Alternative Therapy Applications for Postoperative Nausea and Vomiting

Olfactory Distraction for Management of Nausea in Palliative Care Patients

Nausea is one of the most common and debilitating symptoms Palliative Care patients experience. This can be caused by the life-limiting illness itself, its complications, or its treatments. While there are many options for management, including anti-emetics and motility agents, patients may develop refractory nausea or even intolerance to these treatments. Drug interactions, sedation, extrapyramidal effects, serotonin syndrome, and prolonged QT intervals with risk factors for Torsades de Pointes may all preclude use of these medications. Olfactory distraction using alcohol swabs has supporting literature in the emergency care setting as a means of alleviating nausea in a safe and effective way. We present a case series of 3 patients admitted to a Northwell facility who were referred to the Palliative Care consult service for severe nausea. The patients had nausea of varying etiology and were successfully managed with inhalation of alcohol swabs. This is the first case series that looks into applying this intervention to the Palliative Care population as an easy-to-use, readily-available, and safe method to manage nausea.

The Effect of Acupressure on Daytime Sleepiness and Sleep Quality in Hemodialysis Patients

This study was carried out to evaluate the effect of acupressure applied to hemodialysis patients on the level of daytime sleepiness and sleep quality. The data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. In the study, a total of 12 sessions of acupressure were applied to the Shenmen (HT7), Sanyingjao (Sp6), and Yungquan (KI1) points in the experimental group for 4 weeks. No intervention was applied to the control group. After the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group and that daytime sleepiness was less compared with the control group. After the acupressure, it was determined that the sleep latency of the experimental group was statistically significantly less and their total sleep duration was higher compared with the control group (P < .05). Although there was a decrease in the sleep quality of the experimental group 1 month after the cessation of the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group (P < .05). It was concluded that acupressure was an effective nursing intervention in increasing sleep quality and decreasing daytime sleepiness of hemodialysis patients.

Aromatherapy for treatment of postoperative nausea and vomiting

BACKGROUND

Postoperative nausea and vomiting (PONV) is a common, unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as an addition to the available treatment strategies. This review was originally published in 2012 and updated in 2017.

OBJECTIVES

The main objective was to establish the efficacy and safety of aromatherapy comparable to standard pharmacological treatments for PONV in adults and children.

SEARCH METHODS

We searched CENTRAL; MEDLINE; Embase; CINAHL; CAM on PubMed; Informit; LILACS; and ISI Web of Science as well as grey literature sources and the reference lists of retrieved articles up to March 2017. The original search was performed in August 2011.

SELECTION CRITERIA

We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) where aromatherapy was used to treat PONV. Interventions were all types of aromatherapy compared to placebo or with standard antiemetics. Primary outcomes were severity and duration of PONV. Secondary outcomes were adverse reactions, use of rescue antiemetics and patient satisfaction.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias in the included studies and extracted data. For dichotomous outcome variables, we used a random-effects model and calculated risk ratio (RR) with associated 95% confidence interval (95% CI). For continuous outcome variables, we used a random-effects model and calculated standardized mean difference (SMD) with associated 95% CI. We used the GRADE software to compile 'Summary of findings' tables.

