Evaluation of capsaicin ointment at the Korean hand acupressure point K‐D2 for prevention of postoperative nausea and vomiting Prevention of PONV by acustimulation with capsicum plaster is comparable to ondansetron after middle ear surgery The Efficacy of P6 Acupressure With Sea-Band in Reducing Postoperative Nausea and Vomiting in Patients Undergoing Craniotomy: A Randomized, Double-blinded, Placebo-controlled Study P6 acupoint stimulation for prevention of postoperative nausea and vomiting in patients undergoing craniotomy: study protocol for a randomized controlled trial The safety and efficacy of prophylactic ondansetron in patients undergoing modified radical mastectomy. Use of a Disposable Acupressure Device as Part of a Multimodal Antiemetic Strategy for Reducing Postoperative Nausea and Vomiting Acupressure using ondansetron versus metoclopramide on reduction of postoperative nausea and vomiting after strabismus surgery. Effect of Intraoperative Electroacupuncture on Postoperative Pain, Analgesic Requirements, Nausea and Sedation: A Randomised Controlled Trial Perception of bodily sensation as a predictor of treatment response to acupuncture for postoperative nausea and vomiting prophylaxis. Effect of acupressure on postoperative nausea and vomiting in laparoscopic cholecystectomy. Implementation of Acupuncture and Acupressure under Surgical Procedures in Children: A Pilot Study Effect of acupuncture on nausea and/or vomiting during and after cesarean section in comparison with ondansetron Optimal Timing of Acustimulation for Antiemetic Prophylaxis as an Adjunct to Ondansetron in Patients Undergoing Plastic Surgery Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy Magnetic acupressure for management of postoperative nausea and vomiting: a preliminary study. Electroacupuncture on PC6 prevents opioid-induced nausea and vomiting after laparoscopic surgery Perioperative Acupuncture and Postoperative Acupressure Can Prevent Postoperative Vomiting following Paediatric Tonsillectomy Or Adenoidectomy: A Pragmatic Randomised Controlled Trial P6 Acupressure Does Not Prevent Emesis During Spinal Anesthesia for Cesarean Delivery Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Antiemetic efficacy of capsicum plaster on acupuncture points in patients undergoing thyroid operation PC6 acupoint stimulation for the prevention of postcardiac surgery nausea and vomiting: a protocol for a two-group, parallel, superiority randomised clinical trial The Role of Acu-TENS in Hemodynamic Recovery after Open-Heart Surgery Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial. A Randomized Controlled Comparison of Electro-Acupoint Stimulation or Ondansetron Versus Placebo for the Prevention of Postoperative Nausea and Vomiting [Impacts of electroacupuncture at different frequencies on the postoperative nausea and vomiting of patients with laparoscopic surgery]. P6 Acupressure and Nausea and Vomiting after Gynaecological Surgery Comparison of acupressure bands and droperidol for reducing post-operative nausea and vomiting in gynecologic surgery patients. Comparison of laser acupuncture and metoclopramide in PONV prevention in children. Acupuncture versus ondansetron in the prevention of postoperative vomiting Acupuncture in the prevention of postoperative nausea and vomiting Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient‐controlled analgesia Comparative Efficacy of Acustimulation (ReliefBand®) versus Ondansetron (Zofran®) in Combination with Droperidol for Preventing Nausea and Vomiting Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecological laparoscopy Capsicum Plaster at the Korean Hand Acupuncture Point Reduces Postoperative Nausea and Vomiting After Abdominal Hysterectomy Electroacupoint Stimulation for Postoperative Nausea and Vomiting in Patients Undergoing Supratentorial Craniotomy Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery The effects of acupressure on the incidence of postoperative nausea and vomiting in postsurgical patients. [Preventive effect of acupoint injection at neiguan (PC 6) on postoperative nausea and vomiting after laparoscopic gynecologic surgery]. Searching for unpublished trials in Cochrane reviews may not be worth the effort. The Use of Transcutaneous Acupoint Electrical Stimulation for Preventing Nausea and Vomiting After Laparoscopic Surgery Transcutaneous electrical nerve stimulation in the prevention of postoperative nausea and vomiting after elective laparoscopic cholecystectomy. [A randomized controlled clinical trial for acupuncture stimulation of Neiguan (PC 6) to prevent postoperative nausea and vomiting]. Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy. P6 acupuncture and postoperative vomiting after tonsillectomy in children. [Effects of the Nei-Guan acupressure by wrist band on postoperative nausea and vomiting after middle ear surgery]. Evaluation of transcutaneous electroacupoint stimulation with the train-of-four mode for preventing nausea and vomiting after laparoscopic cholecystectomy Publication bias affected the estimate of postoperative nausea in an acupoint stimulation systematic review. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women The Efficacy of Several Neuromuscular Monitoring Modes at the P6 Acupuncture Point in Preventing Postoperative Nausea and Vomiting Acupressure Versus Intravenous Metoclopramide to Prevent Nausea and Vomiting During Spinal Anesthesia for Cesarean Section Nonpharmacologic treatment of postoperative nausea. Acupressure at acupoint P6 for prevention of postoperative nausea and vomiting: a randomised clinical trial Comparison of Acustimulation and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting Review of randomised controlled trials of traditional Chinese medicine The efficacy of acupressure to prevent nausea and vomiting in post-operative patients. Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy. Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting The Effect of Electroacustimulation on Postoperative Nausea, Vomiting, and Pain in Outpatient Plastic Surgery Patients: A Prospective, Randomized, Blinded, Clinical Trial P6 acustimulation effectively decreases postoperative nausea and vomiting in high-risk patients. Electroacupuncture Prophylaxis of Postoperative Nausea and Vomiting following Pediatric Tonsillectomy with or without Adenoidectomy Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Acupuncture compared to placebo‐acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo‐controlled patient and observer blind trial Transcutaneous Acupoint Electrical Stimulation with the ReliefBand® for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia Acupressure wristbands versus metoclopramide for the prevention of postoperative nausea and vomiting P6 acupressure increases tolerance to nauseogenic motion stimulation in women at high risk for PONV Effects of P6 Acustimulation With the ReliefBand on Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopy Pressure to the p6 acupoint and post-appendectomy pain, nausea, and vomiting: a randomized clinical trial. Acupressure wristbands for the prevention of postoperative nausea and vomiting in adults undergoing cardiac surgery. Traditional Chinese acupuncture: a potentially useful antiemetic? Electro‐acupuncture and postoperative emesis Efficacy of acupuncture in prevention of postoperative nausea in cardiac surgery patients. Local anesthesia blocks the antiemetic action of P6 acupuncture [Effects of Nei-Guan acupressure on nausea, vomiting and level of satisfaction for gynecological surgery patients who are using a patient-controlled analgesia]. Postoperative Nausea is Relieved by Acupressure [Efficacy of preventing postoperative nausea and vomiting after thyroid tumor surgery by TAES at neiguan (P1): a clinical observation]. Acupressure Treatment for Prevention of Postoperative Nausea and Vomiting [Acupressure in the prevention of postoperative nausea and vomiting]. Acupressure and the prevention of nausea and vomiting after laparoscopy. Effect of P‐6 acupressure on prevention of nausea and vomiting after epidural morphine for post‐Cesarean section pain relief Effect of P6 acupressure on postoperative vomiting in children undergoing outpatient strabismus correction. Ineffectiveness of acupuncture and droperidol in preventing vomiting following strabismus repair in children The effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. P6 Acupoint Injections Are as Effective as Droperidol in Controlling Early Postoperative Nausea and Vomiting in Children Acupressure wristbands do not prevent postoperative nausea and vomiting after urological endoscopic surgery A randomised, double-blinded, placebo-controlled study of acupressure wristbands for the prevention of nausea and vomiting during labour and delivery. The Effects of P6 Electrical Acustimulation on Postoperative Nausea and Vomiting in Patients After Infratentorial Craniotomy
The K‐D2 point is the Korean h and acupressure point in Koryo H and Therapy for prevention of postoperative nausea and vomiting . We evaluated the efficacy of capsaicin ointment at the K‐D2 point in 186 patients undergoing laparoscopic cholecystectomy in a r and omised , prospect i ve , double‐blind and placebo‐controlled study . Patients were r and omised to have either placebo ointment or capsaicin ointment applied to the K‐D2 point of both h and s 1 h before surgery under st and ardised anaesthesia . The ointment was removed 8 h later . Postoperative nausea and vomiting was evaluated 6 and 24 h following surgery . The incidence of postoperative nausea and vomiting was lower in the capsaicin group , with an absolute risk reduction ( ARR ) of 21 % , a relative risk reduction ( RRR ) of 50 % and a number‐needed‐to‐treat ( NNT ) of 5 at 0–6 h ( p = 0.001 ) , and an ARR of 11 % , a RRR of 85 % and a NNT of 9 at 6–24 h ( p = 0.003 ) . The need for rescue anti‐emetic treatment was also lower at 0–6 h ( 3 ( 3 % ) vs 11 ( 12 % ) ; p = 0.04 ) and at 6–24 h ( 5 ( 5 % ) vs 0 ; p = 0.02 ) Purpose To compare the efficacy of stimulation of P6 acupoint with capsicum plaster in comparison withiv ondansetron for the prevention of postoperative nausea and vomiting ( PONV ) . Methods : 120 patients of either sex , ASA I-II , undergoing elective middle ear surgeries under general anesthesia were included in this r and omized , prospect i ve , double-blinded and placebo-controlled study . The anesthetic technique was st and ardized . Patients were divided into three groups . Group I was the control group . Capsicum plaster ( 