Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
권호 표지

Effect of Stimulation of the P6 Acupoint on Opioid-induced Nausea

아편양 제제에 의해 유발된 오심에 대한 P6 Acupoint 자극의 효과

Kim, Woong-Mo;Gwak, Sang-Hyeon;Yun, Myeong-Ha
김웅모;곽상현;윤명하

  • Published : 20020400
⟨ Previous Next ⟩

Abstract

Background: Use of opioids to relieve postoperative pain may cause nausea and vomiting. There is growing interest in the use of nonpharmacologic approaches to the prevention of nausea. Particularly transcutaneous electrical nerve stimulation (TENS) of the P6 acupoint has been shown to reduce the incidence of pregnancy-induced nausea and chemotherapy associated emesis. The aim of this study was to investigate the effect of stimulation of the P6 acupoint on nausea induced by opioids for postoperative pain control. Methods: We studied 103 patients receiving intravenous patient controlled analgesia (PCA) with fentanyl after a hysterectomy under general anesthesia. No antiemetic agent or device was provided in the N group (n = 31), and TENS on the P6 acupoint was applied after closure of the peritoneum in the T group (n = 32). In the P group (n = 39), a transdermal scopolamine patch was attached below the mastoid process about 1 hour before induction of general anesthesia. Incidence of nausea and pain score were assessed. Results: The incidence of nausea was significantly less in the T and P groups than in the N group. There was no difference in the incidence of nausea between the T and P groups. The pain score was decreased in all three groups after beginning the PCA. No difference was seen in pain scores among the groups over the time course. Conclusions: TENS of the P6 acupoint reduced the incidence of opioid-induced nausea after a hysterectomy. This result suggests that TENS of the P6 acupoint may be useful as a new therapeutic approach to reduce or prevent nausea caused by opioids.

Keywords

References

  1. Kenny GNC: Risk factors for postoperative nausea and vomiting. Anaesthesia 1994; 49: 6-10. https://doi.org/10.1111/j.1365-2044.1994.tb03576.x
  2. Apfel CC, Greim CA, Haubitz I, Goepfert C, Usadel J, Sefrin P, et al: A risk score to predict the probability of postoperative vomiting in adults. Acta Anaesthesiol Scand 1998; 42: 495-501. https://doi.org/10.1111/j.1399-6576.1998.tb05157.x
  3. Apfel CC, Greim CA, Haubitz I, Goepfert C, Grundt D, Sefrin P, et al: The discriminating power of a risk score for postoperative vomiting on adults undergoing various types of surgery. Acta Anaesthesiol Scand 1998; 42: 502-9. https://doi.org/10.1111/j.1399-6576.1998.tb05158.x
  4. White PF: Use of patient controlled analgesia for management of acute pain. JAMA 1998; 259: 243-7. https://doi.org/10.1001/jama.259.2.243
  5. Watcha MF, White PF: Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology 1992; 77: 162-84. https://doi.org/10.1097/00000542-199209001-00162
  6. Dupre LJ, Stieglitz P: Extrapyramidal syndromes after premedication with droperidol in children. Br J Anaesth 1980; 52: 831-3. https://doi.org/10.1093/bja/52.8.831
  7. Schulze-Delrieu K: Drug therapy: metoclopramide. N Engl J Med 1981; 305: 28-33. https://doi.org/10.1056/NEJM198107023050106
  8. Dundee JW, Chestnutt WN, Ghaly RG, Lynas AG: Traditional chinese acupuncture: a potientially useful antiemetic? BMJ Clin Res 1986; 293: 583-4.
  9. Stein DJ, Birnbach DJ, Danzer Bl, Kuroda MM, Grunebaum A, Thys DM, et al: Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarian section. Anesth Analg 1997; 84: 342-5. https://doi.org/10.1097/00000539-199702000-00018
  10. Ho RT, Jawan B, Fung ST, Cheung HK, Lee JH: Electro-acupuncture and postoperative emesis. Anaesthesia 1990; 45: 327-9. https://doi.org/10.1111/j.1365-2044.1990.tb14744.x
  11. Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M: Transcutaneous electrical nerve stimulation reduces he incidence of vomiting after hysterectomy. Anesth Analg 1993; 76: 1012-4.
  12. Evans AT, Samuels SN, Marshall C, Bertolucci LE: Suppression of pregnancy-induced nausea and vomiting with sensory afferent stimulation. J Reprod Med 1993; 38: 603-6.
  13. Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 1991; 83: 210-2.
  14. White PF: Are nonpharmacologic techniques useful alternatives to antiemetic drugs for the prevevtion of nausea and vomiting? Anesth Analg 1997; 84: 712-4.
  15. Yang LC, Jawan B, Chen CN, Ho RT, Chang KA, Lee JH: Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecologic laparoscopy. Acta Anaesthesiol Scand 1993; 37: 192-4.
  16. Mann F: Textbook of acupuncture. Oxford, Heinemann.1987, pp 32-5.
  17. Dundee JW, McMillan CM: Positive evidence for P6 acupuncture antiemesis. Postgrad Med J 1991; 67: 417-22. https://doi.org/10.1136/pgmj.67.787.417
  18. Al-Sadi M, Newmann B, Julious SA: Acupuncture in the prenvevtion of postoperative nausea and vomiting. Anaesthsia 1997; 52: 658-61. https://doi.org/10.1111/j.1365-2044.1997.143-az0147.x
  19. Han JS, Terenius L: Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982; 22: 193-220. https://doi.org/10.1146/annurev.pa.22.040182.001205
  20. Zarate E, Mingus M, White PF, Chiu JW, Scuderi P, Loskota W, et al: The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 2001;92: 629-35. https://doi.org/10.1213/00000539-200103000-00014
  21. Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KT, Lynas AG, et al: Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Br J Anaesth 1989; 63: 612-8. https://doi.org/10.1093/bja/63.5.612
  22. Barosum G, Perry EP, Fraser IA: Postoperative nausea is relieved by acupressure. J R Soc Med 1990; 83: 86-9. https://doi.org/10.1177/014107689008300209
  23. Lewis IH, Pryn SJ, Reynolds PI, Pandit VA, Wilton NC: Effect of P6 acupressure on postoperative vomiting in children undergoing outpatient strabismus correction. Br J Anaesth 1991; 67: 73-8. https://doi.org/10.1093/bja/67.1.73
  24. Allen DL, Kitching AJ, Nagle C: P6 acupressure and nausea and vomiting after gynaecological surgery. Anaesth Intensive Care 1994; 22: 691-3.
  25. Andrzejouwski J, Woodward D: Semi-permanent acupressure needles in the prevention of postoperative ausea and vomiting. Acupunct Med 1991; 14: 68-70.
  26. Lee A, Done ML: The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88: 1362-9. https://doi.org/10.1097/00000539-199906000-00031
  27. Dundee JW, Ghaly RG: Does the timing of P6 acupuncture influence its efficacy as a postoperative antiemetic?Br J Anaesth 1989; 63: 630
  28. Bailey PL, Streisand JB, Pace NL, Bubbers SJ, East KA, Mulder S, et al: Transdermal scopolamine reduces nausea and vomiting after outpatient laparoscopy.Anesthesiology 1990; 72: 977-80. https://doi.org/10.1097/00000542-199006000-00005
  29. Kotelko DM, Rottman RL, Wright WC, Stone JJ, Yamashiro AY, Rosenblatt RM: Transdermal scopolamine decreases nausea and vomiting following cesarean section in patient recieving epidural morphine. Anesthesiology 1989; 71: 675-8. https://doi.org/10.1097/00000542-198909001-00675