Acupuncture as a Complementary Treatment Modality in the Post-Anesthesia Care Setting: A Feasibility Study.

Introduction: Postoperative pain management and postoperative nausea and vomiting are a persistent challenge for both health care providers and patients. Acupuncture is an effective and safe modality for the management of pain and nausea, and has the potential to play a key role in postoperative pain management. This study explores the utility and feasibility of acupuncture in the immediate postoperative setting. Methods: In a retrospective case-control study, 22 patients who underwent elective surgeries and received acupuncture in the post-anesthesia care unit (PACU) were compared with 88 case controls. Indications for acupuncture therapy included persistent pain, nausea, or anxiety. Patient satisfaction and symptom improvement after acupuncture were assessed. PACU nurses and patients were queried on their perspectives on using this therapy. Demographic data, perioperative opioid consumption, pain score in the PACU, incidence of postoperative nausea, PACU length of stay, and unintended hospital admission were assessed. The groups with/without acupuncture were compared using Wilcoxon rank sum test or Fisher's exact test as appropriate. Results: A total of 78.9% of patients receiving acupuncture felt improvement in their symptoms. 94.7% of recovery nurses who cared for patients who received acupuncture felt that it was helpful and 78.9% did not believe it was disruptive. Patients who opted for acupuncture had a statistically significant higher overall median (interquartile range) pain score in the PACU (7.0 [5.2, 9.5] vs. 5.0 [3.0, 7.0], p = 0.009) and higher postoperative opioid consumption (22.5 [9.8, 44.8] vs. 15.0 [0.0, 30.0], p = 0. 03). There was no difference between total perioperative opioid consumption between groups (p = 0.94). Conclusions: Most patients who received acupuncture therapy in the PACU were satisfied with their therapy and would recommend it to future patients undergoing surgery. Most recovery nurses felt it was helpful, was not disruptive, and would like to see it utilized in the PACU.

Research trends of acupuncture therapy on postoperative nausea and vomiting from 2011 to 2023: A bibliometric analysis.

BACKGROUND: The utilization of acupuncture as a therapeutic intervention for the management of postoperative nausea and vomiting has experienced a notable increase in its popularity, and the purpose of this analysis is to provide a comprehensive understanding of the level of concern within the academic discipline and the main contributors and their partnership, as well as to identify research focal points and trends. METHODS: A comprehensive search was carried out to identify relevant articles on the topic of acupuncture therapy for PONV in the Web of Science and China National Knowledge Internet. The search spanned from January 1, 2011, to June 6, 2023. The annual publications were count to see the degree of scholarly attention devoted to the discipline and how it has changed over time. A statistical analysis of article distribution across various journals was conducted to serve a rough indicator for assessing the quality of articles. And a bibliometric analysis was conducted using the software CiteSpace to visually analyze various aspects of the literature. Analyze authors, institutions and countries to identify the main contributors and their collaborative relationship; and analyze keywords and references to explore research hotspots and trends. RESULTS: This study examined a comprehensive collection of 819 articles focused on acupuncture therapy for PONV, demonstrating a varying upward trend in the quantity of publications. Notably, the most productive author and institution were identified as Zheng Man and Guangzhou University of Traditional Chinese Medicine, respectively. While China had the highest number of publications, the United States held a greater prominence in this specific field. Collaboration among contributors was found to be weak. High-frequency keywords in the publications included "transcutaneous electrical acupoint stimulation," "electroacupuncture," "pain," and so forth. The literature with the highest citation count pertained to "Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting," while the article with the highest centrality was "Consensus Guidelines for the Management of Postoperative Nausea and Vomiting." Several large clusters obtained from the references are also included "postoperative pain," "transcutaneous electrical acupoint stimulation". Nothing pertaining to mechanism study was found in the analysis results. CONCLUSION: The utilization of acupuncture for the treatment of postoperative nausea and vomiting has been gaining increasing recognition, although there remains room for improvement in the quality of research conducted in this area. Chinese authors and institutions have emerged as significant contributors to this field, while the United States has demonstrated greater proficiency in fostering collaborative efforts. It is imperative to enhance collaboration among these contributors. The current focal points of acupuncture for PONV encompass pain management, electroacupuncture, auricular acupuncture, and transcutaneous electrical acupoint stimulation. Additionally, TEA and enhanced recovery after surgery have been identified as the forefronts of research in this particular domain. In addition, there is still much room for research in the aspect of mechanism and insurance coverage. This study provides an in-depth perspective on acupuncture for PONV, which offers reference material for clinicians with rational choice of therapeutic scheme, educators with hot topics, and researchers with valuable research directions.

