Stimulation of the P6 Acupuncture Point for Prophylaxis of Nausea and Vomiting in Pregnant Women Submitted to Cesarean Section: A Blinded Clinical Trial

Luiza Helena Castelo Branco, Luciana Cavalcante Lima, Maria Célia Ferreira Costa, Marilia Santos Lira, Raquel Queiroz Guerra de Andrade Coelho, Tania Cursino de Menezes Couceiro, Anne Danielle Soares, Eusa Maria Belarmino Alcoforado, Maria Emilia Carvalho

Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil..

DOI: 10.4236/ojanes.2013.33037                

Abstract

In pregnant women subjected to spinal anesthesia for a Cesarean section, episodes of nausea and vomiting are common both during and following surgery. Acupuncture for the prophylaxis and treatment of these complications has been gaining in popularity due to its low cost, simplicity, absence of side effects and confirmed efficacy. This study investigated the efficacy of stimulating the P6 acupoint in conjunction with the use of dexamethasone as prophylaxis for nausea and vomiting in pregnant women submitted to spinal anesthesia for a Cesarean section. The patients (n = 100) were randomly distributed into two groups. In the first group (n = 50), a site located one centimeter laterally from P6 was stimulated. This is not a true acupuncture point (sham acupuncture). In the second group (n = 50), P6 was stimulated. In both groups, 4 mg of dexamethasone were administered intravenously. A questionnaire was used to obtain information on the occurrence of nausea and vomiting during surgery and in the first 12 hours postpartum. The chi-square test and Fisher’s exact test were used to assess differences between the groups. Age and physical status were similar in both groups. The incidence of nausea during surgery was 32% (n = 16) in the control group and 22% (n = 11) in the P6 group (p > 0.05). In the first 12 hours following surgery, nausea occurred in 16% of the women in the control group (n = 6) and in 4% in the P6 group (n = 4) (p = 0.045). The incidence of vomiting in the control group was 12% (n = 6) during surgery and 10% (n = 5) in the postoperative period compared to 8% (n = 4) and 4% (n = 2), respectively, in the P6 group (p > 0.05). Although these differences were not statistically significant with the exception of the incidence of nausea in the first 12 hours postpartum, a reduction occurred in the incidence of all the outcomes evaluated in the P6 group.

Keywords

Obstetric Surgery; Cesarean Section; Complications; Nausea; Vomiting; Prophylaxis; Acupuncture

