In order to provide leads and ideas for the future clinical researches, overseas current randomized controlled trials on acupuncture for postoperative nausea and vomiting are studied in this article. Summarization is given on those overseas trials of the recent 20 years from aspects of effectiveness and advantages of acupuncture treatment, treatment methods and the best opportunity of treatment. The result indicates that the therapeutic effect of acupuncture on prevention and treatment of postoperative nausea and vomiting is basically approved by modern clinical researches. Further studies should be focused on the potential of influence on acupuncture effect by different types of anesthetics, durations of operation and sorts of surgery. Importance should also be attached on enhancing therapeutic effect of acupuncture treatment by applying proper differentiation of syndromes, as well as its benefit estimation on health economy.
Acupuncture Therapy ; Electroacupuncture ; Humans ; Postoperative Nausea and Vomiting ; prevention & control ; therapy

OBJECTIVE: To compare the effects of different frequency of transcutaneous electrical acupoint stimulation (TEAS) combined with wristband pressing on Neiguan (PC 6) for nausea and vomiting (PONV) after laparoscopic cholecystectomy, and optimize the TEAS frequency selection for treatment of PONV. METHODS: Eighty patients undergoing laparoscopic cholecystectomy were randomly divided into a postoperative routine care group, a 2 Hz TEAS combined with wristband pressing group (2 Hz TEAS group), a 100 Hz TEAS combined with combined with wristband pressing group (100 Hz TEAS group) and a 2 Hz/100 Hz TEAS wristband pressing group (2 Hz/100 Hz TEAS group), 20 cases in each group (1 patient dropped off in the postoperative routine care group). All the four groups underwent laparoscopic cholecystectomy, and routine nursing was given after the operation. In the postoperative routine nursing group，only routine nursing was received. In the other three groups, 2 Hz TEAS combined with wristband pressing, 100 Hz TEAS combined with wristband pressing, 2 Hz/100 Hz TEAS combined with wristband pressing to simulate Neiguan (PC 6) were treated on the basis of postoperative routine care after surgery. The treatment was given for 30 min each time for a total of 4 treatments. The incidence of PONV in each group was observed at 0-2 h, 2-8 h, 8-24 h and 24-48 h after operation, and the severity of PONV and postoperative pain were evaluated. RESULTS: Compared with the postoperative routine care group, the incidence and severity of PONV in the four time periods after surgery were significantly reduced in the 2 Hz/100 Hz TEAS group (all <0.05), the incidence and severity of PONV in patients at 2 h and 2-8 h after surgery were significantly reduced in the 2Hz TEAS group and the 100 Hz TEAS group (all <0.05), the postoperative pain at 8 h and 24 h after surgery was alleviated in the 100 Hz TEAS group and the 2 Hz/100 Hz TEAS group (all <0.05). CONCLUSION Different frequency of TEAS combined with wristband pressing to stimulating Neiguan (PC 6) have certain therapeutic effects on PONV in patients undergoing laparoscopic cholecystectomy. 2 Hz/100 Hz TEAS combined with wristband pressing at Neiguan (PC 6) is more effective in PONV. 2 Hz/100 Hz TEAS and 100 Hz TEAS combined with wristband pressing at Neiguan (PC 6) have postoperative analgesic effect, and 2 Hz/100 Hz TEAS has the better analgesic effect.
Acupuncture Points ; Cholecystectomy, Laparoscopic ; Humans ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; therapy ; Transcutaneous Electric Nerve Stimulation

Traction of the extraocular muscles during strabismus surgery could cause nausea and vomiting in postoperative period. Although the extent of these symptoms would vary in wide range, sometimes they are so severe that patients may feel very uncomfortable and have difficulties with adjusting back to their routine life in immediate postoperative period. Authors have investigated whether the 5-hydroxytryptamin-3 [5HT3] receptor antagonist, which is now used as an effective antiememtic agent after general anesthesia and anticancer chemotherapy, can control the nausea and vomiting after strabismus surgery or not. As the occurrence of the oculocardiac reflex during strabismus surgery is closely related with postoperative emesis, we also examined if 5HT3 receptor antagonist can suppress the oculocardiac reflex as well. We performed strabismus surgery in 80 patients under topical anesthesia. In experimental group[N=40], 3 milligramof Granistron in 50 milliliter of normal saline was administered intravenously and in control group[N=40], the same amount of normal saline was administered one hour before the surgery. To evaluate the degree of nausea and vomiting, authors used the Rhodes 'Nausea and Vomiting Estimation Index[NVEI]and monitored heart rate for oculo-car-diac reflex. The NVEI in experimental group was 12.10 +/-5.60 compared with 16.85 +/-8.88 in control[P=0.005]. But there was no difference in frequency of oculocardiac reflex and the degree of heart rate decrement between the two groups [P=0.152, P=0.345]. In conclusion, Granisetron, 5HT3 receptor antagonist, is still effective in controlling the nausea and vomiting after strabismus surgery, but it has no suppressive effect on the oculocardiac reflex.
Anesthesia* ; Anesthesia, General ; Drug Therapy ; Granisetron ; Heart Rate ; Humans ; Muscles ; Nausea* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Receptors, Serotonin, 5-HT3* ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction ; Vomiting*

