Acupuncture compared to placebo‐acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo‐controlled patient and observer blind trial

Abstract

SummaryThis randomised, placebo-controlled, patient and observer blinded trial was conducted to determine whether acupuncture at the acupuncture point P6 is effective in preventing postoperative nausea and vomiting (PONV) compared to placebo acupuncture. Female patients (n = 220) scheduled for gynaecological or breast surgery were randomly assigned to two groups receiving either acupuncture (n = 109) or placebo acupuncture (n = 111). Each group was stratified for type of surgery and included two subgroups receiving intervention either before or after induction of anaesthesia. The incidence of PONV and ⁄ or antiemetic rescue medication within 24 h after surgery was the main outcome measure which showed no statistically significant difference between groups (43.7% acupuncture, 50.9% placebo, p = 0.27). The differences were more pronounced for patients having gynaecological surgery (48.9% acupuncture, 67.6% placebo, p = 0.07) than for those having breast surgery (38.7% acupuncture, 40.3% placebo, p = 0.86). The secondary outcome, vomiting, was significantly reduced by acupuncture from 39.6% to 24.8% (p = 0.03). Subgroup analysis showed no difference between applications of acupuncture before compared to after induction of anaesthesia.

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

“…Four of the 40 trials reported adequate allocation concealment (Arnberger 2007;Gan 2004;Schultz 2003;Streitberger 2004). In 34 trials the allocation concealment was unclear, and in one trial (Ferrara-Love 1996) it was inadequate.…”

“…There were 10 types of P6 acupoint stimulation: needle acupuncture (Dundee 1986;Dundee 1989;Sharma 2007;Streitberger 2004;Yentis 1992); infiltration of dextrose (Tavlan 1996;Wang 2002;Yang 1993); semipermanent needles (Andrzejowski 1996); electrical stimulation of needles (Amir 2007;Dundee 1989;Ho 1989;Rusy 2002); transcutaneous electrical nerve stimulation (Fassoulaki 1993;Gan 2004;Habib 2006;Ho 1989); laser stimulation (Butkovic 2005;Schlager 1998); an acu-stimulation device (White 2002;Zarate 2001); and acupressure (Agarwal 2000;Agarwal 2002;Alkaissi 1999;Alkaissi 2002;Allen 1994;Barsoum 1990;Duggal 1998;Ferrara-Love 1996;Gieron 1993;Harmon 1999;Harmon 2000;Ho 1996;Klein 2004;Lewis 1991;Samad 2003;Schultz 2003;Turgut 2007). Two studies used conventional peripheral nerve stimulation (Arnberger 2007;Liu 2008).…”

“…No side effects were observed for patients receiving acupuncture (Dundee 1986;Dundee 1989;Sharma 2007); acupressure, in several trials (Agarwal 2000;Agarwal 2002;Gieron 1993;Harmon 1999;Ho 1996;Klein 2004;Lewis 1991); or transcutaneous electro-acupoint stimulation by a peripheral nerve stimulator (Liu 2008). Haematomas occurred in one patient in the acupuncture group and in two patients in the placebo acupuncture group (Streitberger 2004). Although no side effects were reported in associated with an acu-stimulation device (White 2002), another trial reported mild cutaneous irritation (Zarate 2001).…”

“…Same study as Streitberger et al (2004). Incidence of postoperative nausea and vomiting were not reported separately.…”

Acupuncture in ambulatory anesthesia: a review

“…52,54,55,60 Two out of eight studies on acupuncture and three out of eight studies on acupressure did not find any effect on the selected primary endpoints. 37,[63][64][65][66] Eleven studies reported on PONV as a primary endpoint using acupuncture/acupressure at point PC6, and among these eleven studies one study 60 combined PC6 with CV13. 37,[52][53][54][55]60,[62][63][64][65][66] Three studies 57,58,61 reported on POP as primary endpoint.…”