1 x 1 cm ) was affixed at the P6 acupoint on both forearms 30 min before induction of anesthesia in patients of Group II . Patients of Groups I and III received an inactive adhesive plaster at the same site . Ondansetron 4 mgiv was given to patients of Group III at the end of surgery and the rest of the patients received a placebo . The plasters were removed six hours after transferring the patients to the postoperative unit . Criteria were fixed for the administration of rescue antiemetics ( ondansetron 4 mgiv ) . PONV and the requirement for rescue antiemetics were recorded by a blinded observer . Results The incidence of PONV and the requirement for rescue antiemetics were significantly lower in both the acustimulation and ondansetron groups at six hours . At 24 hr there was a reduction in the requirement for rescue medication in the ondansetron group . Conclusion : Stimulation of the P6 acupoint with capsicum plaster is an effective method for prevention of PONV after middle ear surgery and its efficacy is comparable to ondansetron for the first six hours after surgery.fr]ObjectifComparer l’efficacité de la stimulation de l’acupoint P6 avec un emplâtre de Capsicum et l’administration iv d’ondansétron pour la prévention des nausées et vomissements postopératoires (NVPO).MéthodeCent vingt hommes et femmes , d’état physique ASA I-II , devant subir une opération de l’oreille moyenne sous anesthésie générale , ont participé à l’étude r and omisée , prospect i ve , à double insu et contrôlée par placebo . La technique anesthésique a été normalisée . Les patients ont été répartis en trois groupes . Le groupe I était le groupe témoin . Un emplâtre de Capsicum ( 1 x 1 cm ) a été appliqué à l’acupoint P6 sur les deux avant-bras 30 min avant l’induction de l’anesthésie chez les patients du groupe II . Les patients des groupes I et III ont reçu un emplâtre adhésif inactif au même site . Une dose de 4 mg d’ondansétron iv a été administrée aux patients du groupe III à la fin de l’opération et le reste des patients a reçu un placebo . Les emplâtres ont été enlevés six heures après le transfert à l’unité des soins postopératoires . Les critères ont été fixés pour l’administration d’antiémétiques de secours ( 4 mg d’ondansétron iv ) . Les NVPO et les dem and es d’antiémétiques ont été notées par un observateur neutre . Résultatsà six heures , l’incidence de NVPO et les dem and es d’antiémétiques étaient significativement plus basses avec l’acustimulation et l’ondansétron . à 24 h , il y a eu une réduction des dem and es de médicaments de secours chez ceux qui avaient reçu l’ondansétron . Conclusion La stimulation de l’acupoint P6 avec un emplâtre de Capsicum est aussi efficace que l’ondansétron pendant les six premières heures postopératoires pour prévenir les NVPO après une opération de l’oreille moyenne Background : Postoperative nausea and vomiting ( PONV ) is a multifactorial problem after general anesthesia . Despite antiemetic prophylaxis and improved anesthetic techniques , PONV still occurs frequently after craniotomies . P6 stimulation is described as an alternative method for preventing PONV . The primary aim of this study was to determine whether P6 acupressure with Sea-B and could reduce postoperative nausea after elective craniotomy . Secondary aims were to investigate whether the frequency of vomiting and the need for antiemetics could be reduced . Methods : In this r and omized , double-blinded , placebo-controlled study , patients were r and omized into either a  P6 acupressure group ( n=43 ) or a sham group ( n=52 ) . B and s were applied unilaterally at the end of surgery , and all patients were administered prophylactic ondansetron .  Postoperative nausea was evaluated with a Numerical Rating Scale , 0 to10 , and the frequency of vomiting was recorded for 48 hours . Results : We found no significant effect from P6 acupressure with  Sea-B  and on postoperative nausea or vomiting in patients undergoing craniotomy . Nor was there any difference in the need for rescue antiemetics . Altogether , 67 % experienced PONV , and this was especially an issue at > 24 hours in patients recovering from infratentorial surgery compared with supratentorial surgery ( 55 % vs. 26 % ; P=0.014 ) . Conclusions : Unilateral P6 acupressure with Sea-B and applied at the end of surgery together with prophylactic ondansetron did not significantly reduce PONV or the need for rescue antiemetics in patients undergoing craniotomy . Our study confirmed that PONV is a common issue after craniotomy , especially after infratentorial surgery Background The incidence of postoperative nausea and vomiting ( PONV ) is 50 to 79 % after neurosurgery . Our study is design ed to evaluate the efficacy of pericardium 6 ( P6 ; also known as Neiguan ) acupoint stimulation versus placebo , and versus routine antiemetic for the prevention of PONV after craniotomy , as well as to compare the efficacy of invasive acupuncture with non-invasive transcutaneous electrical nerve stimulation ( TENS ) on P6 . Methods / design This is a single-center , prospect i ve , double-blind , five-arm , parallel-group , r and omized controlled trial ( RCT ) . All groups will be given routine intravenous ondansetron 8 mg administered before skin closure . Upon regaining consciousness from general anaesthesia , patients will receive one of five interventions : 1 ) P6 acupuncture bilaterally for 30 minutes , stimulated every 10 minutes to keep de qi sensation ; 2 ) sham acupuncture bilaterally for 30 minutes with no stimulation ; 3 ) P6 stimulation via active TENS electrodes bilaterally for 30 minutes , with stimulation frequency and intensity set to when de qi sensation is felt ; 4 ) sham P6 stimulation via inactive TENS electrode bilaterally for 30 minutes ; and 5 ) usual practice of pharmacological emesis prevention . The incidence of postoperative vomiting during the first 24 hours is the main outcome . Secondary outcomes include : complete response rate , severity of nausea , total rescue metoclopramide dose used and patient satisfaction with PONV management . Discussion The results from this study could potentially confirm that P6 acupoint stimulation is an effective adjunct to st and ard antiemetic drug therapy for the prevention of PONV in patients undergoing craniotomy . Our study may also confirm that conventional acupuncture is more effective than TENS.Trial registration This study is registered with the Chinese Clinical Trial Registry : ChiCTR-TRC-13003026 UNLABELLED We aim ed to evaluate the antiemetic efficacy , safety , and clinical utility of prophylactic ondansetron administered at the end of the surgery for the prevention of postoperative nausea and vomiting ( PONV ) in a homogenous population of 54 women undergoing modified radical mastectomy ( MRM ) . A st and ard general anesthetic and perioperative analgesic technique were used . After surgery , patients received either saline placebo or ondansetron 4 mg IV . Episodes of PONV , as well as rescue antiemetic requirements , were recorded for the first 24 h after surgery . The 24-h incidence of PONV ( 33.3 % vs 81.5 % ; P = 0.0010 ) was significantly lower in the ondansetron group . The severity of PONV , evaluated by the number of emetic episodes per patient ( 1.59+/-1.90 vs 0.29+/-0.66 ; P = 0.0029 ) , and the rescue antiemetic requirement ( 59.2 % vs 14.8 % ; P = 0.0019 ) was significantly lower , in the ondansetron group . Patient satisfaction scores and number needed to prevent PONV ( 2.07 ) were significantly better and therapeutically more favorable in the ondansetron group . The incidence of adverse events such as headache , dizziness , and increased liver enzyme levels ( number needed to harm = infinity ) was similar in both groups . Administered at the end of the surgery in adult female patients undergoing general anesthesia for MRM , ondansetron 4 mg is effective and safe in preventing PONV . We recommend the clinical practice of routine prophylactic ondansetron to prevent PONV after MRM , as it significantly improves perioperative patient satisfaction and outcome . IMPLICATION S We evaluated the antiemetic efficacy , safety , and routine use of prophylactic ondansetron , a " gold st and ard " antiemetic , in women undergoing radical breast surgery who were at a high risk of postoperative vomiting . We analyzed more meaningful " true " and " therapeutic " outcome measures , and we conclude that prophylactic ondansetron is safe and effective and that its routine use is justified BACKGROUND : There is still controversy regarding the optimal strategy for managing postoperative nausea and vomiting ( PONV ) in high-risk surgical population s. Although acustimulation at the P6 acupoint has been demonstrated to be effective in preventing PONV , the effect of this nonpharmacologic therapy on the patient 's recovery with respect to resumption of normal activities of daily living has not been previously assessed when it is used as part of a multimodal antiemetic regimen . Therefore , we design ed this r and omized , sham-controlled , and double-blind study to assess the efficacy of a disposable acupressure device ( Pressure Right ® ; Pressure Point Inc. , Gr and Rapids , MI ) on the incidence of emetic episodes and quality of recovery when used in combination with ondansetron and dexamethasone for antiemetic prophylaxis . METHODS : One hundred ASA physical status I and II patients undergoing major laparoscopic procedures were r and omly assigned to either a control group ( n = 50 ) receiving a “ sham ” acustimulation device or an acupressure group ( n = 50 ) receiving a disposable Pressure Right device placed bilaterally at the P6 point 30 to 60 minutes before induction of anesthesia . All patients received a st and ardized general anesthetic . A combination of ondansetron , 4 mg IV , and dexamethasone , 4 mg IV , was administered during surgery for antiemetic prophylaxis in both study groups . The incidence of nausea and vomiting and the need for “ rescue ” antiemetic therapy were assessed at specific time intervals for up to 72 hours after surgery . The recovery profiles and quality of recovery question naires were evaluated at 48 hours and 72 hours after surgery . Patient satisfaction with the management of their PONV was assessed at the end of the 72-hour study period . RESULTS : The 2 study groups did not differ in their demographic characteristics or risk factors for PONV . The incidence of vomiting at 24 hours was significantly decreased in the acupressure group ( 10 % vs 26 % , P = 0.04 , 95 % confidence interval for absolute risk reduction 1%–31 % ) . The overall incidence of vomiting from 0 to 72 hours after surgery was also significantly decreased from 30 % to 12 % in the acupressure group ( P = 0.03 , 95 % confidence interval 2%–33 % ) . Furthermore , adjunctive use of the acupressure device seemed to enhance patient satisfaction with their PONV management and quality of recovery at 48 hours after surgery . However , the recovery times to hospital discharge , resumption of normal physical activities , and return to work did not differ significantly between the 2 study groups . CONCLUSION : Use of the Pressure Right acupressure device in combination with antiemetic drugs provided a reduction in the incidence of vomiting from 0 to 72 hours after surgery with an associated improvement in patient satisfaction with their PONV management . However , recovery and outcome variables failed to demonstrate any improvement with the addition of the acupressure device OBJECTIVE To compare the clinical efficacy of acupressure with treatment induced by ondansetron and metoclopramide on reduction of the severity of postoperative nausea and vomiting ( PONV )  after strabismus surgery .  