The effect of lemon inhalation aromatherapy on pain, nausea, as well as vomiting and neurovascular assessment in patients for lower extremity fracture surgery: a randomized trial.

BACKGROUND: Complementary and integrative medicine may be effective for postoperative outcomes. This study aimed to determine the effect of lemon inhalation aromatherapy on pain, nausea, and vomiting and neurovascular assessment in patients for lower extremity fracture surgery. METHODS: This is a randomized clinical trial study. Ninety patients who had undergone lower extremity fracture surgery were randomly assigned to the intervention (lemon aromatherapy) and control groups. Lemon aromatherapy was started in the morning of the surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Numerical pain and nausea and vomiting scales, the Rhodes Index of Nausea, Vomiting, and Retching, and the WACHS Neurovascular Observation Chart were used to assess the outcomes before and after the intervention (in the recovery room and 4, 8, 12, and 16 h post-surgery). The data were analyzed using the Wilcoxon test, ANCOVA, and Repeated Measure ANCOVA. RESULTS: A significant difference was observed between the groups in terms of the intensity of pain (P < 0.001) and nausea and vomiting (P = 0.001) during the study period. Moreover, a significant difference was found between groups as to the frequency and severity of nausea, vomiting, and retching. The amount and duration of postoperative vomiting and nausea were significantly lower in the intervention group compared to the control group. In addition, lemon inhalation aromatherapy decreased the frequency of anti-emetic drug administration in the recovery room (P = 0.04) and 16 h post-surgery (P = 0.03). CONCLUSIONS: This study indicated that aromatherapy reduced pain intensity, postoperative nausea, vomiting, and retching, as well as the incidence of anti-emetic drug administration. Therefore, using lemon inhalation aromatherapy to relieve pain and reduce nausea and vomiting is suggested for lower extremity fracture patients who have undergone surgery. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trail (Number = 57,331, IRCT20130616013690N10, approved 24/07/2021) ( https://www.irct.ir/trial/57331 ).

The Effects of Acupressure on Nausea, Vomiting, and Vital Signs in Patients Undergoing Gynecologic Surgery: A Randomized Controlled Trial.

PURPOSE: This randomized controlled experimental study was conducted to determine the effect of acupressure on nausea, vomiting, and vital signs in patients undergoing gynecologic surgery. DESIGN: A randomized controlled experimental study. METHODS: Study participants consisted of females aged 18 to 65 years who underwent surgery in the gynecology clinic of the related hospital between October 2016 and March 2017. The sample originally consisted of 111 patients: K-K9 group (n = 39), P6 group (n = 37), and control group (n = 35). The point P6 in both wrists was determined, and the patients in that group wore a wristband 1 hour before the operation. The point K-K9 in both hands was determined, and one Black Pepper Seed was fixed on the point with the help of a plaster almost 1 hour before the operation. Once the wristband and the seed were placed, they remained in place for 24 hours. The control group received routine care, with no application of acupressure devices. FINDINGS: Final sample number was 103 after six were lost to follow-up. Vital signs of the patients showed a difference between the intervention groups and control group after the surgical procedure. The pulse values varied at statistically significant levels according to groups in the first and second measurements. The respiratory values of the K-K9 and P6 groups were statistically lower than those in the control group in the first, second, fourth, and fifth measurements (P < .05). The first measurement of nausea scores varied statistically according to the groups. The K-K9 group nausea scores were statistically lower than those in the control group (P < .05). At the time of the first measurement, the number of those who retched in the P6 group was statistically higher than those in the K-K9 group (P < .05). CONCLUSIONS: We examined the effect of two types of acupressure in the management of postoperative nausea and vomiting in the first 24 hours after gynecologic surgeries. Although some findings of ours did not show a statistically significant difference, these alternative therapies showed promise.

[Transcutaneous electrical acupoint stimulation relieves post-operative nausea and vomiting possibly by reducing serum motilin secretion in patients undergoing laparoscopic surgery].