Traction of the extraocular muscles during strabismus surgery could cause nausea and vomiting in postoperative period. Although the extent of these symptoms would vary in wide range, sometimes they are so severe that patients may feel very uncomfortable and have difficulties with adjusting back to their routine life in immediate postoperative period. Authors have investigated whether the 5-hydroxytryptamin-3 [5HT3] receptor antagonist, which is now used as an effective antiememtic agent after general anesthesia and anticancer chemotherapy, can control the nausea and vomiting after strabismus surgery or not. As the occurrence of the oculocardiac reflex during strabismus surgery is closely related with postoperative emesis, we also examined if 5HT3 receptor antagonist can suppress the oculocardiac reflex as well. We performed strabismus surgery in 80 patients under topical anesthesia. In experimental group[N=40], 3 milligramof Granistron in 50 milliliter of normal saline was administered intravenously and in control group[N=40], the same amount of normal saline was administered one hour before the surgery. To evaluate the degree of nausea and vomiting, authors used the Rhodes 'Nausea and Vomiting Estimation Index[NVEI]and monitored heart rate for oculo-car-diac reflex. The NVEI in experimental group was 12.10 +/-5.60 compared with 16.85 +/-8.88 in control[P=0.005]. But there was no difference in frequency of oculocardiac reflex and the degree of heart rate decrement between the two groups [P=0.152, P=0.345]. In conclusion, Granisetron, 5HT3 receptor antagonist, is still effective in controlling the nausea and vomiting after strabismus surgery, but it has no suppressive effect on the oculocardiac reflex.
Anesthesia* ; Anesthesia, General ; Drug Therapy ; Granisetron ; Heart Rate ; Humans ; Muscles ; Nausea* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Receptors, Serotonin, 5-HT3* ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction ; Vomiting*

BACKGROUND: Epidural buprenorphine provides good pain relief after Cesarean section, but is often associated with nausea and vomiting. Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, is known to prevent and treat emesis after chemotherapy in cancer patients and after general anesthesia. The purpose of this study was to compare the prophylactic antiemetic effect of ondansetron and metoclopramide on nausea and vomiting after epidural buprenorphine. METHODS: Sixty women undergoing Cesarean section were studied. The patients were given subarachnoid injections of 0.5% tetracaine 9 mg and were inserted with epidural catheters for postoperative pain control. Prior to closure of the peritoneum, we injected a mixture of buprenorphine and bupivacaine through the epidural catheters and gave intravenous boluses of saline 6 ml, metoclopramide 10 mg and ondansetron 4 mg randomly. The incidence of nausea and vomiting and the degree of satisfaction were evaluated until 24 hr after the injection of epidural buprenorphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between the ondansetron group and the metoclopramide group. Also, subjective ratings of satisfaction and incidence of other side effects did not differ significantly between the groups. CONCLUSIONS: Ondansetron, administered intravenously, prevented postoperative nausea and vomiting associated with epidural buprenorphine equally as well as metoclopramide.
Anesthesia, General ; Antiemetics* ; Bupivacaine ; Buprenorphine* ; Catheters ; Cesarean Section ; Drug Therapy ; Female ; Humans ; Incidence ; Metoclopramide* ; Nausea* ; Ondansetron* ; Pain, Postoperative ; Peritoneum ; Postoperative Nausea and Vomiting ; Pregnancy ; Serotonin ; Tetracaine ; Vomiting*

