Preventing Postoperative Nausea and Vomiting: Is the Answer in your Hands?

Abstract

Nausea and vomiting are unpleasant and frequent side effect of anesthesia. One complimentary therapy that has minimal side effects and good outcomes is acupressure stimulation therapy to P6 (Neiguan point). P6 is located  near the wrist. The precise anatomical site is along the median nerve pathway, two finger widths below the wrist crease. Acupressure stimulation can be created by needle acupuncture, transcutaneous electrical stimulus, acupressure by manual pressure, and acupuncture stimulation device such as wristbands. A Cochrane collaborative report reviewed forty research reports relevant to P6 stimulation (Fan, 2009). Statistical analysis of the studies demonstrated that P6 stimulation worked as well as current pharmacological antiemetic therapies. The method of stimulation of the acupressure point and the duration of time of the intervention varied with each study. There were no recommendations from this report on the best method of acupressure for optimal results (Fan, 2009).  A recent study of a patient undergoing cardiac surgery found that one preoperative treatment with acupuncture  at this site significantly diminished the sensation of nausea on postoperative day one and day two (Korinenko, Y, Vincent, A, Cutshall, S, Li, Z &  Sundt,TM, 2009).  There are many ways to take these findings from the literature and apply them to clinical practice.  The first  application would be to read  the above documents and lead a discussion with the anesthesia care providers  and surgical staff in your care facility. The discussion should focus on the improved patient outcomes associated with decreased PONV.  The second application would  be to develop a teaching protocol that would incorporate teaching the staff and patients the methods  of the technique. The protocol would also strengthen the portion of informed consent for anesthesia which discusses risks, benefits, and alternatives.  As a workgroup the healthcare providers would need to choose the procedural aspects such as method of acupressure stimulation, timing of treatments, and duration. What are your clinical experiences with complimentary therapies?