Effectiveness of P6 Stimulation on Postoperative Nausea and Vomiting: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Dan ,  LV Huangwei

Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China;

Corresponding author：

LV Huangwei, Email: hwl1998@yahoo.com

Keywords：

P6 Stimulation; Acupuncture; Post operation; Nausea; Vomiting; Meta-analysis

DOI：

10.7507/1672-2531.20100521

Video：

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Objective To compare the effectiveness of P6 stimulation and sham stimulation/ drug intervention on prevention of postoperative nausea and vomiting (PONV).
Methods We searched PubMed (1990 to 2010), OVID (1990 to 2010), EBSCO (1990 to 2010), The Cochrane Library (1996 to 2010), PNAI (1990 to 2010), Hight Wirepres (1990 to 2010), and Chinese Digital Hospital Library (www.chkd.cnki.net) (1999 to 2010) to identify randomized controlled trials (RCTs) about P6 stimulation and sham stimulation/drug intervention on prevention of PONV. The methodological quality of the included studies was assessed and the data was extracted according to the Cochrane Reviewer’s Handbook 4.2.2. Meta-analyses were performed using RevMan 4.2 software.
Results A total of 21 studies were included. The results of meta-analyses indicated that: (1) Compared with sham stimulation, P6 stimulation could be effective in preventing postoperative nausea (beginning to termination) (P lt;0.000 01), postoperative early nausea ( lt;after surgery 6 h) (P=0.000 6) and postoperative late nausea ( gt;after surgery 6 h) (P=0.001). (2) Compared with sham stimulation, P6 stimulation could be effective in preventing postoperative vomiting (beginning to termination) (P lt;0.0.000 1) and postoperative early vomiting (P=0.002), but as to postoperative late vomiting ( gt;after surgery 6 h), P6 stimulation had no effective preventive effect (P=0.08). (3) Compared with the drug intervention, P6 stimulation had little effect on preventing postoperative nausea (P=0.29) and vomiting (P=0.15).
Conclusion Compared with sham stimulation, P6 stimulation can be effective in preventing postoperative early nausea and vomiting as well as postoperative late nausea, but not effective in preventing postoperative late vomiting. In comparison with drugs, a large number of clinical trials are needed to prove P6 stimulation can replace drugs to prevent postoperative nausea and vomiting.

Citation： ZHU Dan,LV Huangwei. Effectiveness of P6 Stimulation on Postoperative Nausea and Vomiting: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2010, 10(8): 928-931. doi: 10.7507/1672-2531.20100521 Copy

1.	Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res, 1990, 15(3-4): 211-215.
2.	Boehler M, Mitterschiffthaler G, Schlager A, et al. Korean Hand Acupressure Reduces Postoperative Nausea and Vomiting After Gynecological Laparoscopic Surgery. Anesth Analg, 2002, 94(4): 872–875.
3.	Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure Versus Intravenous Metoclopramide to Prevent Nausea and Vomiting During Spinal Anesthesia for Cesarean Section. Anesth Analg, 1997, 84(2): 342-345.
4.	Gan TJ, Jiao KR, Zenn M, et al. A Randomized Controlled Comparison of Electro-Acupoint Stimulation or Ondansetron Versus Placebo for the Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 2004, 99(4): 1070-1075.
5.	Habib AS, Itchon-Ramoset N, Phillips-Bute BG, et al. Transcutaneous Acupoint Electrical Stimulation with the ReliefBand® for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia. Anesth Analg, 2006, 102(2): 581-584.
6.	Harmon D, Ryan M, Kelly A, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaeathesia for caesarean section. Br J Anaesth, 2000, 84(4): 463-467.
7.	Frey UH, Funk M, Lohlein C, et al. FUNK Effect of P6 acustimulation on post-operative nausea and vomiting in patients undergoing a laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2009, 53(10): 1341-1347.
8.	Arnberger M, Stadelmann K, Alischer P, et al. Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting. Anesthesiology, 2007, 107(6): 903-908.
9.	Sadighha A, Nurai N. Acupressure wristbands versus metoclopramide for the prevention of postoperative nausea and vomiting. Ann Saudi Med, 2008, 28(4): 287-291.
10.	Klein AA, Djaiani G, Karski J, et al. Acupressure Wristbands for the Prevention of Postoperative Nausea and Vomiting in Adults Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth, 2004, 18(1): 68-71.
11.	Schultz AA, Andrews AL, Goran SG, et al. Comparison of Acupressure Bands and Droperidol for Reducing Post-operative Nausea and Vomiting in Gynecologic Surgery Patients. Applied Nursing Research, 2003, 16(4): 256-265.
12.	Harmon D, Gardiner J, Harrison R, et al. Acupressure and the prevention nausea and vomiting after laparoscopy. Br J Anaesth, 1999, 82(3): 387-390.
13.	Fan FC, Tanhui E, Joshi S, et al. Acupressure Treatment for Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 1997, 84(4): 821-825.
14.	Ferrara-Love R,Sekeres L, Bircher NG, et al. Nonpharmacologic Treatment of Postoperative Nause. J PeriAnesthesia Nursing, 1996, 11(6): 378-383.
15.	Wang XQ, Yu JL, Du ZY, et al. Electroacupoint Stimulation for Postoperative Nausea and Vomiting in Patients Undergoing Supratentorial Craniotomy. J Neurosurg Anesthesiol, 2010, 22(2): 128-131.
16.	Duggal KN, Douglas MJ, Peter EA, et al. Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. Int Obstet Anesth, 1998, 7(4): 231-236.
17.	Alkaissi A, Evertsson K, Johnsson Vivi-Ann, et al. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women. Can J Anesth, 2002, 49(10): 1034-1039.
18.	Zárate E, Mingus M, White PF, et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg, 2001, 92(3): 629-635.
19.	Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in chindren undergoing strabismus surgery. Br J Anaesth, 1998, 81(4): 529-532.
20.	Alkaissi A, Stalnert M, Kalman S. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesioloqica Scandinavica, 1999, 43(3): 270-274.
21.	Turgut S, Ozalp G, Dikmen S, et al. Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia. Eur J Anaesthesiol, 2007, 24(1): 87-91.
22.	Coloma M, White PF, Ogunnaike BO, et al. Comparison of Acustimulation and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting. Anesthesiology, 2002, 97(6): 1387-1392.
23.	White PF, Issioui T, Hu J. Comparative Efficacy of Acustimulation (ReliefBand®) versus Ondansetron (Zofran®) in Combination with Droperidol for Preventing Nausea and Vomiting. Anesthesiology, 2002, 97(5): 1075-1081.
24.	Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and analgesia, 1997, 84(2): 342-345.
25.	Tang J, Chen X, White PF, et al. Antiemetic prophylaxis for office-based surgery: are the 5-HT3 receptor antagonists beneficial. Anesthesiology, 2003, 98(2): 293-298.

1. Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res, 1990, 15(3-4): 211-215.
2. Boehler M, Mitterschiffthaler G, Schlager A, et al. Korean Hand Acupressure Reduces Postoperative Nausea and Vomiting After Gynecological Laparoscopic Surgery. Anesth Analg, 2002, 94(4): 872–875.
3. Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure Versus Intravenous Metoclopramide to Prevent Nausea and Vomiting During Spinal Anesthesia for Cesarean Section. Anesth Analg, 1997, 84(2): 342-345.
4. Gan TJ, Jiao KR, Zenn M, et al. A Randomized Controlled Comparison of Electro-Acupoint Stimulation or Ondansetron Versus Placebo for the Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 2004, 99(4): 1070-1075.
5. Habib AS, Itchon-Ramoset N, Phillips-Bute BG, et al. Transcutaneous Acupoint Electrical Stimulation with the ReliefBand® for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia. Anesth Analg, 2006, 102(2): 581-584.
6. Harmon D, Ryan M, Kelly A, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaeathesia for caesarean section. Br J Anaesth, 2000, 84(4): 463-467.
7. Frey UH, Funk M, Lohlein C, et al. FUNK Effect of P6 acustimulation on post-operative nausea and vomiting in patients undergoing a laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2009, 53(10): 1341-1347.
8. Arnberger M, Stadelmann K, Alischer P, et al. Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting. Anesthesiology, 2007, 107(6): 903-908.
9. Sadighha A, Nurai N. Acupressure wristbands versus metoclopramide for the prevention of postoperative nausea and vomiting. Ann Saudi Med, 2008, 28(4): 287-291.
10. Klein AA, Djaiani G, Karski J, et al. Acupressure Wristbands for the Prevention of Postoperative Nausea and Vomiting in Adults Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth, 2004, 18(1): 68-71.
11. Schultz AA, Andrews AL, Goran SG, et al. Comparison of Acupressure Bands and Droperidol for Reducing Post-operative Nausea and Vomiting in Gynecologic Surgery Patients. Applied Nursing Research, 2003, 16(4): 256-265.
12. Harmon D, Gardiner J, Harrison R, et al. Acupressure and the prevention nausea and vomiting after laparoscopy. Br J Anaesth, 1999, 82(3): 387-390.
13. Fan FC, Tanhui E, Joshi S, et al. Acupressure Treatment for Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 1997, 84(4): 821-825.
14. Ferrara-Love R,Sekeres L, Bircher NG, et al. Nonpharmacologic Treatment of Postoperative Nause. J PeriAnesthesia Nursing, 1996, 11(6): 378-383.
15. Wang XQ, Yu JL, Du ZY, et al. Electroacupoint Stimulation for Postoperative Nausea and Vomiting in Patients Undergoing Supratentorial Craniotomy. J Neurosurg Anesthesiol, 2010, 22(2): 128-131.
16. Duggal KN, Douglas MJ, Peter EA, et al. Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. Int Obstet Anesth, 1998, 7(4): 231-236.
17. Alkaissi A, Evertsson K, Johnsson Vivi-Ann, et al. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women. Can J Anesth, 2002, 49(10): 1034-1039.
18. Zárate E, Mingus M, White PF, et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg, 2001, 92(3): 629-635.
19. Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in chindren undergoing strabismus surgery. Br J Anaesth, 1998, 81(4): 529-532.
20. Alkaissi A, Stalnert M, Kalman S. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesioloqica Scandinavica, 1999, 43(3): 270-274.
21. Turgut S, Ozalp G, Dikmen S, et al. Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia. Eur J Anaesthesiol, 2007, 24(1): 87-91.
22. Coloma M, White PF, Ogunnaike BO, et al. Comparison of Acustimulation and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting. Anesthesiology, 2002, 97(6): 1387-1392.
23. White PF, Issioui T, Hu J. Comparative Efficacy of Acustimulation (ReliefBand®) versus Ondansetron (Zofran®) in Combination with Droperidol for Preventing Nausea and Vomiting. Anesthesiology, 2002, 97(5): 1075-1081.
24. Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and analgesia, 1997, 84(2): 342-345.
25. Tang J, Chen X, White PF, et al. Antiemetic prophylaxis for office-based surgery: are the 5-HT3 receptor antagonists beneficial. Anesthesiology, 2003, 98(2): 293-298.

Chinese Journal of Evidence-Based Medicine

Effectiveness of P6 Stimulation on Postoperative Nausea and Vomiting: A Meta-Analysis

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