METHODS There were 200 patients with ASA classes I-II , ages 10 to 60 years old , who underwent strabismus surgery  that were included in this r and omized , prospect i ve , double-blind , placebo-controlled trial . Group I was the control , group II received metoclopramide 0.2 mg/kg , and group III received ondansetron 0.15 mg/kg intravenously immediately prior to anesthesia induction . In Group IV , acupressure wristb and s were applied at the P6 points . Acupressure wrist b and s were not placed appropriately for subjects of groups I-III . The acupressure wrist b and s were applied 30 minutes before anesthesia induction and removed six hours after surgery completion . Anesthesia was st and ardized . PONV was evaluated within 0 - 2 hours and 2 - 24 hours after surgery by a blinded observer . Results were analyzed by the Chi-square or Fisher exact test . A P value of < 0.05 was considered significant . RESULTS The incidence of PONV was not significantly different among acupressure , metoclopramide and ondansetron groups during 24 hours . Also , the severity of PONV was not significantly different between acupressure , metoclopramide , and ondansetron in the recovery and ward . CONCLUSION Acupressure at the P6 point causes a significant reduction in the incidence and severity of PONV 24 hours after strabismus surgery as well as metoclopramide ( 0.2 mg/kg ) and ondansetron ( 0.15 mg/kg ) intravenous for patients aged 10 or older . ( I rct ID : I RCT 138807152556N1 ) Background Acupuncture has potential value in producing analgesia in the postoperative period , but previous trials have inconsistent results . We aim ed to study the effect of electroacupuncture on pain and nausea and the requirement for postoperative analgesia via patient-controlled analgesia . Method 107 patients who were undergoing abdominal hysterectomy or laparascopic cholecystectomy were r and omised to receive either electroacupuncture ( n = 56 ) or no additional treatment ( n = 46 ) during the operative period . We measured the use of patient-controlled analgesia and time in recovery as well as pain , postoperative nausea and vomiting , and sedation .  102 patients were included in the analysis . The majority of patients were female : the laparoscopic cholecystectomy group included 10 males . Adhesive dressings were placed over all acupuncture points in both groups , to ensure blinding of patients and assessors during the recovery period . Results The electroacupuncture group had a longer duration of operation but the difference was not statistically significant . There were no significant differences between the groups for the requirement for patient-controlled analgesia or total time in recovery . Pain scores were marginally lower in the acupuncture group , but not significantly , and there were no differences between the groups in nausea or sedation scores . Conclusion Electroacupuncture at 10 Hz given under general anaesthetic has no effect on postoperative nausea or analgesic requirement . Future studies should investigate acupuncture given before or after surgery OBJECTIVES Conditions associated with the response to acupuncture treatment remain widely elusive . This study aim ed to identify predictors of treatment response in patients undergoing acupuncture treatment for prevention of  postoperative nausea and vomiting ( PONV ) .  An intervention-specific question naire was developed to assess perception of bodily sensations ( PBS ) in patients undergoing acupuncture treatment .  DESIGN Exploratory study in addition to an observer-blinded r and omized controlled trial . SETTING S/LOCATION The departments of anesthesiology and of gynecology , University of Heidelberg , Germany . SUBJECTS Two hundred and twenty ( 220 ) female patients scheduled for breast or gynecologic surgery . INTERVENTIONS True acupuncture on point P6 ( Neiguan ) or placebo/sham acupuncture on a virtual point 1 cm proximal and lateral to P6 . OUTCOME MEASURES Of 220 female patients scheduled for breast or gynecologic surgery who were included in the trial , 202 completed the newly developed PBS question naire before the intervention . The main outcome was incidence of PONV in relationship with PBS and the kind of acupuncture applied . Logistic regression analyses were performed to identify predictors of treatment response for those receiving surgery ( n = 195 ) . RESULTS High PBS predicted low treatment response in patients receiving breast surgery ( odds ratio [ OR ] = 1.6 ; p = 0.039 for each 10-point increase ) . The PBS question naire showed good item difficulty , internal consistency , and divergent validity . Treatment response in patients receiving gynecologic surgery was predicted by the kind of acupuncture applied ( OR = 0.4 ; p = 0.027 ) , whereas PBS played no role in this group . CONCLUSIONS The incidence of PONV after breast surgery seems to be influenced by some psychological mechanisms . In this group of patients , acupuncture might be more effective in patients who have low PBS OBJECTIVE To evaluate the effectiveness of acupressure applied at meridian P6 point for prevention of nausea and vomiting in patients undergoing laparoscopic cholecystectomy . METHODOLOGY A r and omized double blind study was performed in 50 ASA I and II patients scheduled for laparoscopic cholecystectomy . Patients were divided into two groups ; control and placebo . In the control group acupressure was applied at P6 point half an hour before surgery while in the placebo group the acupressure b and was tied on meridian P6 point but the plastic bead was placed on the dosum of right forearm away from meridian P6 point . Patients were assessed for nausea and vomiting for six hours after surgery . Anaesthetic technique and postoperative analgesia were st and ardized for all patients . RESULTS Results showed that the incidence of postoperative nausea and vomiting was 36 % in the treatment group and 40 % in placebo group , which is statistically insignificant . CONCLUSION Application of acupressure at P6 point half an hour before induction of anaesthesia does not significantly alter the incidence of postoperative nausea and /or vomiting within 6 hours after surgery Objective To test the feasibility of research on acupuncture and acupressure for children undergoing tonsillectomy and /or adenoidectomy . Methods During January and February 2008 , 20 patients from the ordinary waiting list at Lovisenberg Diakonale Hospital in Oslo were r and omised to either acupuncture while under anaesthesia or st and ard care as control . The authors gave acupuncture at Pericardium 6 ( P6 ) at a depth of approximately 0.7 cm on both forearms . The needles were removed when the patient was transferred to the recovery unit and replaced with acupressure wristb and s. The outcome measure in the pilot study was to explore if acupuncture and acupressure could be implemented without extending the anaesthesia time and surgical time . This pilot study also tested the feasibility of the research protocol for future investigation in the field , with postoperative nausea , vomiting and retching as the primary end points for effect . Results The study showed no delay in the surgical procedure and no additional anaesthesia time attributable to the introduction of acupuncture . The protocol was found to be feasible with regard to performance of the main study . Vomiting occurred in five patients in the treatment group and 10 patients in the control group . The total numbers of vomiting events were 13 in the treatment group and 19 in the control group . Conclusion The results encouraged performance of the main study according to the research protocol Purpose Acupuncture has been used for the management of  postoperative nausea and vomiting ( PONV ) . This study compared the effect of electrical acustimulation with ondansetron for preventing intraoperative and postoperative emetic symptoms and improving patient satisfaction . Methods After gaining ethical approval , 450 parturients scheduled for elective cesarean delivery were r and omly allocated to receive either electrical stimulation using P6 acupoint ( pericardium 6 ) bilaterally for 30 min before spinal anesthesia ( group III ; n = 150 ) , or 4 mg ondansetron 30 min before spinal anesthesia ( group II ; n = 150 ) , or placebo ( group II ; n = 150 ) . Nausea and vomiting were evaluated and recorded intraoperatively and postoperative for 24 h by an independent anesthetist . Results The three groups were not significantly different with respect to intraoperative ephedrine dose and duration of surgery . Nausea and vomiting occurred statistically significantly less often in the active treatment groups ( II , III ) during operation and for 6 h postoperatively . There was no statistically significant difference between the groups in the incidence of nausea and vomiting from 6 to 24 h postoperatively . Patient satisfaction with PONV control was higher with the active treatment groups compared with group I. Conclusion Electrical acustimulation is comparable to ondansetron in prevention of PONV during and after cesarean delivery under spinal anesthesia and in improving patient satisfaction We design ed this study to evaluate the antiemetic efficacy of transcutaneous electrical acupoint stimulation in combination with ondansetron when applied before , after , or both before