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) of different acupoint combinations on postoperative nausea and vomiting (PONV) and serum motilin (MTL) content in patients undergoing laparoscopic surgery, so as to provide evidence for clinical selection of suitable acupoint compatibility. METHODS: A total of 140 patients undergoing elective laparoscopic surgery were randomly divided into general anesthesia (GA) control, TG2 ［Neiguan (PC6) + Hegu (LI4)］, TG3 ［PC6 + LI4 + Zusanli (ST36)］, and TG4 ［PC6 + LI4 + ST36 + Sanyinjiao (SP6)］ groups, with 35 cases in each group. Patients of the TG2, TG3 and TG4 groups received TEAS (2 Hz/100 Hz, 3-8 mA) of the above mentioned acupoint (bilateral) groups for 30 min before the induction of anesthesia until the end of the operation. Patients of the GA control group received intravenous injection of Midazolam, Sufentanil, Propofol, Rocuronium Bromide, etc. The blood sample (4 mL) from the right median cubital vein was collected at the time of patient's entry, 12 and 24 h after surgery, respectively, for measuring MTL concentration by enzyme-linked immunosorbent assay. The incidence of early and late PONV and changes of PONV degree within 24 h after surgery were recorded. RESULTS: The serum MTL concentrations were significantly decreased at 12 h after surgery in all the 4 groups (P<0.05), and decreased at 24 h after surgery in GA and TG2 groups vs their own pre-surgery (P < 0.05), and considerably higher at both 12 and 24 h after surgery in the TG2, TG3 and TG4 groups than in the GA control group (P<0.05), and also evidently higher in the TG3 and TG4 groups than in the TG2 group (P<0.05). The incidence of PONV was significantly lower in the TG2, TG3 and TG4 groups than in the GA control group in the early and late periods (except TG2 group) of surgery (P<0.05). The number of patients with PONV grade Ⅰ was significantly larger in the TG2, TG3 and TG4 groups than in the GA control group at 24 h after surgery (P<0.05), suggesting a mild PONV in more patients undergoing TEAS. CONCLUSION: TEAS has a preventive effect on PONV in patients undergoing laparoscopic surgery, which may be related to its effect in reducing serum MTL concentration. The preventive effect of TEAS of PC6 + LI4 + ST36 and PC6 +LI4 + ST36 + SP6 is similar and better than TG2 (two acupoints) group.

Acupuncture PC6 for postoperative nausea and vomiting at different times: A protocol for systematic review and meta analysis.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a condition that commonly following anesthesia and surgery, antiemetics can lead to some side effects in treating PONV. Acupuncture PC6(Neiguan) has been widely used in the prevention and treatment of postoperative nausea and vomiting. However, there still exists controversy towards its effectiveness, appropriate, and effective intervention time. We, therefore, design this meta-analysis to assess the effectiveness and confirm the optimal time of acupuncture PC6 point for PONV. METHODS: The following electronic databases will be searched from their inception to April 2020, including PubMed, Cochrane Library, EMBASE, Web of Science, WHO International Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure, WanFang Database, Chinese Biomedical Literature Database, the Chongqing VIP Chinese Science, and Technology Periodical Database. All randomized controlled trials in English or Chinese involving acupuncture PC6 for patients with PONV will be included. Two reviewers will independently responsible for the data extraction, study selection, risk of bias assessment and assessment of study quality. The primary outcome was the number of postoperative nausea, postoperative vomiting and PONV during 0 to 6 hours and after 6 hours of the postoperatively. The secondary outcome is the number of people with side effects and the use of rescue therapy. The meta-analysis will be conducted using RevMan V.5.3.5 statistical software. RESULTS: This systematic review will evaluate the efficacy and appropriateness time of acupuncture PC6 in the treatment of PONV. CONCLUSION: This study will provide high-quality current evidence of the effectiveness and optimal time of acupuncture PC6 point for the patient with PONV. ETHICS AND DISSEMINATION: Ethical approval is not required; this review will not involve individuals' information. The results will be published in a peer-reviewed publication or disseminated in relevant conferences. INPLASY REGISTRATION NUMBER: DOI 10.37766/inplasy2020.4.0012.

