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

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study

OBJECTIVE

To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI).

DESIGN

Randomized, prospective, controlled clinical study.

SETTING

University IVF center.

PATIENT(S)

Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S)

In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S)

Clinical and ongoing pregnancy rates.

RESULT(S)

In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S)

Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Metaanalyses of Acustimulations: Effects on Nausea and Vomiting in Postoperative Adult Patients

OBJECTIVE

Using metaanalysis to examine the effects of acustimulations on nausea and vomiting symptoms (NVS) in postoperative adult populations.

METHODS

Metaanalyses of effects of various acupoints stimulations (AS) (including acupuncture, acupressure, and electrical stimulation) on NVS in postoperative adult populations were performed. Thirty-three quality randomized controlled trials (RCT) published over the past three decades were identified by evaluating the quality of randomization and treatment methods, and results were pooled using a fixed effects model.

RESULTS

Twenty-four trials were pooled for nausea, 29 trials for vomiting, and 19 trials for rescue antiemetics, with AS compared with placebo or controls. Two additional trials did not have control groups but compared AS to medication groups. Compared with the controls, AS (all modalities) reduced nausea (relative risk [RR] = 0.60, 95% confidence interval [CI]: 0.54-0.67, P < .0001), vomiting (RR = 0.51, 95% CI: 0.45-0.57, P < .0001), and use of rescue antiemetics (RR = 0.63, 95% CI: 0.54-0.74, P < 0001). All AS modalities were effective in reducing NVS. Korean hand acupressure stimulations (two trials) had the best impact on reducing vomiting. There were no significant differences on pooled RRs for nausea (five trials) and vomiting (eight trials) between medication and AS groups, but medication groups had increased use of rescue antiemetics (two trials, RR = 2.27, 95% CI: 1.48-3.49, P = .0002). There was a placebo effect when compared with controls in reducing nausea (four trials, RR = 0.67, 95% CI: 0.50-0.90, P = .0069) and vomiting (three trials, RR = 0.39, 95% CI: 0.19-0.80, P = .0106).

CONCLUSIONS

This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations.

Effects of intensity of electroacupuncture upon experimental pain in healthy human volunteers: a randomized, double-blind, placebo-controlled study

Electroacupuncture is commonly used for pain relief. Despite an extensive evidence-base guiding the selection of stimulation parameters, little methodologically robust research exists regarding the level of intensity required to provide effective doses. This study investigated the hypoalgesic effects of two stimulation intensities compared to placebo on pressure pain thresholds (PPTs) in pain-free humans. Forty-eight acupuncture-naïve volunteers (mean age 23), stratified by gender, were screened for relevant contraindications and randomly allocated to four groups: control, placebo, high-intensity ("to tolerance but sub-noxious") or low-intensity ("strong but comfortable"). True or placebo electroacupuncture, using the Streitberger placebo needle, was administered to acupoints on dominant forearm (LI10, TH5) and ipsilateral leg (GB34, ST38). True needles (30 mm long, 0.3 mm diameter) were inserted 20-25 mm and "de-qi" was elicited from active groups, prior to administering 30 min of 4 Hz, 200 micros electroacupuncture. No electrical stimulation was performed on control and placebo groups, and placebo needles were used. After the intervention period, all needles were removed. Volunteers were monitored for 30 further minutes. Two PPT measurements were taken bilaterally from muscle bellies of first dorsal interosseous by an independent rater, at baseline and at six subsequent 10-min intervals. Square-root transformed data were analysed using repeated-measures ANOVA, with baseline data as covariate. The high-intensity group was significantly different from the placebo group for both measurement sites (p=.020, p=.033). The control group displayed stable PPT readings over time. No significant differences were observed between the placebo and control groups. These findings suggest that high-intensity levels may be important in optimal dose selection.

Acupuncture--a critical analysis

Even though widely used in today's clinical practice, acupuncture has remained a controversial subject. Many reviews are currently available but most lack a critical stance and some are overtly promotional. The aim of this overview is to provide a balanced, critical analysis of the existing evidence. Some of the original concepts of traditional acupuncture are not supported by good scientific evidence. Several plausible theories attempt to explain how acupuncture works but none are proved beyond doubt. The clinical effectiveness of acupuncture continues to attract controversy. Many controlled clinical trials and numerous systematic reviews of these studies have been published. Considerable problems are encountered when interpreting these data. Heterogeneity is a significant drawback of both clinical trials and systematic reviews. Some of the controversies may be resolved through the use of the new 'placebo needles' which enable researchers to adequately control for placebo effects of acupuncture. The majority of studies using such devices fails to show effects beyond a placebo response. Acupuncture has been associated with serious adverse events but most large-scale studies suggest that these are probably rare. Nonserious adverse effects occur in 7-11% of all patients. In conclusion, acupuncture remains steeped in controversy. Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response.

