Wrist Acupuncture May Reduce Postop Nausea

Stimulation of the P6 acupuncture point on the wrist significantly reduced the risk of postoperative nausea and vomiting, according to a new meta-analysis of 40 randomized, controlled trials involving 4,856 participants.

Compared with sham treatment, several forms of P6 stimulation reduced the risk of nausea by 29%, the risk of vomiting by 30%, and the need for rescue antiemetics by 31%, wrote Dr. Anna Lee and Dr. Lawrence T.Y. Fan for the Cochrane Collaboration (Cochrane Database Syst. Rev. 2009 [doi:10.1002/14651858.CD003281.pub3

Those relative risks were statistically significant. In direct comparisons with antiemetic drugs, P6 stimulation proved to be equally effective in reducing nausea, vomiting, and the need for rescue antiemetics.

The side effects of P6 stimulation were minor, whether the stimulation was performed with traditional acupuncture needles, electroacupuncture, laser acupuncture, transcutaneous electrical stimulation, an acustimulation device, acupressure, or capsicum plaster.

Acupuncture needles produced hematomas on rare occasions, and some patients reported pain, irritation, redness, fatigue, or sleepiness. Patients receiving acupressure with wrist bands occasionally complained of discomfort, red indentations, blisters, and swelling. One patient complained of mild irritation at the site of the capsicum plaster.

“Drugs only partially prevent postoperative nausea and vomiting, and they, of course, have a lot of adverse side effects,” said Dr. Geno J. Merli in an interview. Dr. Merli, chief medical officer of Thomas Jefferson University Hospital, Philadelphia, was not involved in the meta-analysis. Patients on antiemetic drugs can have changes in mental status and can develop confusion or disorientation. Some patients become stimulated by the antiemetic agent, while others can experience oculogyric crises, a very rare complication.

Dr. Merli was especially intrigued by the notion that wrist stimulation could be used prophylactically to prevent nausea and vomiting. Antiemetic medications are typically given as needed if postop patients develop symptoms.

Dr. Lee and Dr. Fan, both from the Chinese University of Hong Kong, acknowledged that publication bias is a frequent problem in randomized, controlled trials of traditional Chinese medicine. Negative studies are less likely to be published than are positive ones. But using a statistical technique called “contour enhanced funnel plots,” the investigators found no evidence of publication bias among the studies included in their meta-analysis.

“I was not a believer in acupuncture as a postoperative nausea and vomiting preventative,” Dr. Merli said. “I saw this review and said we should be doing this more often.”

However, hospitals would have to be convinced of the cost-effectiveness of P6 stimulation, Dr. Merli added. He noted that the acupressure wristbands available in drugstores cost about $10. Even if hospitals could get that cost down to $5, they would have to compare that to 5 cents or so for a dose of prochlorperazine. The real savings would come, Dr. Merli noted, if P6 stimulation reduced the average length of hospital stays.

Dr. Merli suggested that P6 stimulation might be reserved for patients for whom postop nausea and vomiting present a particular risk, such as those undergoing abdominal, thoracic, or brain surgery.

P6 stimulation “is a good option,” said Dr. Jessica Zuleta, an internal medicine hospitalist at the University of Miami. But it shouldn't completely replace antiemetics, she added, because the studies are limited. She called for more rigidly controlled, blinded studies comparing P6 stimulation and antiemetic drugs.

Dr. Lee and Dr. Fan said they had no relevant conflicts of interest. The study was supported by the U.S. National Center for Complementary and Alternative Medicine, the Chinese University of Hong Kong's department of anesthesia and intensive care, and the Cochrane Complementary Medicine Field Bursary.

EMILY BRANNAN/ILLUSTRATION

Stimulation of the P6 acupuncture point on the wrist significantly reduced the risk of postoperative nausea and vomiting, according to a new meta-analysis of 40 randomized, controlled trials involving 4,856 participants.

Compared with sham treatment, several forms of P6 stimulation reduced the risk of nausea by 29%, the risk of vomiting by 30%, and the need for rescue antiemetics by 31%, wrote Dr. Anna Lee and Dr. Lawrence T.Y. Fan for the Cochrane Collaboration (Cochrane Database Syst. Rev. 2009 [doi:10.1002/14651858.CD003281.pub3

Those relative risks were statistically significant. In direct comparisons with antiemetic drugs, P6 stimulation proved to be equally effective in reducing nausea, vomiting, and the need for rescue antiemetics.

The side effects of P6 stimulation were minor, whether the stimulation was performed with traditional acupuncture needles, electroacupuncture, laser acupuncture, transcutaneous electrical stimulation, an acustimulation device, acupressure, or capsicum plaster.

Acupuncture needles produced hematomas on rare occasions, and some patients reported pain, irritation, redness, fatigue, or sleepiness. Patients receiving acupressure with wrist bands occasionally complained of discomfort, red indentations, blisters, and swelling. One patient complained of mild irritation at the site of the capsicum plaster.

“Drugs only partially prevent postoperative nausea and vomiting, and they, of course, have a lot of adverse side effects,” said Dr. Geno J. Merli in an interview. Dr. Merli, chief medical officer of Thomas Jefferson University Hospital, Philadelphia, was not involved in the meta-analysis. Patients on antiemetic drugs can have changes in mental status and can develop confusion or disorientation. Some patients become stimulated by the antiemetic agent, while others can experience oculogyric crises, a very rare complication.