Acupuncture therapy on postoperative nausea and vomiting in abdominal operation: A Bayesian network meta analysis.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after surgery. However, drugs cannot prevent it completely, and acupuncture therapy shows the potential in preventing PONV, yet the best choice hasn't been demonstrated. OBJECTIVE: This network meta analysis aimed to evaluate the effectiveness of different acupuncture therapies used for preventing PONV in abdominal operation. METHODS: Authors searched articles from PubMed/Medline, Cochrane library, Web of Science, Ebsco and Ovid/Embase, and established database from setup time to June 2019. Quality evaluation of included studies was performed with Cochrane risk-of-bias tool (ROB 2.0). Pairwise and network meta analysis were conducted by RevMan and Addis respectively. RESULTS: Twenty studies with 2862 patients were included in this research. Pairwise meta analysis shows that compared with placebo, transcutaneous electric nerve stimulation had lower risk of postoperative nausea (PON) (odds ratio (OR) = 0.42, 95%confidence interval (CI): 0.30-0.60), postoperative vomiting (POV) (OR = 0.53, 95%CI: 0.36-0.78), PONVs (OR = 0.46, 95%CI: 0.31-0.68), and postoperative rescue (POR) (OR = 0.61, 95%CI: 0.41-0.90), Capsicum had lower risk of PON (OR = 0.16, 95%CI: 0.09-0.28), PONVs (OR = 0.23, 95%CI: 0.12-0.45), Acupressure had lower risk of POV (OR = 0.42, 95%CI: 0.25-0.70), POR (OR = 0.42, 95%CI: 0.27-0.64). In network meta analysis, compared with usual care, the probability rank suggested that Acupoint Injection showed lowest risk of PON (OR = 0.02, 95%CI: 0.00-0.11), POV (OR = 0.06, 95%CI: 0.01-0.49), Usual care for PONVs (OR = 0.31, 95%CI: 0.13-0.75), and Capsicum for POR (OR = 0.39, 95%CI: 0.07-2.33). Further study should be carried out to verify this result. CONCLUSION: Both pairwise and network meta analysis showed acupuncture therapy was superior to placebo and usual care. Different acupuncture therapy regimens may have advantages in different aspects. And compared with POV, PON seems easier to control. Research results may provide guidance for the prevention of PONV.Systematic review registration: PROSPERO CRD42019147556.

Effect of Electroacupuncture on Postoperative Gastrointestinal Recovery in Patients Undergoing Thoracoscopic Surgery: A Feasibility Study.

BACKGROUND The aim of this study was to study the feasibility and acceptability of electroacupuncture (EA) for preventing postoperative gastrointestinal complications in patients undergoing thoracoscopic segmentectomy/lobectomy. MATERIAL AND METHODS Sixty patients who underwent video-assisted thoracoscopic (VATS) segmentectomy/lobectomy received either EA treatments plus usual care (EA group) or usual care alone (UC group). Patients in the EA group were given 30 minutes of bilateral electroacupuncture on 3 acupoints [Neiguan (PC6), Zusanli (ST36), and Shangjuxu (ST37)] at 3 time points (24 hours before surgery, and 4 hours and 24 hours after surgery). The primary outcomes were recruitment, retention, acceptability of the EA intervention, incidence and severity of abdominal distension (AD), and time to first flatus and defecation. Secondary outcomes included postoperative nausea and vomiting (PONV), pain intensity, and duration of hospital stay. RESULTS We recruited 60 participants and 59 were randomized into 2 groups for this study: 30 in the EA group and 29 in the UC group. In total, 57 participants completed the study. With the exception of one participant in the EA group, all participants completed all three sessions of EA. The one exclusion was a case where a paravertebral block was not used during the surgery. Qualitative findings from the acceptability questionnaire indicated that participants viewed the EA treatment as acceptable. After EA treatment, there was a small but statistically significant improvement in participants' acceptance of EA for alleviating postoperative gastrointestinal discomfort (P=0.001). The EA group showed improved outcomes compared to the UC group in terms of time to first flatus (20.8±4.6 versus 24.1±6.2 hours, P=0.026) and defecation (53.9±6.0 versus 57.5±7.2 hours, P=0.046). No significant differences appeared regarding AD, rescue medication, or duration of hospitalization. PONV and pain intensity were similar in both groups at the recorded time periods. CONCLUSIONS EA is feasible and acceptable to patients undergoing VATS surgery. Our preliminary findings of EA promoting postoperative recovery of gastrointestinal function warrants large randomized controlled trials.

Intraoperative Multipoint Acupuncture for Reducing Postoperative Nausea and Vomiting in High-Risk Children: A Case Series.

Acupuncture studies have demonstrated varying effects on pediatric postoperative nausea and vomiting (PONV). Unanswered questions include whether the type of therapy, number of points used, or timing of treatments vary the effect of acupuncture. We present a case series of intraoperative multipoint acupuncture treatments for high-risk pediatric patients. Fourteen patients were included, and 19 treatments were provided. Twelve patients (85.7%) had previous PONV. Patients who received intraoperative acupunctur e reported no early phase PONV, and 3 patients (15.8%) reported late-phase PONV. One patient required postoperative antiemetics. Intraoperative multipoint acupuncture may be a safe and efficacious adjunct for PONV in high-risk pediatric patients.

Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting.

Introduction: Postoperative nausea and vomiting (PONV) are frequent in patients undergoing laparoscopic cholecystectomy. The aim of this study is to evaluate the effectiveness of intraoperative laser acupuncture stimulation of Pericardium 6 (PC6) and Large Intestine 4 (LI4) acupoints combined with antiemetic drug prophylaxis on PONV. Methods: A total of 88 patients, scheduled for laparoscopic cholecystectomy, were assigned into 2 groups. Group I received bilateral laser acupuncture on PC6 and LI4 acupoints after induction of anesthesia and also received antiemetic drug (metoclopramide) prophylaxis. Patients in Group II received only antiemetic drug prophylaxis. Nausea and vomiting frequencies and need for rescue antiemetic drug (ondansetron) were recorded after extubation, at 30th minute at recovery room and at 6th hour at ward. Results: The incidence of nausea and rescue antiemetic drug need was higher at postoperative 6th hour in Group II. Vomiting was not different in groups at any time. Conclusion: Intraoperative laser acupuncture stimulation of PC6 and LI4 acupoints combined with antiemetic drug prophylaxis decreases nausea and rescue antiemetic drug need in late postoperative period in patients undergoing laparoscopic cholecystectomy.

[Effect of intravenous granisetron combined and acupuncture point injection at PC6(Neiguan) with 0.9% sodium chlorideon postoperative nausea and vomiting after gynecological laparoscopy].

Objective: To observe the effects of intravenous granisetron and acupuncture point injection at PC6(Neiguan) with 0.9% sodium chloride on postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery. Methods: Qualified cases were collected according to prospective randomized controlled clinical trial design. 94 cases patients undergoing gynecological laparoscopic surgery without postoperative intravenous analgesia were selected from February 2017 to November 2018 in Beijing Aerospace General Hospital and The Affiliated Hangzhou Hospital of Nanjing Medical University. The patients were randomly divided into three groups: bilateral PC6 sham injection of 0.9% sodium chloride+ intravenous granisetron(group A, n=31); bilateral acupuncture point injection at PC6 of 0.9% sodium chloride+ intravenous 0.9% sodium chloride(group B, n=33); bilateral acupuncture point injection at PC6 of 0.9% sodium chloride+ intravenous granisetron(group C, n=30). The indexes including age, body mass index(BMI), type of surgery, surgery time, anesthesia time, liquid intake and output volume, the time from the completion of the operation to the removal of the tracheal catheter, the time from the completion to follow the instruction, respiratory depression, restlessness, arrhythmias and other adverse reactions during anesthesia recovery were recorded. Evaluated the nausea and vomiting according to the visual analogue scales (nausea visual analog scale, NVAS) 12 hours after the operation. Not only the dose and the related frequency of antiemetic drugs for rescue, but also the time of the first anal exsufflation and the pain 24 hours after the operation were recorded. Detected the concentration of motilin (MTL), when the operation started/awake after extubation/12 hours after the operation Results: The incidence of nausea and vomiting 12 hours after the operation in group A, B and C was 35.5%, 33.3%, 10.0%. The difference was statistically significant (χ(2)=0.654, P<0.05). The motilin after 12 hours of operation in group A, B and C was (564±76),(559±84),(472±69) ng/L. The difference was statistically significant (F=14.033, P<0.05). The incidence of nausea and vomiting and the motilin after 12 hours of operation in group C were lower than group A and B. The time for the first anal exsufflation in group A, B and C was (19±8),(19±7),(14±8)h.The difference was statistically significant (F=4.523, P<0.05). The time for the first anal exsufflation in group C was earlier than group A and B. Conclusion: Either intravenous granisetron or acupuncture point injection at PC6 of 0.9% sodium chloride can effectively reduce the incidence of postoperative nausea and vomiting after gynecological laparoscopic surgery. Intravenous granisetron combined with acupuncture point injection at PC6 of 0.9% sodium chloride has better effect and promotes the first anal exsufflation time, which is conducive to the rapid postoperative recovery of patients.

Parents' experiences of an inpatient pediatric integrative medicine service for symptom management.

