[Effects of Nei-Guan acupressure on nausea, vomiting and level of satisfaction for gynecological surgery patients who are using a patient-controlled analgesia]

Effectiveness of Integrated Education to Reduce Postoperative Nausea, Vomiting, and Dizziness after Abdominal Surgery under General Anesthesia

This study presents an anticipatory integrated education program for nausea, vomiting, and dizziness prevention (anti-NVD education program) for patients undergoing abdominal surgery under general anesthesia. The anti-NVD education program for nephrectomy patients consisted of the following: the causes of postoperative nausea, vomiting, and dizziness; effective deep breathing and how to use an inspirometer; postoperative nausea and vomiting; effective methods of patient-controlled analgesia; and the stepwise standing up method to prevent dizziness. A study was conducted among 79 adults (experimental group: n = 40, control group: n = 39). The degree of nausea and dizziness was measured using a numerical rating scale (NRS), and vomiting and the frequency of antiemetic use were measured in terms of the number of patients. The experimental group, which received the anti-NVD education, showed remarkably lower levels of nausea (p = 0.013) and dizziness (p < 0.001) than the control group. The frequency of antiemetic use 48 hours after surgery was significantly lower in the experimental group (p = 0.03). This study proved the efficacy of the anti-NVD education program for reducing postoperative nausea and dizziness. This program can be used as a noninvasive nursing intervention to prevent nausea, vomiting, and dizziness among patients undergoing abdominal surgery.

Factors Influencing Satisfaction with Patient-Controlled Analgesia Among Postoperative Patients Using a Generalized Ordinal Logistic Regression Model

PURPOSE

The purpose of this study was to identify the factors affecting the satisfaction with patient-controlled analgesia (PCA) of patients using a generalized ordinal logistic regression model and to evaluate the difference in results of the ordinal regression from those of binary regression.

METHODS

The study design involved secondary analysis of electronic medical records from a single tertiary care hospital in Seoul, Korea. It included 2,409 patients treated with PCA for postoperative pain management after open or laparoscopic abdominal surgery. Binary logistic regression and generalized ordinal logistic regression were used to identify factors affecting satisfaction.

RESULTS

Binary logistic regression analysis showed that there was insufficient information for analysis. Generalized ordinal logistic regression revealed that sex, age, pain, PCA usage, and side-effects were common factors affecting PCA satisfaction. However, the effect of some factors affecting PCA satisfaction differed with the level of satisfaction. In open surgery patients, the effect of pain at 6 hours after surgery was significantly greater in the group with lower satisfaction. While, in the laparoscopic surgery patients, the effect of pain at 6-24 hours after surgery was significantly greater in the group with lower satisfaction.

CONCLUSION

Generalized logistic regression may be an appropriate statistical method for analyzing ordinal data. Degree of postoperative pain and assessment interval are the most important factors associated with PCA satisfaction. Because the factors affecting PCA satisfaction were different for the two types of abdominal surgeries, customizing PCA to individual patients may potentially improve pain management and consequently increase PCA satisfaction.

Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments

Since time immemorial, complementary and alternative medicines (CAM) have played a significant role in human health care. CAM is known to have a strong reputation and reliability within every culture to provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being for treating various diseases and improving quality of life with apt consideration to the economic aspects. Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other body parts. This review outlines various types, devices and mechanisms involved in the acupressure treatment.

Effectiveness of Ginger Essential Oil on Postoperative Nausea and Vomiting in Abdominal Surgery Patients

BACKGROUND

The purpose of this study was to examine the effectiveness of aromatherapy with ginger essential oil on nausea and vomiting in abdominal surgery patients.

METHOD

This was a quasi-experimental study with a nonequivalent control group and repeated measures. The experimental group (n = 30) received ginger essential oil inhalation. The placebo control group (n = 30) received normal saline inhalation. The level of postoperative nausea and vomiting was measured using a Korean version of the Index of Nausea, Vomiting, and Retching (INVR) at baseline and at 6, 12, and 24 h after aromatherapy administration. The data were collected from July 23 to August 22, 2012.

RESULTS

Nausea and vomiting scores were significantly lower in the experimental group with ginger essential oil inhalation than those in the placebo control group with normal saline. In the experimental group, the nausea and vomiting scores decreased considerably in the first 6 h after inhaled aromatherapy with ginger essential oil.

CONCLUSION

Findings indicate that ginger essential oil inhalation has implications for alleviating postoperative nausea and vomiting in abdominal surgery patients.

Comparing Effects of Two Different Types of Nei-Guan Acupuncture Stimulation Devices in Reducing Postoperative Nausea and Vomiting

PURPOSE

To compare the effects of a relief band using transcutaneous electrical nerve stimulation with a wrist band using acupressure on the Nei-Guan acupuncture point to relieve postoperative nausea and vomiting (PONV) in patients who had undergone gynecologic surgery.

DESIGN

A double-blinded randomized controlled trial.

METHODS

In total, 54 patients scheduled for gynecologic surgery under general anesthesia were included in this study. Assessments of PONV were performed 0, 2, 6, and 24 hours after discharge from the postanesthesia care unit. The severity of PONV was measured using the Rhodes' Index of Nausea, Vomiting and Retching and by recording the frequency of patient-requested antiemetic administration that is used to treat severe cases of PONV.

FINDINGS

The relief band reduced the severity of PONV and the need for antiemetic administration within the first 24 hours postsurgery.

CONCLUSIONS

The results of this study support the use of a relief band when compared with a wrist band and with a control group to reduce PONV in women after gynecologic surgery.

Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting

BACKGROUND

Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Antiemetic drugs are only partially effective in preventing PONV. An alternative approach is to stimulate the PC6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004, updated in 2009 and now in 2015.

OBJECTIVES

To determine the effectiveness and safety of PC6 acupoint stimulation with or without antiemetic drug versus sham or antiemetic drug for the prevention of PONV in people undergoing surgery.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 12, 2014), MEDLINE (January 2008 to December 2014), EMBASE (January 2008 to December 2014), ISI Web of Science (January 2008 to December 2014), World Health Organization Clinical Trials Registry, ClinicalTrials.gov, and reference lists of articles to identify additional studies. We applied no language restrictions.

SELECTION CRITERIA

All randomized trials of techniques that stimulated the PC6 acupoint compared with sham treatment or drug therapy, or combined PC6 acupoint and drug therapy compared to drug therapy, for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous electrical acupoint stimulation, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, acu-stimulation device, and acupressure in people undergoing surgery. Primary outcomes were the incidences of nausea and vomiting after surgery. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and assessed the risk of bias domains for each trial. We used a random-effects model and reported risk ratio (RR) with associated 95% confidence interval (95% CI). We used trial sequential analyses to help provide information on when we had reached firm evidence in cumulative meta-analyses of the primary outcomes, based on a 30% risk ratio reduction in PONV.

MAIN RESULTS

We included 59 trials involving 7667 participants. We rated two trials at low risk of bias in all domains (selection, attrition, reporting, blinding and other). We rated 25 trials at high risk in one or more risk-of-bias domains. Compared with sham treatment, PC6 acupoint stimulation significantly reduced the incidence of nausea (RR 0.68, 95% CI 0.60 to 0.77; 40 trials, 4742 participants), vomiting (RR 0.60, 95% CI 0.51 to 0.71; 45 trials, 5147 participants) and the need for rescue antiemetics (RR 0.64, 95% CI 0.55 to 0.73; 39 trials, 4622 participants). As heterogeneity among trials was substantial and there were study limitations, we rated the quality of evidence as low. Using trial sequential analysis, the required information size and boundary for benefit were reached for both primary outcomes.PC6 acupoint stimulation was compared with six different types of antiemetic drugs (metoclopramide, cyclizine, prochlorperazine, droperidol. ondansetron and dexamethasone). There was no difference between PC6 acupoint stimulation and antiemetic drugs in the incidence of nausea (RR 0.91, 95% CI 0.75 to 1.10; 14 trials, 1332 participants), vomiting (RR 0.93, 95% CI 0.74 to 1.17; 19 trials, 1708 participants), or the need for rescue antiemetics (RR 0.87, 95% CI 0.65 to 1.16; 9 trials, 895 participants). We rated the quality of evidence as moderate, due to the study limitations. Using trial sequential analyses, the futility boundary was crossed before the required information size was surpassed for both primary outcomes.Compared to antiemetic drugs, the combination of PC6 acupoint stimulation and antiemetic therapy reduced the incidence of vomiting (RR 0.56, 95% CI 0.35 to 0.91; 9 trials, 687 participants) but not nausea (RR 0.79, 95% CI 0.55 to 1.13; 8 trials, 642 participants). We rated the quality of evidence as very low, due to substantial heterogeneity among trials, study limitations and imprecision. Using trial sequential analysis, none of the boundaries for benefit, harm or futility were crossed for PONV. The need for rescue antiemetic was lower in the combination PC6 acupoint stimulation and antiemetic group than the antiemetic group (RR 0.61, 95% CI 0.44 to 0.86; 5 trials, 419 participants).The side effects associated with PC6 acupoint stimulation were minor, transient and self-limiting (e.g. skin irritation, blistering, redness and pain) in 14 trials. Publication bias was not apparent in the contour-enhanced funnel plots.

AUTHORS' CONCLUSIONS

There is low-quality evidence supporting the use of PC6 acupoint stimulation over sham. Compared to the last update in 2009, no further sham comparison trials are needed. We found that there is moderate-quality evidence showing no difference between PC6 acupoint stimulation and antiemetic drugs to prevent PONV. Further PC6 acupoint stimulation versus antiemetic trials are futile in showing a significant difference, which is a new finding in this update. There is inconclusive evidence supporting the use of a combined strategy of PC6 acupoint stimulation and antiemetic drug over drug prophylaxis, and further high-quality trials are needed.

[Combination effects of capsicum plaster at the Korean hand acupuncture points k-d2 with prophylactic antiemetic on postoperative nausea and vomiting after gynecologic laparoscopy]

PURPOSE

This study was done to evaluate the combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on Postoperative Nausea and Vomiting (PONV).

METHODS

An experimental research design (a randomized, a double-blinded, and a placebo-control procedure) was used. The participants were female patients undergoing gynecologic laparoscopy; the control group (n=34) received intravenous prophylactic ramosetron 0.3mg, while the experimental group (n=34) had Korean Hand Therapy additionally. In the experimental group, capsicum plaster was applied at K-D2 of both 2nd and 4th fingers by means of Korean Hand Therapy for a period of 30 minutes before the induction of anesthesia and removed 8 hours after the laparoscopy.

RESULTS

The occurrence of nausea, nausea intensity and need for rescue with antiemetic in the experimental group was significantly less than in the control group 2 hours after surgery.

CONCLUSION

Results of the study show capsicum plaster at K-D2 is an effective method for reducing PONV in spite of the low occurrence of PONV because of the prophylactic antiemetic medication.