The Use of Nonpharmacologic Techniques to Prevent Postoperative Nausea and Vomiting

Lee, Anna; Done, M.

doi:10.1213/00000539-199906000-00031

Cited by 241 publications

(107 citation statements)

References 40 publications

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“…In children, however, no benefit was found (IIA). 38 More recently, however, the effectiveness of acupuncture for the prophylaxis of PONV in children has been demonstrated (IIIA). [108][109][110][111] In a recent randomized placebo controlled study in patients undergoing breast surgery, Gan and colleagues reported similar efficacy of electroacupuncture at the P6 point and prophylactic ondansetron.…”

Section: Non-pharmacological Techniquesmentioning

confidence: 99%

“…37,117,119 The addition of TIVA to a combination of two antiemetics results in a further improved prophylaxis (IIIA). 136 Figure illus- 38 -α 2 -adrenergic agonists e.g. clonidine (IIIA) 101,102 FIGURE PONV = postoperative nausea and vomiting; Emetogenic surgery = surgery with a high risk for PONV e.g., intra-abdominal surgery, gynecologic surgery, breast surgery, strabismus surgery, and ENT surgery.…”

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

“…The available options for PONV prophylaxis are presented in Table III. A number of antiemetic interventions have been studied in systematic reviews. 9,14,[29][30][31][32][33][34][35][36][37][38] As a measure of antiemetic efficacy, the number needed-to-treat (NNT) is calculated. In this context, the NNT indicates the number of patients needed to receive a particular antiemetic intervention to prevent one emetic event that would have occurred had the patient not received the intervention.…”

mentioning

confidence: 99%

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Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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Section: Non-pharmacological Techniquesmentioning

confidence: 99%

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

mentioning

confidence: 99%

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Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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“…Our previous systematic review of trials (Lee 1999), including trials published up to 1997, showed no difference between P6 acupoint stimulation and commonly used antiemetic drugs in preventing PONV after surgery. This review also indicated that the technique was more effective than placebo (sham treatment or no treatment) in preventing PONV in adults but not in children.…”

mentioning

confidence: 95%

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

Lee

Done

2004

Cochrane Database of Systematic Reviews

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“…(48) Alternative and nonpharmacologic therapy Studies disclose that nonpharmacological or alternative therapies may be beneficial for prophylaxis and treatment of PONV, such as acupuncture, transcutaneous nerve stimulation, hypnosis and aromatherapy. (49) Noteworthy is stimulus of the acupoint P6 (Nei-Guan), located on the median nerve, between the tendons of the flexor carpi radialis and palmaris longus muscles, that has proven efficient in comparison to antiemetics. (50) …”

Section: Preoperative Strategiesmentioning

confidence: 99%