BACKGROUND: Pediatric integrative medicine (PIM) refers to the combination of treatments from conventional medicine and complementary therapies for which there is evidence of safety and effectiveness. As pediatric use of complementary therapies increases, it is important to determine parental views on the use of these therapies by their children. OBJECTIVE: To describe parental experiences with a PIM service for management of pain, nausea/vomiting and anxiety in the context of an inpatient pediatric cardiology unit. DESIGN: Telephone interviews were carried out with the parents of pediatric cardiology inpatients. The interviews focused on their and their child's experiences with the PIM service while in the hospital. Interviews were transcribed, and analyzed using qualitative content analysis. RESULTS: Data saturation was reached after nine interviews conducted during the period between June 2015 and January 2016. Parents self-reported that the PIM service was particularly helpful at alleviating symptoms of anxiety in their children. Moreover, because their children were more at ease, parents also felt less anxiety. CONCLUSION: Pediatric integrative medicine as an adjunct to conventional care is seen as beneficial by parents of children admitted to a pediatric cardiology unit.

Acupressure the PC6 point for alleviating postoperative nausea and vomiting: A systematic review protocol.

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications following surgery and anesthesia, conventional drugs can carry some side effect in treating PONV. Acupressure PC6 point has been widely used in clinical, but there still exist controversy towards its effectiveness and safety. We, therefore, design this study to systematically assess the effectiveness and safety of acupressure PC6 point for treating PONV. METHODS AND ANALYSIS: Nine online databases will be searched from their inception to May 2019. We will include randomized controlled trials (RCTs) involving patients with PONV and receiving acupressure PC6 point treatment. Two independent reviewers will be responsible for the selection of studies, data extraction and risk of bias assessment. RevMan V.5.3 software will be used for data synthesis with either a fixed effects model or random effects model depending on the heterogeneity test. Evidence quality will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation system (GRADE). The primary outcome is incidence of postoperative nausea (PON), postoperative vomiting (POV) and PONV events during 0 to 6 hours and after 6 hours of the treatment. The secondary outcome is the number of people who use emergency drugs and the number of people with adverse reactions. A meta-analysis will be conducted if no considerable heterogeneity is detected. The results will be presented as risk ratios with 95% confidence interval (CIs) for dichotomous data and weighted mean differences or standardized mean differences with 95% CIs for continuous data. RESULTS: This study will provide a high-quality evidence to assess the effectiveness and safety of acupressure PC6 point for patient with PONV. CONCLUSION: This review will provide up-date evidence of whether acupressure of PC6 point is an effective and safe intervention for PONV. PROSPERO registration number: CRD42019135598.

The effects of listening to music on the postoperative nausea and vomiting.

AIM: To determine the effect of music on the severity of postoperative nausea and vomiting after the laparoscopic cholecystectomy. METHODS: This study was a randomized, controlled clinical study. The subjects were randomly divided into two groups (intervention group and control group). The numerical scale of nausea was used in rating the nausea complaints of the patients and the vomiting incidence assessment form in determining the incidence of vomiting. RESULTS: There were statistically significant difference between the groups in terms of the severity of nausea complaint (W = 110.826 p < 0.001). When compared to the control group, the vomiting incidence of the patients was statistically significantly lower in intervention group. CONCLUSIONS: This study demonstrated that listening to music decreased the severity nausea and the incidence of vomiting in the postoperative period.

[The curative effect observation of different frequency of TEAS combined with wristband pressing on Neiguan (PC 6) for nausea and vomiting after laparoscopic cholecystectomy].

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 P<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 P<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 P<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.

Effect of Classic Foot Massage on Vital Signs, Pain, and Nausea/Vomiting Symptoms After Laparoscopic Cholecystectomy.

This semiexperimental study on the effects of foot massage recruited 88 patients who underwent laparoscopic cholecystectomy at the general surgery clinics of our hospital in Turkey (June 2017 to May 2018). Patients were assigned to either the intervention group (n=44, 10 min of classic foot massage) or the control group (n=44, no intervention). Pretest assessment, intervention, and posttest assessment were conducted within 1 to 6 hours postoperatively. Outcome measures included vital signs, pain, and nausea/vomiting symptoms. The intervention was associated with a significant decrease in pain scores and incidence of nausea. Despite being associated with an increase in body temperature, the intervention was also associated with a decrease in systolic blood pressure without increasing diastolic blood pressure or respiratory rate, suggesting a positive effect on blood circulation. Classic foot massage may serve as an affordable and useful way to help improve pain, nausea, and blood circulation after laparoscopic cholecystectomy.