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. N. Mendes, R. S. Monteiro and F. A. Martins, “Prophylaxis of Postoperative Nausea and Vomiting in Morbidly Obese Patients undergoing Laparoscopic Gastroplasties. A Comparative Study among Three Methods,” Revista Brasileira de Anestesiologia, Vol. 59, No. 5, 2009, pp. 570-576. doi:10.1590/S0034-70942009000500005
[2]	M. Arnberger, K. Stadelmann, P. Alischer, R. Ponert, A. Melber and R. Greif, “Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting,” Anesthesiology, Vol. 107, No. 6, 2007, pp. 903-908. doi:10.1097/01.anes.0000290617.98058.d9
[3]	C. A. Patti, J. E. Vieira and F. E. Bensenõr, “Incidence and Prophylaxis of Nausea and Vomiting in Post-Anesthetic Recovery in a Tertiary Teaching Hospital,” Revista Brasileira de Anestesiologia, Vol. 58, No. 5, 2008, pp. 462-469.
[4]	T. J. Gan, T. A. Meyer, C. C. Apfel, F. Chung, P. J. Davis, A. S. Habib, V. D. Hooper, A. L. Kovac, P. Kranke, P. Myles, B. K. Philip, G. Samsa, D. I. Sessler, J. Temo, M. R. Tramèr, C. Vander Kolk and M. Watcha, “Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting,” Anesthesia and Analgesia, Vol. 105, No. 6, 2007, pp. 1615-1628. doi:10.1213/01.ane.0000295230.55439.f4
[5]	C. Nunley, J. Wakim and C. Guinn, “The Effects of Stimulation of Acupressure Point P6 on Postoperative Nausea and Vomiting: A Review of Literature,” Journal of Perianesthesia Nursing, Vol. 23, No. 4, 2008, pp. 247-261. doi:10.1016/j.jopan.2008.05.001
[6]	T. K. Allen and A. S. Habib, “P6 Stimulation for the Prevention of Nausea and Vomiting Associated with Cesarean Delivery under Neuraxial Anesthesia: A Systematic Review of Randomized Controlled Trials,” Anesthesia and Analgesia, Vol. 107, No. 4, 2008, pp. 1308-1312. doi:10.1213/ane.0b013e31816d1864
[7]	J. B. Dahl, I. S. Jeppesen, H. Jørgensen, J. Wetterslev and S. Møiniche, “Intraoperative and Postoperative Analgesic Efficacy and Adverse Effects of Intrathecal Opioids in Patients Undergoing Cesarean Section with Spinal Anesthesia: A Qualitative and Quantitative Systematic Review of Randomized, Controlled Trials,” Anesthesiology, Vol. 91, No. 6, 1999, pp. 1919-1927. doi:10.1097/00000542-199912000-00045
[8]	Y. Fujii, H. Tanaka and H. Toyooka, “Prevention of Nausea and Vomiting with Granisetron, Droperidol and Metoclopramide during and after Spinal Anesthesia for Caesarean Section: A Randomized, Double-Blind, Placebo-Controlled Trial,” Acta Anaesthesiologica Scandinavica, Vol. 42, No. 8, 1998, pp. 921-925. doi:10.1111/j.1399-6576.1998.tb05350.x
[9]	M. A. Chaney, “Side Effects of Intrathecal and Epidural Opioids,” Canadian Journal of Anaesthesia, Vol. 42, No. 10, 1995, pp. 891-903. doi:10.1007/BF03011037
[10]	A. S. Habib, N. Itchon-Ramos, B. G. Phillips-Bute, T. J. Gan and Duke Women’s Anesthesia (DWA) Research Group, “Transcutaneous Acupoint Electrical Stimulation with the Relief Band® for the Prevention of Nausea and Vomiting during and after Cesarean Delivery under Spinal Anesthesia,” Anesthesia and Analgesia, Vol. 102, No. 2, 2006, pp. 581-584. doi:10.1213/01.ane.0000189217.19600.5c
[11]	P. E. Scuderi, “P6 Stimulation: A New Approach to an Ancient Technique,” Anesthesiology, Vol. 107, No. 6, 2007, pp. 870-872. doi:10.1097/01.anes.0000291438.04166.84
[12]	Y. C. Arai, N. Kato, M. Matsura, H. Ito, N. Kandatsu, S. Kurokawa, M. Mizutani, Y. Shibata and T. Komatsu, “Transcutaneous Electrical Nerve Stimulation at the PC-5 and PC-6 Acupoints Reduced the Severity of Hypotension after Spinal Anesthesia in Patients Undergoing Caesarean Section,” British Journal of Anaesthesia, Vol. 100, No. 1, 2008, pp. 78-81. doi:10.1093/bja/aem306
[13]	N. M. Carneiro, “Acupuntura na Prevencão e Tratamento de Náuseas e Vômitos,” Projeto Diretrizes—Associacão Médica Brasileira e Conselho Federal de Medicina, 2002. http://www.projetodiretrizes.org.br/projeto_diretrizes/011.pdf
[14]	B. Erdur, P. Tura, B. Aydin, M. Ozen, A. Ergin, I. Parlak and B. Kabay, “A Trial of Midazolam vs. Diphenhydramine in Prophylaxis of Metoclopramide-Induced Akathisia,” The American Journal of Emergency Medicine, Vol. 30, No. 1, 2012, pp. 84-91. doi:10.1016/j.ajem.2010.10.007
[15]	A. M. El-Deeb and M. S. Ahmady, “Effect of Acupuncture on Nausea and/or Vomiting during and after Cesarean Section in Comparison with Ondansetron,” Journal of Anesthesia, Vol. 25, No. 5, 2011, pp. 698-703. doi:10.1007/s00540-011-1198-0
[16]	F. S. Pécora, L. M. Malbouisson and M. L. Torres, “Supplemental Oxygen and the Incidence of Perioperative Nausea and Vomiting in Cesarean Sections under Subarachnoid Block,” Revista Brasileira de Anestesiologia, Vol. 59, No. 5, 2009, pp. 558-569. doi:10.1590/S0034-70942009000500004
[17]	E. A. Muñoz, F. P. Abizanda, P. R. De Diego and F. Gilsanz Rodríguez, “Ephedrine vs. Phenylephrine by Intravenous Bolus and Continuous Infusion to Prevent Hypotension Secondary to Spinal Anesthesia during Cesarean Section: a Randomized Comparative Trial,” Revista Española de Anestesiología y Reanimación, Vol. 58, No. 7, 2011, pp. 412-416.