BACKGROUND: The previous studies on the influence of perioperative supplemental oxygen or generous fluid on postoperative nausea and vomiting (PONV) were inconsistent. We hypothesized in this trial that together with supplemental intraoperative oxygen and liberal fluid therapy would decrease PONV and pain. METHODS: Two hundred ASA 1 or 2 patients undergoing laparotomy and laparoscopic abdominal or gynecological surgery were randomly assigned to one of 4 groups: intraoperative FiO2 0.3 and crystalloid 6 ml/kg/h; FiO2 0.3 and 18 ml/kg/h; FiO2 0.8 and 6 ml/kg/h; FiO2 0.8 and 18 ml/kg/h. The incidence of PONV, nausea and pain scores, and amount of rescue antiemetic and analgesic drugs were studied. RESULTS: Overall incidence of PONV was 38%, 50%, 48%, 44% for group 1, 2, 3, and 4, respectively. There were no statistically significant differences among the 4 groups in the incidence of PONV, degree of nausea and pain, and the amount of antiemetics and analgesics in 2, 6, and 24 h postoperatively. The number of laparotomy and laparoscopy, and gender ratio were similar among the groups. CONCLUSIONS: We could not demonstrate an advantage of combination of intraoperative supplementary oxygen and liberal fluid in reducing PONV, pain, and amount of antiemetics and analgesics after intra-abdominal surgery.
Analgesics ; Antiemetics ; Female ; Fluid Therapy ; Gynecologic Surgical Procedures ; Humans ; Hyperoxia ; Incidence ; Laparoscopy ; Laparotomy ; Nausea ; Oxygen ; Postoperative Nausea and Vomiting*

OBJECTIVETo explore an optimum method on postoperative recovery of general-anesthesia gynecological laparoscopic surgery.

METHODSOne hundred and twenty cases of gynecological laparoscopic surgery were randomly divided into three groups, 40 cases in each one. The sensitive points of bilateral Shenmen (TF4), Zigong (TF2), Wei (CO4), Dachang (CO7) and so on were selected in all three groups one night before the surgery. The sticking with magnetic beads was applied in the group A. The magnetic beads were in-pair stuck at front-back corresponding location of both ears in the group B. The same-appearance plaster was put at the corresponding acupoints in the group C. The intubation anesthesia was applied in all three groups and postoperative recovery of gynecological laparoscopic surgery was observed.

RESULTSThe postoperative visual analogue scale (VAS) was (1.77 +/- 1.65) in the group A and (1.80 +/- 1.96) in the group B, which was both lower than (2.62 +/- 1.46) in the group C (both P < 0.01). The occurrence rate of nausea and vomiting was 25.0% (9/36) in the group A and 20.0% (8/40) in the group B, which was both lower than 50.0% (19/38) in the group C (both P < 0.01). The recovery of borborygmus on postoperative 1st and 3rd day in the group A and B was faster than that in the group C (both P < 0.05), while time of fart and defecation in the group A and B was earlier than that in the group C (both P < 0.05). The score of state-trait anxiety inventory in the group A and B was lower than that in the group C (both P < 0.05), but the differences of each item between the group A and B were not obvious (both P > 0.05).

CONCLUSIONThe auricular point sticking could support analgesia of general-anesthesia gynecological laparoscopic surgery, which could relieve anxiety mood, reduce occurrence of nausea and vomiting and improve function of stomach and intestine to benefit postoperative recovery. However, the effect of in-pair sticking of auricular point with magnetic beads at front-back acupoints was not obviously strengthened.

Acupuncture, Ear ; Adult ; Aged ; Female ; Humans ; Laparoscopy ; Middle Aged ; Postoperative Nausea and Vomiting ; therapy ; Young Adult

OBJECTIVETo evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery during the early period after laparoscopic cholecystectomy and the dosage of anesthetic and analgesic.

METHODSOne hundred patients who received laparoscopic cholecystectomy with gradeⅠand Ⅱ of American Society of Anesthesiologists (ASA) criteria were randomly assigned into an observation group and a control group according to random number table, 50 cases in each group. The patients in the two groups were treated with conventional endotracheal intubation anesthesia, anesthesia induction and maintenance. The patients in the observation group were treated with TEAS (2 Hz/100 Hz, 8 to 12 mA) at bilateral Hegu (LI 4) and Neiguan (PC 6), as well as Zusanli (ST 36) and the non-acupoint 2 outboard from Zusanli (ST 36) from 30 min before anesthesia induction to the end of operation. The patients in the control group were applied by stimulation electrode in the corresponding points without electrical stimulation. The dosage of intraoperative remifentanil and the analgesic dosage of dezocine for postoperation were recorded. The recovery time, extubation time, the changes of heart rate (HR) and mean arterial pressure (MAP) during extubation were recorded. The quality of recovery was assessed by the quality of recovery-40 questionnaire (QoR-40) 1 day before surgery (T)，and 4 h (T), 8 h (T), 24 h (T), 48 h (T) after surgery. The patient's cognitive function was assessed by mini-mental state examination (MMSE) scale at the 5 time points. The incidences of postoperative nausea and vomiting were recorded at T through T.