MAIN RESULTS

We included seven new studies with 663 participants in the 2017 update; five RCTs and two CCTs. These were added to the nine previously included studies (six RCTs and three CCTs with a total of 373 participants) for a total of 16 included studies and 1036 participants in this updated review. The mean age and range data for all participants were not reported for all studies. We identified two registered trials that met the inclusion criteria for this review; however there are no results for these studies yet.Overall, the GRADE assessment of evidence quality ranged from moderate to very low. The method of randomization in 11 of the 12 included RCTs was explicitly stated and adequate. Incomplete or methodologically diverse reporting of data affected the completeness of the analysis. Data on additional aromatherapies were added in the 2017 update (blended aromatherapy products, and peppermint products). Heterogeneity of outcome measures and time points between studies affected the completeness of the analysis.In the summary of the findings of six studies, we did not find aromatherapy to be effective in reducing nausea severity in comparison to placebo (SMD -0.22, 95% CI -0.63 to 0.18, P value = 0.28, 241 participants, level of evidence: low). Those participants receiving aromatherapy were no more likely to be free of nausea at the end of the treatment period than those receiving placebo (RR 3.25, 95% CI 0.31 to 34.33, P value = 0.33, 4 trials, 193 participants, evidence level: very low), however they were less likely to require rescue antiemetics (RR 0.60, 95% CI 0.37 to 0.97, P value = 0.04, 7 trials, 609 participants, evidence level: low). There were no data reported on adverse events or patient satisfaction for this comparison.A specific comparison of peppermint aromatherapy to placebo did not show evidence of an effect on nausea severity at five minutes post-treatment in the pooled results (SMD -0.18, 95% CI -0.86 to 0.49, P value = 0.59, 4 trials, 115 participants, evidence level: low). There were no data reported on nausea duration, use of rescue antiemetics, adverse events or patient satisfaction for this comparison.When we pooled studies comparing isopropyl alcohol to standard antiemetic treatment in a GRADE summary of findings, in terms of nausea duration, there was a significant effect on the time in minutes to a 50% reduction in nausea scores (SMD -1.10, 95% CI -1.43 to -0.78, P value < 0.00001, 3 trials, 176 participants, evidence level: moderate). Fewer participants who received isopropyl alcohol required rescue antiemetics (RR 0.67, 95% CI 0.46 to 0.98, P value = 0.04, 215 participants, 4 trials, evidence level: moderate). Two studies with 172 participants measured patient satisfaction; there were high levels of satisfaction across both aromatherapy and standard treatment groups and no differences found (evidence level: low). There were no data reported on nausea severity or adverse events for this comparison.There was no difference in effectiveness between isopropyl alcohol vapour inhalation and placebo for reducing the proportion of participants requiring rescue antiemetics (RR 0.39, 95% CI 0.12 to 1.24, P value = 0.11, 291 participants, 4 trials, evidence level: very low). There were no data reported on nausea severity, nausea duration, adverse events or patient satisfaction for this comparison.

AUTHORS' CONCLUSIONS

Overall, for nausea severity at the end of treatment, aromatherapy may have similar effectiveness to placebo and similar numbers of participants were nausea-free. However, this finding is based on low-quality evidence and therefore very uncertain. Low-quality evidence also suggests that participants who received aromatherapy may need fewer antiemetic medications, but again, this is uncertain. Participants receiving either aromatherapy or antiemetic medications may report similar levels of satisfaction with their treatment, according to low-quality evidence.

Acupressure in Management of Postoperative Nausea and Vomiting in High-Risk Ambulatory Surgical Patients

PURPOSE

The purpose of this randomized blinded placebo-controlled research study was to investigate the effect of acupressure over 24 hours postoperatively for ambulatory surgical patients who are identified as high risk for PONV.

DESIGN

A randomized blinded placebo-controlled study design was implemented.

METHODS

Study enrollment criteria included four of five risk factors as defined in 2006 by American Society of PeriAnesthesia Nurses PONV/postdischarge nausea and vomiting guidelines: female, PONV history or motion sickness, nonsmoker, and volatile gas general anesthetic. One hundred ten patients were randomly assigned to an intervention (N = 57) acupressure bead patch or control (N = 53) sham acupressure patch group. Patients rated PONV on scale (0 to 10).

FINDINGS

Acupressure use at P6 preoperatively was statistically significant in reducing PONV in all three postoperative phases. One hundred ten patients were enrolled; 93 patients finished the study's three phases and nine were admitted postoperatively.

CONCLUSIONS

Acupressure is an effective minimal risk and low-cost adjunctive therapy for prevention and treatment in ambulatory surgical patients at high risk for PONV. Further studies using other acupressure points should be conducted.