Prophylaxis of Postoperative Nausea and Vomiting in Patients Scheduled for Breast Surgery

Breast surgery performed under general anaesthesia is associated with a high incidence of postoperative nausea and vomiting (PONV). Between 60% and 80% of patients undergoing mastectomy (with axillary dissection) experience PONV. Pharmacological approaches have been investigated to reduce PONV after breast surgery. Traditional antiemetics (droperidol and metoclopramide) are frequently used for the prevention of PONV during the first 24 hours after anaesthesia. The available non-traditional antiemetics that have been shown to be effective for prophylaxis against PONV are dexamethasone, clonidine, propofol and supplemental oxygen. Antiserotonins (ondansetron, granisetron, tropisetron, dolasetron and ramosetron) are highly effective for preventing PONV for 24 hours postoperatively, compared with traditional antiemetics. Ramosetron is effective for the long-term (up to 48 hours) prevention of PONV. Better results can be obtained by combining antiemetics, because they have different sites of action. Combination antiemetic therapy is often effective for preventing PONV after breast surgery. Combinations of an antiserotonin (granisetron or dolasetron) and droperidol or dexamethasone are more effective than monotherapy with antiserotonins. A non-pharmacological technique is acupuncture at the P6 (Nei-Kuan) point. Overall, these pharmacological and non-pharmacological approaches reduce the incidence of PONV following breast surgery. Most of the published trials indicate improved prophylaxis of PONV following breast surgery by avoiding risk factors, and by using effective antiemetic agents in women scheduled for mastectomy (with axillary dissection). The clinician must weigh the benefits of using pharmacological and non-pharmacological approaches for PONV against the risk of occurrence of adverse events.

Alternative Therapy Applications for Postoperative Nausea and Vomiting

The potential for postoperative nausea and vomiting is present in any patient who undergoes surgery and both are unpleasant and potentially dangerous consequences of surgery. Three types of complementary and alternative therapies that may help patients with postoperative nausea and vomiting include acupressure, acupuncture, and aromatherapy.

Perception of bodily sensation as a predictor of treatment response to acupuncture for postoperative nausea and vomiting prophylaxis

OBJECTIVES

Conditions associated with the response to acupuncture treatment remain widely elusive. This study aimed to identify predictors of treatment response in patients undergoing acupuncture treatment for prevention of postoperative nausea and vomiting (PONV). An intervention-specific questionnaire was developed to assess perception of bodily sensations (PBS) in patients undergoing acupuncture treatment.

DESIGN

Exploratory study in addition to an observer-blinded randomized controlled trial.

SETTINGS/LOCATION

The departments of anesthesiology and of gynecology, University of Heidelberg, Germany.

SUBJECTS

Two hundred and twenty (220) female patients scheduled for breast or gynecologic surgery.

INTERVENTIONS

True acupuncture on point P6 (Neiguan) or placebo/sham acupuncture on a virtual point 1 cm proximal and lateral to P6.

OUTCOME MEASURES

Of 220 female patients scheduled for breast or gynecologic surgery who were included in the trial, 202 completed the newly developed PBS questionnaire before the intervention. The main outcome was incidence of PONV in relationship with PBS and the kind of acupuncture applied. Logistic regression analyses were performed to identify predictors of treatment response for those receiving surgery (n = 195).

RESULTS

High PBS predicted low treatment response in patients receiving breast surgery (odds ratio [OR] = 1.6; p = 0.039 for each 10-point increase). The PBS questionnaire showed good item difficulty, internal consistency, and divergent validity. Treatment response in patients receiving gynecologic surgery was predicted by the kind of acupuncture applied (OR = 0.4; p = 0.027), whereas PBS played no role in this group.

CONCLUSIONS

The incidence of PONV after breast surgery seems to be influenced by some psychological mechanisms. In this group of patients, acupuncture might be more effective in patients who have low PBS.

Acupuncture: A Clinical Review

This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.