and after plastic surgery . A r and omized , double-blind , sham-controlled study design was used to compare three prophylactic acustimulation treatment schedules : preoperative — an active device was applied for 30 min before and a sham device for 72 h after surgery ; postoperative — a sham device was applied for 30 min before and an active device for 72 h after surgery ; and perioperative — an active device was applied for 30 min before and 72 h after surgery ( n = 35 per group ) . All patients received a  st and ardized general anesthetic  , and ondansetron 4 mg IV was administered at the end of surgery . The incidence of vomiting/retching and the need for rescue antiemetics were determined at specific time intervals for up to 72 h after surgery . Nausea scores were recorded with an 11-point verbal rating scale . Other outcome variables assessed included discharge times ( for out patients ) , resumption of normal activities of daily living , complete antiemetic response rate , and patient satisfaction with antiemetic therapy and quality of recovery . Perioperative use of the ReliefB and ® significantly increased complete responses ( 68 % ) compared with use of the device before surgery only ( 43 % ) . Median postoperative nausea scores were significantly reduced in the peri- and postoperative ( versus preoperative ) treatment groups . Finally , patient satisfaction with the quality of recovery ( 83 ± 16 and 85 ± 13 vs 72 ± 18 ) and antiemetic management ( 96 ± 9 and 94 ± 10 vs 86 ± 13 ) on an arbitrary scale from 0 = worst to 100 = best was significantly higher in the groups receiving peri- or postoperative ( versus preoperative ) acustimulation therapy . For patients discharged on the day of surgery , the time to home readiness was significantly reduced ( 114 ± 41 min versus 164 ± 50 min ; P < 0.05 ) when acustimulation was administered perioperatively ( versus preoperatively ) . In conclusion , acustimulation with the ReliefB and ® was most effective in reducing postoperative nausea and vomiting and improving patients ’ satisfaction with their antiemetic therapy when it was administered after surgery Purpose To compare the efficacy of acupressure wrist b and s and ondansetron for the prevention of postoperative nausea and vomiting ( PONV ) . Methods One hundred and fifty ASA I – II , patients undergoing elective laparoscopic cholecystectomy were included in a r and omized , prospect i ve , double-blind and placebo-controlled study . Patients were divided into three groups of SO . Group I was the control ; Group II received ondansetron 4 mgiv just prior to induction of anesthesia ; in Group III acupressure wristb and s were applied at the P6 points . Acupressure wrist b and s were placed inappropriately in Groups I and II . The acupressure wrist b and s were applied 30 min prior to induction of anesthesia and removed six hours following surgery . Anesthesia was st and ardized . PONV were evaluated separately as none , mild , moderate or severe within six hours of patients ’ arrival in the postanesthesia care unit and then at 24 hr after surgery by a blinded observer . If patients vomited more than once , they were given 4 mg ondansetroniv as the rescue antiemetic . Results were analyzed by Ztest . AP value of < 0.05 was taken as significant . Results The incidence of PONV and the requirement of rescue medication were significantly lower in both the acupressure and ondansetron groups during the first six hours . Conclusion Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy , similar to that of ondansetron 4 mgiv . RésuméObjectifComparer l’efficacité des b and es d’acupression et de l’ondansétron comme prévention des nausées et vomissements postopératoires (NVPO).MéthodeCent  cinquante patients d’état physique ASA I– II devant subir une cholécystectomie laparoscopique ont été recrutés pour une étude prospect i ve , r and omisée et à double insu contre placebo . Ils ont été répartis en trois groupes de 50 . Le groupe I a été le groupe témoin ; les patients du groupe II ont reçu 4 mg iv d’ondansétron juste avant l’induction de l’anesthésie ; chez les patients du groupe III , on a appliqué des b and es d’acupression aux point P6 . Des b and es d’acupression ont été placées de façon inappropriée chez les patients des groupes I et II . Les b and es ont été appliquées 30 min avant l’induction et enlevées six heures après l’opération . Lanesthésie a été normalisée . Les NVPO ont été évalués séparément comme inexistants , légers , modérés ou sévères pendant les six premières heures en salle de réveil , puis 24 h après l’opération par un observateur impartial . Si les patients vomissaient plus d’une fois , ils recevaient 4 mg d’ondansétron iv comme antiémétique de secours . Les résultats ont été analysés avec le test Z. Une valeur de P < 0,05 était considérée significative . RésultatsL’incidence de NVPO et les besoins de médication de secours ont été significativement plus faibles autant avec l’acupression qu’avec l’ondansétron pendant les six premières heures . Conclusion Lacupression en Pô réduit de façon significative l’incidence de NVPO et la nécessité d’antiémétique de secours pendant les six premières heures suivant la cholécystectomie laparoscopique . Son effet est donc similaire à celui de 4 mg iv d’ondansétron BACKGROUND To assess the efficacy of magnetic acupressure in the prevention of postoperative nausea and vomiting ( PONV ) . METHODS Fifty-eight patients were included in this r and omized , double blind , preliminary prospect i ve study . Thirty-three underwent ear , nose , and throat ( ENT ) procedures and twenty-five underwent gynaecological procedures . A magnet patch ( M ) or a placebo patch ( P ) was applied to patients in each group r and omly . The patch was applied 15 min before surgery to P6 a point situated above the wrist , on the medial aspect of the arm between the palmaris longus and flexor carpi radicis ( REF point ) . Anaesthesia was st and ardized for all patients . Primary study endpoints included PONV scores and number of rescue antiemetic administrations . Secondary endpoints included pain scores , percentage of patients who required rescue analgesics and satisfaction scores . Study variables were measured on arrival in the PACU and 8 , 16 and 24 h after surgery . RESULTS The global incidence of PONV was 50 % . We found no significant difference in the incidence of PONV between ENT patients ( 46 % ) and gynaecology patients ( 56 % ) , and no difference between patients who received magnet treatment ( 47 % ) and those that did not ( 54 % ) . Patients receiving the magnet had a similar satisfaction level ( 75 % satisfied ) to those receiving placebo ( 73 % satisfied ) . In addition , magnet-treated patients had similar pain and PONV scores , and a similar percentage of patients in each groups received postoperative rescue analgesics . Finally , there was no difference in the number of rescue antiemetic administrations between the two groups . CONCLUSION The use of magnetic acupressure as a prophylactic antiemetic treatment prior to ENT or gynaecology surgeries produced no benefit when compared to placebo Objective To investigate the treatment time dependence of electroacupuncture ( EA ) on Neiguan ( PC6 ) for preventing postoperative nausea and vomiting ( PONV ) . Methods One hundred and seventy-eight patients , who had received intravenous patient-controlled analgesia ( PCA ) with Fentanyl  , were assigned r and omly to three groups using r and om numbers : a pre-operative EA group ( PrEA ) , a post-operative EA group ( PoEA ) , and a non-acupuncture control group ( NC ) . An anesthetist evaluated the incidence and severity of nausea and vomiting for 48 h after surgery blindly . The main outcomes were severity and freguency of PONV , which were measured with a self-reported question naire and a confirmation from the anesthetist . The data were analyzed with ANOVA and Z-test . Results The incidence of nausea and vomiting was significantly lower in the PrEA group than the NC group during 48 h after surgery ( P<0.01 , P<0.05 ) . The incidence of vomiting was also significantly lower in the PrEA group than the PoEA group ( P<0.05 ) . The PoEA subjects evidence d no significant differences compared with the NC subjects in terms of the incidence of nausea and vomiting ( P<0.05 ) . The severity of nausea was significantly lower in the PrEA group than in the NC and PoEA groups ( P<0.05 ) . Conclusions EA on PC6 is effective in the prevention of PONV , and pre-operative acupuncture is more effective than post-operative acupuncture Objective To investigate the effectiveness of acupuncture and acupressure as supplements to st and ard treatment for postoperative vomiting  in children undergoing tonsillectomy and /or adenoidectomy . Methods A pragmatic , open , block-r and omised controlled trial . The results were analysed according to the intention-to-treat principle . The study was conducted without extra re sources in a normal setting at the day-surgery department of Lovisenberg Diakonale Hospital in Oslo . 