Sources of Placebo-Induced Relief From Nausea: The Role of Instruction and Conditioning

OBJECTIVES

It is well documented that expectancies alter the nauseous response. However, the lack of integration in research examining sources of expectancy has limited our understanding of how expectancies are formed and, consequently, our ability to intervene. The present study explored the role of both instructions and conditioning in placebo-induced relief from nausea.

METHODS

The study used a 2 × 2 between-subjects design with instruction and conditioning as factors with 56 healthy volunteers. The instruction manipulation involved randomizing participants to receive information that a sham treatment (a peppermint essence vapor) would reduce nausea or no such instructions. The conditioning manipulation involved further randomizing participants to have the first administration of this sham treatment paired with a surreptitious reduction in galvanic vestibular stimulation (GVS) intensity or no prior pairing. Nausea was induced through GVS. On test, all groups received the same level of GVS with the sham treatment present.

RESULTS

On test, participants who received instruction had significantly lower nauseous response scores than those who did not (F(1,46) = 6.71, p = .013), and those who received conditioning also reported less nausea than those who did not (F(1,46) = 5.20, p = .027), with the interaction between the two not reaching statistical significance (F(1,46) = 2.33, p = .13).

CONCLUSIONS

These findings indicate that placebo responding in nausea can be induced both through positive instructions and as little as one pairing of a treatment with a reduction in nausea, as well as their combination. This suggests that using placebo effects to complement antiemetic therapy may offer an important method of further reducing nausea in the clinic.

A prospective randomized study of the effectiveness of aromatherapy for relief of postoperative nausea and vomiting

INTRODUCTION

Postoperative nausea and vomiting (PONV) is a major concern for patients having surgery under general anesthesia as it causes subjective distress along with increased complications and delays in discharge from the hospital. Aromatherapy represents a complementary and alternative therapy for the management of PONV.

PURPOSE

The objective of this study was to compare the effectiveness of aromatherapy (QueaseEase, Soothing Scents, Inc, Enterprise, AL) versus an unscented inhalant in relieving PONV.

METHODS

One hundred twenty-one patients with postoperative nausea were randomized into a treatment group receiving an aromatic inhaler and a control group receiving a placebo inhaler to evaluate the effectiveness of aromatherapy.

FINDINGS

Initial and follow-up nausea assessment scores in both treatment and placebo groups decreased significantly (P < .01), and there was a significant difference between the two groups (P = .03). Perceived effectiveness of aromatherapy was significantly higher in the treatment group (P < .001).

CONCLUSIONS

Aromatherapy was favorably received by most patients and represents an effective treatment option for postoperative nausea.

Changes in the use of complementary and alternative medicine in Taiwan: a comparison study of 2007 and 2011

OBJECTIVE

In this study, we explored the differences in the use of complementary and alternative medicine (CAM) based on data from 2007 and 2011 national surveys in Taiwan.

RESEARCH DESIGN

Two cross-sectional, community-based epidemiological surveys were conducted in Taiwan. Participants 18 years and older were interviewed regarding their CAM use in the previous 12 months. Nationally representative random-household telephone surveys using a sampling method with a probability proportional to size were conducted in 2007 and 2011. The data were analysed to compare the results between surveys.

RESULTS

We obtained a total of 1260 and 2266 valid responses in 2007 and 2011, respectively. The use of at least one or more CAM therapies during the previous year decreased from 48.9% in 2007 to 37.8% in 2011 (p < .001). In both surveys, the most common CAM therapies used were Chinese medicinal herbs followed by health supplement products and tuina. We observed the greatest relative increase in CAM use between 2007 and 2011 in health supplement products (12.8% vs. 16.0%) and massage (1.3% vs. 2.9%), whereas the largest relative decrease occurred for tuina (24.4-13.4%) and Chinese medicinal herbs (31.6-25.4%).

CONCLUSION

Widespread CAM use reflects a more personal orientation towards maintaining health and selecting health care support services. Thus, a set of standards should be established for the safety and effectiveness of therapies, and consensus building is required to overcome the differences among practitioners from various backgrounds and traditions.