RESULTSThe dosages of intraoperative remifentanil and dezocine in the observation group were less than those in the control group; the recovery time and extubation time were shorter than those in the control group; the HR of extubation was lower than that in the control group (all <0.05). There was no statistic difference about MAP between the two groups (>0.05). Compared with T, the total scores of QoR-40 decreased in the two groups at T, T, T (all <0.05), and the total scores in the observation group were higher than those in the control group (all <0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores at T in the observation group and at T, T, T in the control group were lower than those at T (all <0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores in the observation group were higher than those in the control group at T, T, T (all <0.05). Compared with T, the MMSE scores in the two groups decreased at T and T (all <0.05). At T, T, T, the MMSE scores in the observation group were higher than those in the control group (all <0.05). At T and T, the incidence rates of nausea and vomiting were 22.0% (11/50), 12.0% (6/50) respectively in the observation group, which were lower than 32.0% (16/50) and 24.0% (12/50) in the control group (both <0.05). At T and T, the incidence rates of nausea and vomiting were 6.0% (3/50), 2.0% (1/50) respectively in the observation group, which were not significantly different from 8.0% (4/50) and 4.0% (2/50) in the control group (both >0.05).

CONCLUSIONTEAS can improve the quality of recovery during the early period after laparoscopic cholecystectomy and reduce the dosage of anesthetic and analgesic.

Acupuncture Points ; Cholecystectomy, Laparoscopic ; adverse effects ; Humans ; Postoperative Nausea and Vomiting ; therapy ; Transcutaneous Electric Nerve Stimulation

OBJECTIVETo assess the impacts on postoperative nausea and vomiting of the patients with laparoscopic surgery undergoing the general anesthesia by electroacupuncture (EA) at different frequencies at bilateral Neiguan (PC 6).

METHODSOne hundred and twenty female patients with laparoscopic surgery undergoing the general anesthesia were randomized into 4 groups: 2 Hz EA treatment group (group A), 2 Hz/100 Hz EA treatment group (group B), 100 Hz EA treatment group (group C) and a control group (group D), 30 cases in each one. The same anesthetic program was adopted in each group. For the patients in A, B and C groups, in the first half a hour undergoing the conventional drug anesthesia, acupuncture was applied to bilateral Neiguan (PC 6). After arrival of qi, HANS-200A electroacupuncture apparatus was connected, at the frequency as 2 Hz, 2 Hz/100 Hz and 100 Hz separately. The electric stimulation was discontinued at the end of surgery. The life physical signs after surgery, the occurrence of postoperative nausea and vomiting and the severity grades of postoperative nausea and vomiting were observed and recorded for the patients in each group.

RESULTSThe differences in the postoperative 1 h heart rate, mean arterial pressure (MAP), finger pulse oxygen saturation and respiratory frequency were not significant statistically in comparison of the patients among groups (all P > 0.05). The incidence of postoperative nausea and vomiting of the patients in group B was lower apparently than that in A, C and D groups [10.0% (3/30) vs 30.0% (9/30), 36.7% (11/30), 53.3% (16/30), all P < 0.01]. The severity of postoperative nausea and vomiting of the patients in group B was lower apparently than that in the rest three groups (all P < 0.01).

CONCLUSIONThe electroacupuncture at 2 Hz/100 Hz reduces effectively the incidence and the severity of postopera tive nausea and vomiting of the patients with laparoscopic surgery undergoing the general anesthesia.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Postoperative Nausea and Vomiting ; therapy ; Vomiting ; etiology ; therapy ; Young Adult

BACKGROUND: Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief. OBJECTIVE: This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room. OUTCOMES AND MEASURES: Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy. RESULTS: The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy. CONCLUSION Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.
Male ; Humans ; Ankle ; Wrist ; Duration of Therapy ; Thyroidectomy ; Postoperative Nausea and Vomiting/drug therapy* ; Acupuncture Therapy ; Analgesics/therapeutic use* ; Pain/drug therapy*