154 children with an American Society of Anesthesiologists grade 1–2 , weighing at least 10 kg , were included . Children with concomitant gastrointestinal diseases , emesis or antiemetic treatment < 24 h preoperatively , rash or local infection over the actual acupuncture points were excluded together with patients whose parents ’ informed consent could not be obtained . The intervention group received acupuncture at pericardium 6 bilaterally , at a depth of approximately 0.7 cm with a median of 21 min during anaesthesia , followed by acupressure wristb and s for 24 h and st and ard treatment . The control group received st and ard treatment . The primary end point was the occurrence of vomiting or retching during 24 h postoperatively . Results Children in the acustimulation group experienced less retching and vomiting than the control group—46.8 % versus 66.2 % ( p=0.015 ) . The effect of acustimulation was specifically pronounced in girls and children aged 1–3 years . Conclusion This trial indicates the effectiveness of acustimulation as an adjunct to st and ard treatment . The results should encourage and promote the implementation of acustimulation for postoperative vomiting in children undergoing adenoidectomy or tonsillectomy Nausea and vomiting are major adverse effects during spinal anesthesia for cesarean delivery . Stimulation of the P6 ( Neiguan ) acupoint is a traditional Chinese acupuncture technique used for effective antiemetic purpose s. In this study , we evaluated the antiemetic effect of P6 acupressure in parturients during spinal anesthesia for cesarean delivery . In a r and omized , double-blind , controlled trial , 110 parturients scheduled for elective cesarean delivery were enrolled in the study . Thirty minutes before initiation of spinal anesthesia , parturients were r and omized to acupressure b and s or placebo b and s bilaterally on the P6 acupoint and nausea and vomiting were observed over the study period . There were no statistically significant differences in maternal characteristics . Incidence rates for intraoperative nausea were 64 % ( acupressure group ) and 71 % ( control group ) ( P = 0.416 ) , with an incidence of intraoperative vomiting of 22 % ( acupressure group ) and 27 % ( control group ) ( P = 0.506 ) . The results suggest that prophylactic use of acupressure b and s bilaterally on the P6 acupoint failed to prevent nausea and vomiting during spinal anesthesia for cesarean delivery The efficacy of acupressure at the P6 point in the prevention of nausea and vomiting during and after Caesarean section was studied . A double-blind , r and omized controlled study of acupressure vs placebo was design ed . Ninety-four patients scheduled for Caesarean section were included . The anaesthetic technique and postoperative analgesia were st and ardized . The use of acupressure reduced the incidence of nausea or vomiting from 53 % to 23 % compared with placebo ( 95 % confidence interval ( CI ) 0.34 - 0.25 ; P = 0.002 ) during the operation and from 66 % to 36 % compared with placebo ( 95 % CI 0.34 - 0.19 ; P = 0.003 ) after the operation . Other variables were similar between the groups Background Postoperative nausea and vomiting ( PONV ) occurs in up to 63 - 84 % of patients after thyroid surgery . This study aims to assess the effects of using a capsicum plaster to reduce PONV after thyroid surgery at either the Chinese acupuncture point ( acupoint ) Pericardium 6 ( P6 ) or Korean h and acupuncture point K-D2 . Methods One-hundred eighty-four patients who underwent thyroid surgery were r and omized in four groups ( n = 46 each ) : control group = inactive tape at P6 acupoints and on both shoulders as a nonacupoint ; P6 group = capsicum plaster at P6 points and inactive tape on both shoulders ; K-D2 group = capsicum plaster at K-D2 acupoints and inactive tape on both shoulders ; Sham group = capsicum plaster on both shoulders and inactive tape at P6 acupoints . The capsicum plaster was applied before the induction of anesthesia and removed at 8 hr after surgery . Results The incidence and severity of nausea and vomiting and the need for rescue antiemetics were decreased in the patients in the P6 and K-D2 groups compared to the patients in the control and sham groups ( P < 0.001 ) . The patients in the P6 and K-D2 groups also reported that they were more satisfied ( P < 0.05 ) . Conclusions We conclude that the capsicum plaster at the P6 and K-D2 acupoint was a promising antiemetic method for the patients undergoing thyroid surgery Introduction Postoperative nausea and vomiting ( PONV ) are frequent but unwanted complications for patients following anaesthesia and cardiac surgery , affecting at least a third of patients , despite pharmacological treatment . The primary aim of the proposed research is to test the efficacy of PC6 acupoint stimulation versus placebo for reducing PONV in cardiac surgery patients . In conjunction with this we aim to develop an underst and ing of intervention fidelity and factors that support , or impede , the use of PC6 acupoint stimulation , a knowledge translation approach . Methods and analysis 712 postcardiac surgery participants will be recruited to take part in a two-group , parallel , superiority , r and omised controlled trial . Participants will be r and omised to receive a wrist b and on each wrist providing acupressure to PC six using acupoint stimulation or a placebo . R and omisation will be computer generated , use r and omly varied block sizes , and be concealed prior to the enrolment of each patient . The wristb and s will remain in place for 36 h. PONV will be evaluated by the assessment of both nausea and vomiting , use of rescue antiemetics , quality of recovery and cost . Patient satisfaction with PONV care will be measured and clinical staff interviewed about the clinical use , feasibility , acceptability and challenges of using acupressure wristb and s for PONV . Ethics and dissemination Ethics approval will be sought from appropriate Human Research Ethics Committee/s before start of the study . A systematic review of the use of wrist acupressure for PC6 acupoint stimulation reported minor side effects only . Study progress will be review ed by a Data Safety Monitoring Committee ( DSMC ) for nausea and vomiting outcomes at n=350 . Dissemination of results will include conference presentations at national and international scientific meetings and publications in peer- review ed journals . Study participants will receive a one-page lay- summary of results . Trial registration number Australian New Zeal and Clinical Trials Registry — ACTRN12614000589684 Increased heart rate ( HR ) and reduced blood pressure ( BP ) are common consequences of cardiac surgery . This study investigated the effect of transcutaneous electrical nervous stimulation applied over acupuncture points ( Acu-TENS ) on HR , BP , rate pressure product ( RPP ) and nausea and vomiting score after open-heart surgery . After open heart surgery , 40 patients were r and omly allocated to either an Acu-TENS group , which received a 40-min session of TENS applied bilaterally over the acupuncture point PC6 on postoperative days 1–5 , or a Placebo-TENS group , which received identical electrode placement but with no electrical output from the TENS unit , despite an output indicator light appearing activated . HR , systolic and diastolic BPs ( SBP and DBP ) were recorded and RPP computed . Nausea and vomiting symptoms were quantified using a 4-point Likert scale before and after TENS intervention . Daily HR , BP and antiemetic administration data were recorded from a further 20 consecutive subjects who received no intervention and formed the Control group . A trend of decreasing HR and increasing BP in the Acu-TENS group was observed over the five postoperative days , with all variables returning to preoperative values by Day 4 ( P > .2 ) . In the Placebo-TENS and Control groups the HR remained higher ( P < .0001 ) , BP lower ( P < .05 ) and RPP higher ( P = .01 ) than respective preoperative values at Day 4 . The dose of Maxolon required was lowest in the Acu-TENS group ( P = .038 ) . We concluded that Acu-TENS facilitated an earlier return to preoperative BP , HR and RPP values in patients after acute heart surgery BACKGROUND Although opioids are widely used as analgesics in general anaesthesia , they have unpleasant side-effects and can delay postoperative recovery . Acupuncture and related techniques are effective for acute and chronic pain , and reduces some side-effects . We assessed the effect of transcutaneous electric acupoint stimulation ( TEAS ) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects . METHODS Sixty patients undergoing sinusotomy were r and omly assigned to TEAS or control group . TEAS consisted of 30 min of stimulation ( 6 - 9 mA , 2/10 Hz ) on the Hegu ( LI4 ) , Neiguan ( PC6 ) , and Zusanli ( ST36 ) before anaesthesia . The patients in the control group had the electrodes applied , but received no stimulation . Bispectral index  was used to monitor the depth of anaesthesia . Perioperative haemodynamics were recorded , and peripheral blood sample s were collected to measure the levels of mediators of surgical stress . The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anaesthesia-related side-effects . RESULTS Patients in the TEAS group required 39 % less remifentanil during surgery than controls [ 0.0907 ( SD 0.026 ) μg kg(-1 ) min(-1 ) vs 0.051 ( 0.018 ) μg kg(-1 ) min(-1 ) ] . There were no differences in intra-operative haemodynamics or surgical stress between groups . However , the time to extubation and recall in the control group was 16.8 ( 6.8 ) min and 23.0 ( 5.0 ) min , respectively , significantly longer than that in the TEAS group ( P<0.01 ) . TEAS also decreased the incidence of dizziness and pruritus within the first 24 h after surgery ( P<0.01 ) . CONCLUSION The use of TEAS significantly reduced intra-operative remifentanil consumption and alleviated postoperative side-effects in patients undergoing sinusotomy . CLINICAL TRIAL REGISTRATION The trial was registered at clinical trials.gov ( NCT01700855 ) In this study we evaluated the efficacy of electro-acupoint stimulation , ondansetron versus placebo for the prevention of  postoperative nausea and vomiting ( PONV ) . Patients undergoing major breast surgery under general anesthesia were r and omized into active electro-acupoint stimulation ( A ) , ondansetron 4 mg IV ( O ) , or sham control ( placement of electrodes without electro-acupoint stimulation ; placebo [ P ] ) . The anesthetic regimen was st and ardized . The incidence of nausea , vomiting , rescue antiemetic use , pain , and patient satisfaction with management of PONV were assessed at 0 , 30 , 60 , 90 , 120 min , and at 24 h. The complete response ( no nausea , vomiting , or use of rescue antiemetic ) was significantly more frequent in the active treatment groups compared with placebo both at 2 h ( A/O/P = 77%/64%/42 % , respectively ; P = 0.01 ) and 24 h postoperatively ( A/O/P = 73%/52%/38 % , respectively ; P = 0.006 ) . The need for rescue antiemetic was less in the treatment groups ( A/O/P = 19%/28%/54 % ; P = 0.04 ) . Specifically , the incidence and severity of nausea were significantly less in the A group compared with the other groups , and in the O group compared with the P group ( A/O/P = 19%/40%/79 % , respectively ) . The A group experienced less pain in the postanesthesia care unit , compared with the O and P groups . Patients in the treatment groups were more satisfied with their management of PONV compared with placebo . When used for the prevention of PONV , electro-acupoint stimulation or ondansetron was more effective than placebo with greater degree of patient satisfaction , but electro-acupoint stimulation seems to be more effective in controlling nausea , compared with ondansetron . Stimulation at P6 also has analgesic effects OBJECTIVE To 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 ) . METHODS One hundred and twenty female patients