), the National Library of Medicine publication list of acupuncture studies, and reference lists of articles.

Selection criteria: All randomized trials of techniques that stimulated the P6 acupoint compared with sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acu-stimulation device, and acupressure in patients undergoing surgery. Primary outcomes were the risks of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.

Data collection and analysis: Two review authors independently assessed trial quality and extracted the data. We collected adverse effect information from the trials. We used a random-effects model and reported relative risk (RR) with associated 95% confidence intervals (95% CI).

Main results: We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots.

Authors' conclusions: P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.

Figures

Figure 1

Searching results

Figure 2

Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies.

Figure 3

Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.

Figure 4

Forest plot of comparison: 1 Acupoint P6 stimulation versus sham, outcome: 1.1 Nausea.

Figure 5

Contour-enhanced funnel plot of comparison: 1 Acupoint P6 stimulation versus sham, outcome: 1.1 Nausea. Contour lines are at 1%, 5% and 10% levels of statistical significance.

Figure 6

Forest plot of comparison: 1 Acupoint P6 stimulation versus sham, outcome: 1.2 Vomiting.

Figure 7

Contour-enhanced funnel plot of comparison: 1 Acupoint P6 stimulation versus sham, outcome: 1.2 Vomiting. Contour lines are at 1%, 5% and 10% levels of statistical significance.

Figure 8

Forest plot of comparison: 1 Acupoint P6 stimulation versus sham, outcome: 1.3 Rescue antiemetics.

Figure 9

Forest plot of comparison: 2 Acupoint P6 stimulation versus antiemetic, outcome: 2.1 Nausea.

Figure 10

Contour-enhanced funnel plot of comparison: 2 Acupoint P6 stimulation versus antiemetic, outcome: 2.1 Nausea. Contour lines are at 1%, 5% and 10% levels of statistical significance.

Figure 11

Forest plot of comparison: 2 Acupoint P6 stimulation versus antiemetic, outcome: 2.2 Vomiting.

Figure 12

Contour-enhanced funnel plot of comparison: 2 Acupoint P6 stimulation versus antiemetic, outcome: 2.2 Vomiting. Contour lines are at 1%, 5% and 10% levels of statistical significance.

Figure 13

Forest plot of comparison: 2 Acupoint P6 stimulation versus antiemetic, outcome: 2.3 Rescue antiemetic.