Placebo by proxy expectations toward acupuncture change over time: a survey comparing parental expectations to acupuncture pre- and postoperatively.

BACKGROUND: Patients entering a treatment have expectancy to outcome based on their previous experience, the information received, and the credibility of the treatment. Once the treatment has started, patients may detect and interpret contextual cues and somatic state. Influenced and conditioned by positive or negative interpretations, their reappraisal may improve or worsen the treatment outcome. The aims were to investigate whether parental pre-treatment expectancies towards acupuncture differ compared to post-treatment expectancies, and assess predictors for possible change of parental expectancy. Further, we wanted to explore whether the change correlates with the treatment outcome, i.e. postoperative vomiting in children. METHODS: Two hundred and eighty-two parents completed per- and 24 h postoperatively a survey on their expectancy to acupuncture treatment for alleviation of postoperative vomiting in children. The survey was embedded in a randomised controlled trial. RESULTS: Parental expectancy to acupuncture treatment changed over time. The changes were predicted by several variables such as children's gender, parents' age and education, previous experiences, and assignment to treatment group. The strongest predictor was parental anxiety to their child undergoing surgery. Further, the change of parental expectancy was correlated with postoperative vomiting. CONCLUSIONS: Anxious parents are prone to change their expectancy in a positive direction during the treatment period, which in turn may improve treatment outcome. Acupuncture therapists in clinical practice should pay a special attention to the potential that lies here, and acknowledge parental anxiety as a possible facilitator, and not a barrier, to elicit placebo by proxy effects. Further research to expand the findings of the present study into other treatments is in order. Future research should also provide more knowledge about how parental expectancy changes over time, and how different factors predict and produce change of parental expectancy. TRIAL REGISTRATION: ClinicalTrials.gov NCT01729052 . Registered November 20, 2012.

Treating pediatric post-tonsillectomy pain and nausea with complementary and alternative medicine.

OBJECTIVES: Although tonsillectomy is a common and largely safe procedure, pain management in children remains a controversial topic. In addition to the challenge of choosing appropriate analgesia, there is often low parent and child adherence. This article presents a review, and evaluates the potential role, of a range of complementary and alternative therapies that may be sought out by parents. METHODS: A literature review of complementary and alternative interventions performed using PubMed, Cochrane Library, and EMBASE, supplemented by searches from Google and hand searches of cross-references of selected articles, yielded 32 studies for qualitative analysis. RESULTS: The studies included for analysis investigated a wide variety of alternative treatment modalities: acupuncture and related therapies, aromatherapy, homeopathy, honey, intravenous fluid, speech therapy, hyaluronic acid, behavioral therapies, ice/cold, hydrogen peroxide rinse, and chewing gum. CONCLUSION: At this time, stronger conclusions cannot be made about the therapies investigated because there are many methodology limitations of the studies analyzed. However, our results suggest merit for these treatments as adjuvant therapies that can enhance analgesia and decrease requirements of controversial medications. Honey and acupuncture have the greatest amount of evidence for postoperative pain and nausea; however, all interventions examined were cost-effective and safe. We recommend against hydrogen peroxide rinses and chewing gum. Laryngoscope, 2625-2634, 2018.

[Effects of transcutaneous electrical acupoint stimulation on quality of recovery during early period after laparoscopic cholecystectomy].

OBJECTIVE: To 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. METHODS: One 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 cun 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 (T0)，and 4 h (T1), 8 h (T2), 24 h (T3), 48 h (T4) 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 T1 through T4. RESULTS: The 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 P<0.05). There was no statistic difference about MAP between the two groups (P>0.05). Compared with T0, the total scores of QoR-40 decreased in the two groups at T1, T2, T3 (all P<0.05), and the total scores in the observation group were higher than those in the control group (all P<0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores at T1 in the observation group and at T1, T2, T3 in the control group were lower than those at T0 (all P<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 T1, T2, T3 (all P<0.05). Compared with T0, the MMSE scores in the two groups decreased at T1 and T2 (all P<0.05). At T1, T2, T3, the MMSE scores in the observation group were higher than those in the control group (all P<0.05). At T1 and T2, 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 P<0.05). At T3 and T4, 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 P>0.05). CONCLUSION: TEAS can improve the quality of recovery during the early period after laparoscopic cholecystectomy and reduce the dosage of anesthetic and analgesic.