with laparoscopic surgery undergoing the general anesthesia were r and omized 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 grade s of postoperative nausea and vomiting were observed and recorded for the patients in each group . RESULTS The 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 ) . CONCLUSION The 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 We studied the effect of P6 acupressure on 46 women undergoing laparotomy for major gynaecological surgery who received patient-controlled analgesia . Half the patients received acupressure at the P6 site , the remainder received acupressure at a “ sham ” site . There was a reduction in the requests for anti-emetic therapy in the group receiving P6 acupressure but there was no difference in the incidence of nausea and vomiting . There was no difference in total morphine consumption between the two groups The purpose of this study was to evaluate the effectiveness of acupressure b and s , droperidol , and the combined modalities , administered preoperatively , in reducing PONV in inpatient gynecologic patients . One hundred and forty-three patients were r and omized to one of four groups : droperidol and acupressure b and s , droperidol and placebo b and s , placebo drug and acupressure b and s , or placebo drug and placebo b and s. Overall , during their hospital stay , 69 % of the women experienced PONV and 45 % experienced vomiting at some time . Although droperidol was most effective the day of surgery , neither acupressure b and s or droperidol were effective in reducing PONV BACKGROUND Postoperative nausea and vomiting ( PONV ) are frequent side effects of general anesthesia in children . The aim of this study was to compare the effectiveness of laser acupuncture with metoclopramide in prevention of PONV in children after sevoflurane anesthesia . METHODS A total of 120 children ASA I and II , scheduled for hernia repair , circumcision or orchidopexy were r and omly assigned into three groups : group I , received laser acupuncture on P6 point and saline infusion ; group II , metoclopramide 0.1 mg.kg(-1 ) i.v . and sham laser ; group III had sham laser and saline infusion . Anesthesia was maintained with sevoflurane and N(2)O/O(2 ) . Patients were monitored for any symptoms of retching and vomiting at 2 , 6 and 24 h postoperatively . RESULTS The incidence of vomiting was higher in the control group in the first 2 h postoperatively ( P < 0.001 ) , compared with the other groups . There was no statistically significant difference between acupuncture and metoclopramide groups in occurrence and timing of vomiting ( P < 0.001 ) . CONCLUSION Laser acupuncture is equally effective as metoclopramide in preventing PONV in children This study compares the anti‐emetic effect of acupuncture with that of ondansetron and a placebo .  Ninety children undergoing dental treatment under general anaesthesia were r and omly allocated to one of the three equal groups , to receive acupuncture needle insertion , intravenous ondansetron 0.15 mg.kg−1 or a placebo . Parental satisfaction scores and the incidence of emetic episodes were recorded . A significant difference was found in the number of patients who vomited and the total number of the emetic episodes when comparing the two treatment groups with the placebo group ( p < 0.0001 ) . A significant difference was also found between the treatment groups and the placebo group with respect to parental satisfaction score ( p < 0.03 ) . We conclude that traditional Chinese acupuncture is a valid non‐pharmacological alternative anti‐emetic treatment that can be recommended as a prophylactic technique in children undergoing dental surgery under general anaesthesia The efficacy of intra‐operative acupuncture at the PC6 point in the prevention of postoperative nausea or vomiting was studied . A double‐blind r and omised controlled study of acupuncture versus placebo was performed in 81 patients scheduled for day case gynaecological laparoscopic surgery . Failure of treatment was defined as the occurrence of nausea or vomiting prior to or within 24 h of discharge . The use of acupuncture  reduced the incidence of postoperative nausea or vomiting in hospital from 65 % to 35 % compared with placebo and after discharge from 69 % to 31 % compared with placebo In this r and omized double-blind trial we investigated the effect of acupressure on the incidence of  nausea and vomiting after caesarean section under spinal anaesthesia with added intrathecal morphine . Parturients wore either acupressure or placebo wristb and s during surgery and postoperatively for at least 10 h. There was no significant difference overall between the two groups in the incidence of intra- or postoperative nausea or vomiting/retching . Dem and for antiemetic medication was also similar in the two groups . However , in the sub-group of parturients who gave a previous history of  postoperative nausea or vomiting  , there was a statistically significant reduction in both postoperative nausea and vomiting/retching in the acupressure group . Further investigations are needed to see whether acupressure may be an effective non-pharmacological , non-invasive treatment for a common problem in this sub-group of patients Background and objectives : To evaluate the effectiveness of acupressure in preventing nausea and vomiting in patients undergoing gynaecological operations and receiving a patient‐controlled analgesia device . Methods : Patients aged between 40 and 65 yr were included . Exclusion criteria were obesity , diabetes mellitus , and history of motion sickness , postoperative nausea and vomiting , or smoking . Patients were r and omized into one of two groups , acupressure and control . In the acupressure group , acupressure b and s were placed on both wrists with the plastic bead positioned at the P6 point . In controls , beads were placed at a non‐acupoint site . All patients received a st and ard general anaesthetic . Postoperatively , patients were connected to a patient‐controlled analgesia device with morphine ( loading dose 5 mg , background infusion 1 mg h−1 , bolus dose 1 mg and lock‐out time 10 min ) . Pain and sedation scores , respiratory rate , heart rate , arterial pressure and oxygen saturation were recorded for 24 h. Metoclopramide 10 mg was administered intravenously as a rescue antiemetic . Results : Fifty patients received acupressure and 50 were controls . In the acupressure group , 33 % of patients had nausea compared with 63 % controls . The cumulative incidence of vomiting at 24 h was 25 % with acupressure and 61 % in controls . The incidence of nausea , vomiting and antiemetic use was significantly lower with acupressure . Conclusions : Acupressure at the P6 meridian point is an effective alternative for the prevention of nausea and vomiting in patients receiving patient‐controlled analgesia with morphine after gynaecological surgery Background Antiemetic drugs are costly , are associated with variable efficacy , and can produce unwanted side effects when used for prophylaxis against postoperative nausea and vomiting . This clinical study was design ed to compare the efficacy of transcutaneous electrical acupoint stimulation using a ReliefB and ® to ondansetron ( Zofran ® ) when utilized alone or in combination for preventing postoperative nausea and vomiting after plastic surgery . Methods A single-center , r and omized , double-blind , placebo- and sham-controlled study design was conducted to compare three prophylactic antiemetic treatment regimens in 120 out patients undergoing plastic surgery procedures with routine low-dose droperidol prophylaxis : ( 1 ) ondansetron ( n = 40 ) , 4 mg intravenous ondansetron and a sham ReliefB and ® ; ( 2 ) acustimulation ( n = 40 ) , 2 ml intravenous saline and an active ReliefB and ® ; and ( 3 ) combination ( n = 40 ) , 4 mg intravenous ondansetron and an active ReliefB and ® . The incidences of postoperative nausea and vomiting , as well as the need for “ rescue ” antiemetics , were determined at specific time intervals for up to 72 h after surgery . The outcome variables assessed included recovery times , quality of recovery score , time to resumption of normal diet , and patient satisfaction with the prophylactic antiemetic therapy . Results Use of the ReliefB and ® in combination with ondansetron significantly reduced nausea ( 20 vs. 50 % ) , vomiting ( 0 vs. 20 % ) , and the need for rescue antiemetics ( 10 vs. 37 % ) compared with ondansetron alone at 24 h after surgery . Furthermore , the ability to resume a normal diet ( 74 vs. 35 % ) within 24 h after surgery was significantly improved when the ReliefB and ® was used to supplement ondansetron ( vs. ondansetron alone ) . Finally , the quality of recovery ( 90 ± 10 vs. 70 ± 20 ) and patient satisfaction ( 94 ± 10 vs. 75 ± 22 ) scores were significantly higher in the combination group versus the ondansetron group . There were no significant differences between the ReliefB and ® and ondansetron when administered as adjuvants to droperidol for antiemetic prophylaxis . Conclusions The ReliefB and ® compared favorably to ondansetron ( 4 mg intravenously ) when used for prophylaxis against postoperative nausea and vomiting . Furthermore , the acustimulation device enhanced the antiemetic efficacy of ondansetron after plastic surgery Postoperative vomiting causes patients distress and delays discharge after outpatient surgery . Although P6 electroacupuncture is recognized as having an antiemetic effect , its inconvenient instrumentation may limit its clinical applicability . The purpose of this study was to explore a simple and effective alternative method for control of postoperative vomiting in outpatient surgery . We prospect ively compared the effect of P6 acupoint injection with 0.2 ml 50 % glucose in water ( G/W ) and intravenous injection of 20 μg/kg droperidol for prevention of vomiting in 120 consecutive out patients undergoing gynecological laparoscopy with general anesthesia .  Patients were r and omly allocated to receive P6 acupoint injection , i.v . droperidol , or nothing as control group . Both P6 acupoint injection and i.v . droperidol 20 μg/kg were found to have a significant antiemetic effect when compared with the control group . We conclude that P6 acupoint injection with 50 % G/W is a simple and effective method for reducing the incidence of postoperative emesis in outpatient surgery Postoperative nausea and vomiting ( PONV ) are still common and distressing problems after general anesthesia , especially in patients undergoing abdominal hysterectomy . We studied a nonpharmacological therapy of PONV — capsicum plaster (PAS)—at either the Korean h and acupuncture point K-D2 or the Chinese acupuncture point Pericardium 6 ( P6 ) of both h and s.  