Dr. Merli was especially intrigued by the notion that wrist stimulation could be used prophylactically to prevent nausea and vomiting. Antiemetic medications are typically given as needed if postop patients develop symptoms.

Dr. Lee and Dr. Fan, both from the Chinese University of Hong Kong, acknowledged that publication bias is a frequent problem in randomized, controlled trials of traditional Chinese medicine. Negative studies are less likely to be published than are positive ones. But using a statistical technique called “contour enhanced funnel plots,” the investigators found no evidence of publication bias among the studies included in their meta-analysis.

“I was not a believer in acupuncture as a postoperative nausea and vomiting preventative,” Dr. Merli said. “I saw this review and said we should be doing this more often.”

However, hospitals would have to be convinced of the cost-effectiveness of P6 stimulation, Dr. Merli added. He noted that the acupressure wristbands available in drugstores cost about $10. Even if hospitals could get that cost down to $5, they would have to compare that to 5 cents or so for a dose of prochlorperazine. The real savings would come, Dr. Merli noted, if P6 stimulation reduced the average length of hospital stays.

Dr. Merli suggested that P6 stimulation might be reserved for patients for whom postop nausea and vomiting present a particular risk, such as those undergoing abdominal, thoracic, or brain surgery.

P6 stimulation “is a good option,” said Dr. Jessica Zuleta, an internal medicine hospitalist at the University of Miami. But it shouldn't completely replace antiemetics, she added, because the studies are limited. She called for more rigidly controlled, blinded studies comparing P6 stimulation and antiemetic drugs.

Dr. Lee and Dr. Fan said they had no relevant conflicts of interest. The study was supported by the U.S. National Center for Complementary and Alternative Medicine, the Chinese University of Hong Kong's department of anesthesia and intensive care, and the Cochrane Complementary Medicine Field Bursary.

EMILY BRANNAN/ILLUSTRATION

Stimulation of the P6 acupuncture point on the wrist significantly reduced the risk of postoperative nausea and vomiting, according to a new meta-analysis of 40 randomized, controlled trials involving 4,856 participants.

Compared with sham treatment, several forms of P6 stimulation reduced the risk of nausea by 29%, the risk of vomiting by 30%, and the need for rescue antiemetics by 31%, wrote Dr. Anna Lee and Dr. Lawrence T.Y. Fan for the Cochrane Collaboration (Cochrane Database Syst. Rev. 2009 [doi:10.1002/14651858.CD003281.pub3

Those relative risks were statistically significant. In direct comparisons with antiemetic drugs, P6 stimulation proved to be equally effective in reducing nausea, vomiting, and the need for rescue antiemetics.

The side effects of P6 stimulation were minor, whether the stimulation was performed with traditional acupuncture needles, electroacupuncture, laser acupuncture, transcutaneous electrical stimulation, an acustimulation device, acupressure, or capsicum plaster.

Acupuncture needles produced hematomas on rare occasions, and some patients reported pain, irritation, redness, fatigue, or sleepiness. Patients receiving acupressure with wrist bands occasionally complained of discomfort, red indentations, blisters, and swelling. One patient complained of mild irritation at the site of the capsicum plaster.

“Drugs only partially prevent postoperative nausea and vomiting, and they, of course, have a lot of adverse side effects,” said Dr. Geno J. Merli in an interview. Dr. Merli, chief medical officer of Thomas Jefferson University Hospital, Philadelphia, was not involved in the meta-analysis. Patients on antiemetic drugs can have changes in mental status and can develop confusion or disorientation. Some patients become stimulated by the antiemetic agent, while others can experience oculogyric crises, a very rare complication.

Dr. Merli was especially intrigued by the notion that wrist stimulation could be used prophylactically to prevent nausea and vomiting. Antiemetic medications are typically given as needed if postop patients develop symptoms.

Dr. Lee and Dr. Fan, both from the Chinese University of Hong Kong, acknowledged that publication bias is a frequent problem in randomized, controlled trials of traditional Chinese medicine. Negative studies are less likely to be published than are positive ones. But using a statistical technique called “contour enhanced funnel plots,” the investigators found no evidence of publication bias among the studies included in their meta-analysis.

“I was not a believer in acupuncture as a postoperative nausea and vomiting preventative,” Dr. Merli said. “I saw this review and said we should be doing this more often.”

However, hospitals would have to be convinced of the cost-effectiveness of P6 stimulation, Dr. Merli added. He noted that the acupressure wristbands available in drugstores cost about $10. Even if hospitals could get that cost down to $5, they would have to compare that to 5 cents or so for a dose of prochlorperazine. The real savings would come, Dr. Merli noted, if P6 stimulation reduced the average length of hospital stays.

Dr. Merli suggested that P6 stimulation might be reserved for patients for whom postop nausea and vomiting present a particular risk, such as those undergoing abdominal, thoracic, or brain surgery.

P6 stimulation “is a good option,” said Dr. Jessica Zuleta, an internal medicine hospitalist at the University of Miami. But it shouldn't completely replace antiemetics, she added, because the studies are limited. She called for more rigidly controlled, blinded studies comparing P6 stimulation and antiemetic drugs.

Dr. Lee and Dr. Fan said they had no relevant conflicts of interest. The study was supported by the U.S. National Center for Complementary and Alternative Medicine, the Chinese University of Hong Kong's department of anesthesia and intensive care, and the Cochrane Complementary Medicine Field Bursary.

EMILY BRANNAN/ILLUSTRATION