Effect of lavender inhalation on the symptoms of primary dysmenorrhea and the amount of menstrual bleeding: A randomized clinical trial

OBJECTIVE

The purpose of this study was to explore the effect of Lavandula angustifolia (lavender) inhalation on the symptoms of dysmenorrhea and the amount of menstrual bleeding in female students with primary dysmenorrhea.

DESIGN

This study is an experimental clinical trial. The subjects were 96 female students residing in dormitory at Tehran University of Medical Sciences in 2011 and suffering from level two or three dysmenorrhea according to the verbal multi-dimensional scoring system. The inclusion criteria were as: being single, suffering from primary dysmenorrhea, having no genital organs disorder, having no systemic disease, having regular menstrual cycles, using no contraceptives, etc. The follow-up time was 4 menstrual cycles.

INTERVENTIONS

The subjects were randomized into two groups: experimental (n=48) who inhaled lavender based on sesame oil, and placebo (n=48) who inhaled sesame oil only.

MAIN OUTCOME MEASURES

The severity of dysmenorrhea symptoms was measured through a questionnaire, and the amount of menstrual bleeding was measured by sanitary towel usage.

METHODS

Ordinal logistic regression and generalized estimating equation (GEE) were used to analyze the data.

RESULTS

The symptoms of dysmenorrhea were significantly lowered in the lavender group compared to the placebo group (p<0.001). The amount of menstrual bleeding in the lavender group was reduced in comparison to the placebo group but the difference was not statistically significant (p=0.25). No significant difference was observed for blood clot among the students (p=0.666).

CONCLUSIONS

This study showed that lavender inhalation was effective in alleviating dysmenorrhea symptoms, suggesting that it could be applied by midwives in a safe manner because of no side effects, simplicity and cost-effectiveness for all patients.

The effect of aromatherapy on postoperative nausea in women undergoing surgical procedures

Postoperative nausea and vomiting (PONV) is a common source of patient discomfort and decreased satisfaction. Aromatherapy has been identified as a complementary modality for the prevention and management of PONV. The purpose of this study was to assess the effect of aromatherapy on the severity of postoperative nausea (PON) in women undergoing surgical procedures in the postanesthesia care unit. Women complaining of PON received traditional antiemetics, inhalation of peppermint oil, or saline vapor. A visual analog scale was used to rate nausea at the first complaint; at 5 minutes after intervention; and, if nausea persisted, at 10 minutes after intervention. At both 5 and 10 minutes, statistical analysis showed no significant differences between intervention and nausea rating. Obtaining eligible subjects was challenging. Although many women consented, most received intraoperative antiemetics and did not report nausea postoperatively.

Aromatherapy for treatment of postoperative nausea and vomiting

BACKGROUND

Postoperative nausea and vomiting is a common and unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as a possible addition to the available treatment strategies.

OBJECTIVES

This review sought to establish what effect the use of aromatherapy has on the severity and duration of established postoperative nausea and vomiting and whether aromatherapy can be used with safety and clinical effectiveness comparable to standard pharmacological treatments.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); MEDLINE; EMBASE; CINAHL; CAM on PubMed; Meditext; LILACS; and ISI Web of Science as well as grey literature sources and the reference lists of retrieved articles. We conducted database searches up to August 2011.

SELECTION CRITERIA

We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) where aromatherapy was used to treat postoperative nausea and vomiting. Interventions were all types of aromatherapy. Aromatherapy was defined as the inhalation of the vapours of any substance for the purposes of a therapeutic benefit. Primary outcomes were the severity and duration of postoperative nausea and vomiting. Secondary outcomes were adverse reactions, use of rescue anti-emetics and patient satisfaction with treatment.

DATA COLLECTION AND ANALYSIS

Two review authors assessed risk of bias in the included studies and extracted data. As all outcomes analysed were dichotomous, we used a fixed-effect model and calculated relative risk (RR) with associated 95% confidence interval (95% CI).