One-hundred-sixty healthy patients were included in a r and omized , double-blinded study : 60 patients were in the control group , 50 patients were in the K-D2 group , and 50 patients were in the P6  group . PAS was applied at the K-D2 point in the K-D2 group and at the P6 point in the P6 group , whereas in the control group , an inactive tape was fixed at the K-D2 point of both h and s. The PAS was applied before the induction of anesthesia and removed at 8 h after surgery . The incidence of PONV and the need for rescue medication were evaluated at predetermined time intervals . In the treatment group , the incidence of vomiting was significantly less ( 22 % for the K-D2 group and 26 % for the P6 group ) than in the control group ( 56.7 % ) at 24 h after surgery ( P < 0.001 ) . The need for rescue antiemetics was significantly less in the treatment groups compared with the control group ( P < 0.001 ) . We conclude that PAS at the Korean h and acupuncture point K-D2 was an effective method for reducing PONV , as was PAS at the P6 acupoint , after abdominal hysterectomy Objects We evaluated the effectiveness of transcutaneous electrical acupoint stimulation ( TEAS ) at the P6 acupoint for prevention of postoperative nausea and vomiting in patients undergoing supratentorial craniotomy . Methods The study population was patients aged 20 to 60 years who underwent supratentorial craniotomy under general anesthesia . Exclusion criteria were obesity , diabetes mellitus , and a history of motion sickness , postoperative nausea and vomiting , or smoking . Patients were r and omized into 2 groups : stimulation and control . In the former , transcutaneous stimulation electrodes were placed at the right P6 acupoint . In controls , electrodes were positioned at a nonacupoint site . Patients received a st and ard general anesthesia . Ondansetron was given as a routine antiemetic treatment for each patient before skin closure . Postoperatively , metoclopramide ( 10 mg , i.v . ) was administered as a rescue antiemetic . Result Forty patients received TEAS and 40 were controls . In the TEAS group , 18 % of patients had nausea compared with 37 % of the controls . The cumulative prevalence of vomiting was 12.5 % with acustimulation and 32.5 % in controls ( P<0.05 ) . The prevalence of nausea , vomiting was significantly lower with TEAS at the P6 acupoint . Conclusions TEAS at the P6 meridian points is an effective adjunct to st and ard antiemetic drug therapy for prevention of nausea and vomiting in patients undergoing supratentorial craniotomy Background : Acupuncture and acupressure have previously been reported to possess antiemetic effect . We wanted to investigate the “ true ” and placebo effect of acupressure in prevention of postoperative nausea and vomiting ( PONV ) Postoperative  nausea and vomiting ( PONV ) is one of the most common postoperative complications . Aside from pharmacological interventions , other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes . This study examined acupressure as a potentially holistic and safe complement to the more traditional approach of using drugs to prevent and /or relieve nausea and vomiting in the postoperative patient .  Acupressure involves constant pressure ( without puncture of the skin ) on the Nei Guan acupuncture points through the use of a British product called Sea-B and s ( Sea B and UK Ltd , Leics , Engl and ) . These b and s are made of elasticated fabric , with a small round plastic button inside . A quasi-experimental research design was used to examine the effects of unilateral and bilateral application of acupressure on 157 patients who are prone to PONV : postgynecological , postplastic , and posturological surgery patients . The incidence of PONV was determined through retrospective chart review s. The hypothesis was that there would be a difference in the incidence of PONV between 5 groups : group 1 (  Sea-B and s with acupressure on both wrists ) , group 2  ( Sea-B and s with acupressure on one wrist ) , group 3  ( wristb and without acupressure on both wrists ) , group 4  ( wristb and without acupressure on one wrist ) , and group 5  ( no wristb and ) . This hypothesis was examined by using a one-way analysis of variance ( ANOVA ) ; it was not supported . Neither unilateral nor bilateral application of acupressure significantly affected the incidence of nausea and vomiting . These findings must be viewed with caution , however , because power analysis showed low effect sizes and an inadequate sample size . Further research is recommended with a larger sample size . This study has made perianesthesia nurses more aware of other complementary modalities to assist patients with nausea and vomiting OBJECTIVE To investigate the method for preventing the postoperative nausea and vomiting ( PONV ) after laparoscopic gynecologic surgery . METHODS One hundred and twenty patients being for laparoscopic gynecologic surgery at I- II grade as American Society of anesthesiologists ( ASA ) were r and omly divided into three groups , 40 cases in each group . Twenty minutes before the operation , the mixture of 2 . 5 mg Droperidol ( 1 mL ) and 1 mL 0 . 9 % sodium chloride solution was injected into the bilateral Neiguan ( PC 6 ) in group I , and an intravenous injection with 1 mL Droperidol was used in group II , while there was no treatment carried out in group Ill ' . Twenty four hours after the operation , the frequency and degree of nausea and vomiting were observed and scored according to the criteria st and ard . RESULTS The incidence rate of nausea was 10 . 0 % ( 4/40 ) in group I , 57 . 5 % ( 23/40 ) in group II , which was significantly different from 80 . 0 % ( 32/40 ) in group III ( P<0 . 01 , P<0 . 05 , respectively ) , while it was lower in group I than in group II ( P<0 . 01 ) . The incidence rate of vomiting was 7 . 5 % ( 3/40 ) in group I , 52 . 5 % ( 21/40 ) in group II , which was significantly different from 75.0 % ( 30/40 ) in group III ( P<0.01 , P<0.05 respectively ) , while it was lower in group I than in group II ( P<0.01 ) . No complication , such as obvious drowsiness , anxiety and extracorticospinal tract reaction , was observed among the three groups . CONCLUSION Acupoint injection at Neiguan ( PC 6 ) with a small dose of Droperidol can effectively prevent the PONV after laparoscopic gynecologic surgery without other adverse effects OBJECTIVE To assess the value of search ing for unpublished data by exploring the extent to which Cochrane review s include unpublished data and by evaluating the quality of unpublished trials . STUDY DESIGN AND SETTING We screened all 2,462 completed Cochrane review s published since 2000 in the Cochrane Data base of Systematic Review s Issue 3 , 2006 . In a r and om sample ( n=61 ) of 292 review s , including unpublished trials , we studied all 116 references . RESULTS Unpublished trials make up 8.8 % of all included trials in our sample . Thirty-eight percent of the " unpublished " trials have in fact been published . Allocation concealment was " unclear " or not adequate in 54.3 % and 61.3 % reported blinding . In 47.2 % reported withdrawal rates were > 20 % . Trials that were eventually published had larger mean population sizes ( P-value , 0.02 ) . Of the reported sponsors , 87.3 % were drug companies . Method ological quality and publication bias are mentioned in half of the review s and explored in a third . Quality ratings did not have consequences for pooling , because 82.8 % was included in the forest plots . CONCLUSIONS A minority of Cochrane review s include " unpublished trials " and many of these are eventually published . Truly unpublished studies have poor or unclear method ological quality . Therefore , it may be better to invest in regular updating of review s , rather than in extensive search ing for unpublished data Nonpharmacologic techniques may be effective in preventing postoperative nausea and vomiting ( PONV ) . This sham-controlled , double-blinded study was design ed to examine the antiemetic efficacy of transcutaneous acupoint electrical stimulation ( TAES ) in a surgical population at high risk of developing PONV . We studied 221 out patients undergoing laparoscopic cholecystectomy with a st and ardized general anesthetic technique in this r and omized , multicenter trial . In the TAES group , an active ReliefB and ® ( Woodside Biomedical , Inc. , Carlsbad , CA ) device was placed at the P6 acupoint , whereas in the Sham and Placebo groups , an inactive device was applied at the P6 acupoint and at the dorsal aspect of the wrist , respectively . The ReliefB and was applied after completion of electrocautery and remained in place for 9 h after surgery . The incidence of PONV and need for “ rescue ” medication were evaluated at predetermined time intervals . TAES was associated with a significantly decreased incidence of moderate-to-severe nausea as denoted on the Functional Living Index — Emesis score for up to 9 h after surgery ( 5%–11 % for the TAES group vs 16%–38 % [ P < 0.05 ] and 15%–26 % [ P < 0.05 ] for Sham and Placebo groups , respectively ) . TAES was also associated with a larger proportion of patients free from moderate to severe nausea symptoms ( 73 % vs 41 % and 49 % for Sham and Placebo groups , respectively;P < 0.05 ) . However , there were no statistically significant differences among the three groups with regard to incidence of vomiting or the need for rescue antiemetic drugs . We conclude that TAES with the ReliefB and at the P6 acupoint reduces nausea , but not vomiting , after laparoscopic cholecystectomy STUDY OBJECTIVE To examine the effectiveness of transcutaneous electrical nerve stimulation ( TENS ) on  postoperative nausea and vomiting ( PONV ) . DESIGN R and omized , prospect i ve , controlled study . SETTING Gazi University Medical School Hospital . PATIENTS 40 ASA physical status I-II patients who underwent elective laparoscopic cholecystectomy . INTERVENTIONS Patients were r and omly divided into two equal groups . Group I received TENS ( stimulation group ) , whereas group II served as the control group ( nonstimulation group ) . In group I , one electrode was applied to the hairless skin on the neck as anode , and the other 2 ( electrodes ) were applied to the mastoid area . The stimulator at a frequency of 5 Hz , 50 milliseconds , with a current density of 0.5 to 4 mA was applied on the trapezoid area for 6 hours to all patients postoperatively . MEASUREMENTS All patients in both groups were evaluated for side effects , antiemetic effects , and analgesic and antiemetic need for 24 hours . MAIN RESULTS Postoperative nausea and vomiting , frequency of dizziness , additional antiemetic and analgesic need , and PONV scores were lower in group I than group II . CONCLUSIONS Electrical stimulation of the vestibular system may be useful in the prevention of PONV OBJECTIVE To observe whether acupuncture stimulation of Neiguan ( PC 6 ) can prevent postoperative nausea and vomiting ( PONV ) in patients undergoing craniotomy . METHODS A total of 60 patients scheduled for craniotomy were r and omly assigned to acupuncture group ( n = 30 ) and control group ( n = 30 ) . When regaining consciousness from the surgical anesthesia , patients of the acupuncture group received immediate acupuncture stimulation of bilateral Neiguan ( PC 6 ) . After insertion , the filiform needles were manipulated with uniform reinforcing-reducing method for about 1 min ( re-manipulated once again 10 min later ) , followed by retaining it for 20 min . Patients of the control group received no treatment .  