Acupressure Versus Ondansetron Usage for Postoperative Nausea and Vomiting After Gynecologic Surgeries.

Abstract

Introduction Anti-emetic interventions include pharmacologic and non-pharmacologic strategies. Acupressure is a non-pharmacologic and non-invasive therapeutic method that involves applying physical pressure to acupuncture points with fingers or devices. The pericardium (PC6) acupoint is located on the palm side of the wrist between the palmaris longus and flexor carpi radialis tendons, three fingers across the wrist starting at the wrist crease. Our first aim was to assess the effect of PC6 point acupressure on PONV after gynecological surgeries compared to intravenous (IV) ondansetron. Secondly, we aimed to assess the factors associated with the firstand second hours (early) postoperative nausea scores. Methods This was a prospective, randomized, and single-centered intervention study conducted between November 1, 2022, and December 31, 2022, in a tertiary care hospital. Sancaktepe Martyr Prof. Dr. Ilhan Varank Education and Research Hospital Ethical Committee provided ethical approval for this study on October 14, 2022 (No: E-46059653-020). Randomization was done using the lottery method.Patients, who were over the age of 18with an American Society of Anesthesiologists (ASA) physical score of I, II, or III status and had undergone gynecologic surgery under general anesthesia, were included. Patients, who were ASAIV, under continuous use of opioids or corticoids, underwent surgery with regional anesthesia, or declined to participate in the study, were excluded.There were two comparisons in this study. First, we divided patients into two groups according to anti-emetic prevention. Patients, who received IV 4 mg ondansetron (Group O), and patients, who placed acupressure bands at the P6 points on both forearms (Group B). The second comparison was done to assess the factors associated with early postoperative nausea. Patients were divided into two groups according to the mean early postoperative nausea scores as low (< 4, Group 1) and high/moderate (≥ 4, Group 2).PONV and pain scores were collected at five-time points: the first, second, sixth, twelfth, and twenty-fourth hours after surgery. Results Of 102 patients, 50were in Group O and 52were in Group B. There was no significant difference in postoperative pain, nausea, and vomiting scores. Fifty patients (50%), including 24 patients (48%) in Group O and 26 patients (52%) in Group B, experienced early moderate/high postoperative nausea in our study. According to the second comparison, 52 patients were in Group 1, and 50 patients were in Group 2. Operation time; first and second-hour pain scores; first, second, sixth, twelfth, and twenty-fourth-hourscores; and first and second-hour vomiting scores were all significantly different across groups. Conclusion The effect of PC6 point acupressure on early PONV compared to IV ondansetron was similar after gynecological surgeries. However, using only one anti-emetic treatment did not adequately relieve early PONV. Of all patients, 11(10%) required an extra anti-emetic medication at the ward. 50% of patients experienced early moderate/high postoperative nausea in our study. Motion sickness history, operation time, and early postoperative pain scores were associated with early PONV.