MAIN RESULTS

The nine included studies comprised six RCTs and three CCTs with a total of 402 participants. The mean age and range data for all participants were not reported for all studies. The method of randomization in four of the six included RCTs was explicitly stated and was adequate. Incomplete reporting of data affected the completeness of the analysis. Compared with placebo, isopropyl alcohol vapour inhalation was effective in reducing the proportion of participants requiring rescue anti-emetics (RR 0.30, 95% CI 0.09 to 1.00, P = 0.05). However, compared with standard anti-emetic treatment, isopropyl alcohol was not effective in reducing the proportion of participants requiring rescue anti-emetics (RR 0.66, 95% CI 0.39 to 1.13, P = 0.13) except when the data from a possibly confounded study were included (RR 0.66, 95% CI 0.45 to 0.98, P = 0.04). Where studies reported data on patient satisfaction with aromatherapy, there were no statistically significant differences between the groups (RR 1.12, 95% CI 0.62 to 2.03, P = 0.71).

AUTHORS' CONCLUSIONS

Isopropyl alcohol was more effective than saline placebo for reducing postoperative nausea and vomiting but less effective than standard anti-emetic drugs. There is currently no reliable evidence for the use of peppermint oil.

Management of nausea, vomiting, and diarrhea during critical illness

Symptoms are subjective patient experiences that may negatively impact the patient's hospitalization, treatment plan, and quality of life. Critically ill patients frequently experience nausea, vomiting, and diarrhea related to underlying disease, procedures, and medical interventions (eg, medication, enteral feeding, surgery). Optimally, the nurse performs a subjective assessment that explores the patient's perception and impact of these symptoms to develop a comprehensive plan of care. Unfortunately, little evidence is available to guide assessment of nausea, vomiting, and diarrhea in critically ill nonverbal patients. Understanding the disease processes, medical treatments, and pathophysiology of these symptoms will assist the critical care nurse in the anticipation of symptoms and development of a proactive plan to alleviate the symptom-associated discomfort.

The effect of lavender oil on stress, bispectral index values, and needle insertion pain in volunteers

OBJECTIVES

The purpose of this study was to investigate whether lavender oil aromatherapy can reduce the bispectral index (BIS) values and stress and decrease the pain of needle insertion in 30 volunteers.

SUBJECTS AND METHODS

Thirty (30) healthy volunteers were randomly allocated to 2 groups: the experimental group received oxygen with a face mask coated with lavender oil for 5 minutes, and the control group received oxygen through a face mask with no lavender oil for 5 minutes. The stress level (0=no stress, 10=maximum stress), BIS value, and pain intensity of needle insertion (0=no pain, 10=worst pain imaginable) were measured.

RESULTS

There were no significant differences in age, sex, height, and weight between the two groups. Stress level, BIS value, and pain intensity of needle insertion before aromatherapy were similar between the two groups. However, the stress values (p<0.001) and BIS value (p<0.001) after aromatherapy were significantly reduced compared with the control. In addition, the pain intensity of needle insertion was significantly decreased after aromatherapy compared with the control (p<0.001).

CONCLUSIONS

Lavender aromatherapy in volunteers provided a significant decrease in the stress levels and in the BIS values. In addition, it significantly reduced the pain intensity of needle insertion.

Prevention and management of postoperative nausea and vomiting: a look at complementary techniques

Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV.

Nausea and nutrition

Nausea and vomiting are symptoms associated with a wide variety of diseases and particular life conditions, such as pregnancy. The symptoms may occur in acute form or chronically depending on the underlying pathogenesis. In some cases, nausea and vomiting are directly triggered by food, e.g. in patients suffering from food allergy or food intolerances. In other cases, food is not the primary cause but dietetic manipulations may still contribute to the management of the nausea and vomiting. Therefore, food plays an important pathophysiological and therapeutic role in nausea and vomiting. In the present article, we describe the most relevant nutrient triggers for nausea and vomiting, discuss food allergy and intolerance as cause of nausea and vomiting, propose a clinical classification of nausea and vomiting, and present in detail dietetic and other therapeutic strategies of relevance for the management of nausea and vomiting.