Aromatherapy for treatment of postoperative nausea and vomiting.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common, unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as an addition to the available treatment strategies. This review was originally published in 2012 and updated in 2017. OBJECTIVES: The main objective was to establish the efficacy and safety of aromatherapy comparable to standard pharmacological treatments for PONV in adults and children. SEARCH METHODS: We searched CENTRAL; MEDLINE; Embase; CINAHL; CAM on PubMed; Informit; LILACS; and ISI Web of Science as well as grey literature sources and the reference lists of retrieved articles up to March 2017. The original search was performed in August 2011. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) where aromatherapy was used to treat PONV. Interventions were all types of aromatherapy compared to placebo or with standard antiemetics. Primary outcomes were severity and duration of PONV. Secondary outcomes were adverse reactions, use of rescue antiemetics and patient satisfaction. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias in the included studies and extracted data. For dichotomous outcome variables, we used a random-effects model and calculated risk ratio (RR) with associated 95% confidence interval (95% CI). For continuous outcome variables, we used a random-effects model and calculated standardized mean difference (SMD) with associated 95% CI. We used the GRADE software to compile 'Summary of findings' tables. MAIN RESULTS: We included seven new studies with 663 participants in the 2017 update; five RCTs and two CCTs. These were added to the nine previously included studies (six RCTs and three CCTs with a total of 373 participants) for a total of 16 included studies and 1036 participants in this updated review. The mean age and range data for all participants were not reported for all studies. We identified two registered trials that met the inclusion criteria for this review; however there are no results for these studies yet.Overall, the GRADE assessment of evidence quality ranged from moderate to very low. The method of randomization in 11 of the 12 included RCTs was explicitly stated and adequate. Incomplete or methodologically diverse reporting of data affected the completeness of the analysis. Data on additional aromatherapies were added in the 2017 update (blended aromatherapy products, and peppermint products). Heterogeneity of outcome measures and time points between studies affected the completeness of the analysis.In the summary of the findings of six studies, we did not find aromatherapy to be effective in reducing nausea severity in comparison to placebo (SMD -0.22, 95% CI -0.63 to 0.18, P value = 0.28, 241 participants, level of evidence: low). Those participants receiving aromatherapy were no more likely to be free of nausea at the end of the treatment period than those receiving placebo (RR 3.25, 95% CI 0.31 to 34.33, P value = 0.33, 4 trials, 193 participants, evidence level: very low), however they were less likely to require rescue antiemetics (RR 0.60, 95% CI 0.37 to 0.97, P value = 0.04, 7 trials, 609 participants, evidence level: low). There were no data reported on adverse events or patient satisfaction for this comparison.A specific comparison of peppermint aromatherapy to placebo did not show evidence of an effect on nausea severity at five minutes post-treatment in the pooled results (SMD -0.18, 95% CI -0.86 to 0.49, P value = 0.59, 4 trials, 115 participants, evidence level: low). There were no data reported on nausea duration, use of rescue antiemetics, adverse events or patient satisfaction for this comparison.When we pooled studies comparing isopropyl alcohol to standard antiemetic treatment in a GRADE summary of findings, in terms of nausea duration, there was a significant effect on the time in minutes to a 50% reduction in nausea scores (SMD -1.10, 95% CI -1.43 to -0.78, P value < 0.00001, 3 trials, 176 participants, evidence level: moderate). Fewer participants who received isopropyl alcohol required rescue antiemetics (RR 0.67, 95% CI 0.46 to 0.98, P value = 0.04, 215 participants, 4 trials, evidence level: moderate). Two studies with 172 participants measured patient satisfaction; there were high levels of satisfaction across both aromatherapy and standard treatment groups and no differences found (evidence level: low). There were no data reported on nausea severity or adverse events for this comparison.There was no difference in effectiveness between isopropyl alcohol vapour inhalation and placebo for reducing the proportion of participants requiring rescue antiemetics (RR 0.39, 95% CI 0.12 to 1.24, P value = 0.11, 291 participants, 4 trials, evidence level: very low). There were no data reported on nausea severity, nausea duration, adverse events or patient satisfaction for this comparison. AUTHORS' CONCLUSIONS: Overall, for nausea severity at the end of treatment, aromatherapy may have similar effectiveness to placebo and similar numbers of participants were nausea-free. However, this finding is based on low-quality evidence and therefore very uncertain. Low-quality evidence also suggests that participants who received aromatherapy may need fewer antiemetic medications, but again, this is uncertain. Participants receiving either aromatherapy or antiemetic medications may report similar levels of satisfaction with their treatment, according to low-quality evidence.