Vomiting or retching ( having vomitus ) was considered as an emetic episode . Nausea was assessed by a four-point verbal rating scale ( none , mild , moderate , severe ) . RESULTS Following the treatment , in the acupuncture group , 1 patient had a vomiting from 0 to 2 h , and 1 patient had a vomiting from 2 to 6 h after the operation , and no patients had this symptom 6 h after the operation . While in the control group , the vomiting occurred in 11 patients from 0 to 2 h , 8 cases from 2 to 6 h , and other 8 cases from 6 to 24 h after the operation . Comparison between two groups showed that the nausea scores in the 3 time-stages were significantly lower in the acupuncture group than in the control group ( P < 0.05 ) . CONCLUSION Acupuncture stimulation of PC 6 is effective in preventing and treating PONV in patients undergoing craniotomy OBJECTIVES Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort , distress , and complications . Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV . The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists , such as ondansetron . We aim ed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation ( TEAS ) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting . SUBJECT AND DESIGN : This r and omized , controlled , prospect i ve study was carried out in a group of 90 children ( in three equal r and omly assigned groups ) , aged between 4 and 12 who underwent tonsillectomy under general anesthesia . In the first group , electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed ( 20 Hz , 5 minutes ) . The second group received a single dose of Ondansetron ( 0.15 mg . kg(-1 ) ) . No treatment was given to the control group . OUTCOME MEASURES The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit , on the day of surgery after discharge , and on the first day after surgery . A satisfaction scale was completed by each family . RESULTS There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge ( p < 0.001 ) . In the ondansetron group , side-effects were seen in more patients than in the other groups ( p < 0.001 ) . The satisfaction scores of the parents were greater in the treatment groups than in the control group ( p < 0.05 ) . CONCLUSION Application of TEAS on se date d children is an easy , painless , reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy We have studied the effect of P6 acupuncture on postoperative vomiting in 45 children undergoing tonsillectomy .  After induction of anaesthesia and before the start of surgery , 50 % of the patients received P6 acupuncture ( in the middle of the ventral surface of the wrist ) for 5 min . There was no difference in the incidence of vomiting between the acupuncture ( 39 % ) and non-acupuncture ( 36 % ) groups . We conclude that , when administered after induction of anaesthesia , P6 acupuncture is ineffective in reducing vomiting after tonsillectomy in children PURPOSE This study was to identify the effects of Nei-Guan acupressure using a wrist b and on postoperative nausea and vomiting after middle ear surgery . METHODS The study design was a nonequivalent control group non-synchronized posttest design . Forty patients were assigned into two groups of 20 patients , the wrist b and group and the control group . In the wrist b and group , acupressure was applied with a wrist b and on the P6 point at both wrists from 30 min before to 24 hr after anesthesia . RESULTS The 1st hypothesis ' Applied wrist b and groups will have a greater reduction in the nausea & vomiting grade s by INVR than the control group ' was accepted ( t=2.303 , p=.028 ) . The 2nd hypothesis ' The Applied wrist b and groups will have a greater reduction in the occurrence of nausea & vomiting than the control group ' was partly accepted . The 3rd hypothesis ' The applied wrist b and group will have a greater reduction in injection of antiemetics for 24 hr . post anesthesia than the control group ' was rejected . CONCLUSION Acupressure on the P6 point using a wrist b and is effective to alleviate nausea for middle ear surgery patients Objective To evaluate the efficacy of transcutaneous electroacupoint stimulation with a train-of-four ( TOF ) mode for the prevention of postoperative nausea and vomiting ( PONV ) in the patients undergoing laparoscopic cholecystectomy . Methods Ninety-six ASA Grade I — II patients scheduled for laparoscopic cholecystectomy were r and omized into  Neiguan ( P6 ) electroacupoint stimulation group ( treated group ) and a placebo control group ( placement of electrodes without electroacupoint stimulation ) . The anesthetic regimen was st and ardized by needling at Neiguan on the left side and connecting the TOF peripheral nerve stimulator . The incidence of nausea , vomiting , severity , antiemetic dosage and the degree of pain were assessed at 0 , 60 , 120 min , and 24 h after surgery . Results The incidence of nausea and vomiting , the dose of antiemetics and the occurrence of severe nausea were all significantly lower in the treated group compared with the control group and the score for pain was obviously reduced in patients of the treated group at 24 h post-operation ( P<0.05 or P<0.01 ) . Conclusion Transcutaneous electroacupoint stimulation at P6 with the TOF mode could reduce the incidence and severity of nausea and vomiting with analgesic effects BACKGROUND AND OBJECTIVE To assess the effect of publication bias and country effect on the results and conclusion of a systematic review of wrist P6 acupoint stimulation for the prevention of  postoperative nausea and vomiting .  METHODS Re analysis of a systematic review of 26 r and omized trials comparing P6 acupoint stimulation with sham published in the Cochrane Data base of Systematic Review s using the Copas ' sensitivity approach . RESULTS If it is assumed that all studies that have ever been carried out are included , or that those selected for review are truly representative of all such studies , then the estimated relative risk ( RR ) for nausea was 0.71 ( 95 % CI : 0.58 to 0.88 , P<.01 ) and for vomiting was 0.70 ( 95 % CI : 0.56 to 0.88 , P<.01 ) after adjusting for country effect . For nausea , adjustment for publication bias suggests that the risk has been overestimated . If around 33 % of studies have been unpublished , the RR of nausea ( 0.92 , 95 % CI : 0.80 to 1.06 , P=.25 ) is no longer significant . For vomiting , however , there is no strong evidence of publication bias . The number of unpublished studies required to substantially overturn the above significant result is implausibly large . CONCLUSION Publication bias affects the published estimate of postoperative nausea , not vomiting Purpose To investigate the effect of sensory stimulation of the P6 point on postoperative nausea and vomiting ( PONV )  after gynecological surgery in the everyday clinical setting ( effectiveness study ) . Methods Four hundred and ten women undergoing general anesthesia for elective gynecological surgery were included in a prospect i ve , consecutive , r and omized , multicentre , placebo-controlled , double-blind clinical trial with a reference group . One group was given bilateral P6 acupressure ( n = 135 ) , a second group similar pressure on bilateral non-acupressure points ( n = 139 ) , and a third group ( n = 136 ) served as reference  group . Nausea ( scale 0–6 ) , vomiting , pain , and satisfaction with the treatment were recorded . Primary outcome was complete response , i.e. , no nausea , vomiting or rescue medication for 24 hr . Results were analyzed by applying logistic regression with indicators of treatments , type of operation and risk score for PONV as explanatory variables . Results Complete response was more frequent in the P6 acupressure group than in the reference group ( P = 0.0194 ) Conversely , the incidence of PONV was 46 % in the reference group , 38 % after pressure on a non-acupoint and 33 % after P6 acupressure . The decrease from 46 % to 33 % was statistically significant . When considering vaginal cases separately , the decrease in PONV was from 36 % to 20 % ( P = 0.0168 ) . The corresponding decrease from 59 % to 55 % in the laparoscopic surgery group was not statistically significant . Conclusion P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynecological surgery . RésuméObjectifRechercher l’effet d’une stimulation sensorielle acupressive en P6 sur les nausées et vomissements postopératoires ( NVPO ) à la suite d’une intervention chirurgicale gynécologique dans un cadre clinique normal ( étude d’efficacité).MéthodeUn essai clinique prospect if , r and omisé , multicentrique , en double aveugle contre placebo et comportant un groupe de référence a été réalisé auprès de 410 femmes qui se sont présentées successivement pour une intervention gynécologique non urgente sous anesthésie générale . Les patientes d’un premier groupe ont reçu de l’acupression en P6 ( n = 135 ) , celles d’un second groupe ont reçu une  pression semblable sur des points bilatéraux , non d’acupression , ( n = 139 ) et un troisième groupe ( n = 136 ) a servi de référence . Les nausées ( échelle de 0–6 ) , les vomissements , la douleur et la satisfaction face au traitement ont été notés . Le premier résultat était une réponse complète , donc absence de nausées , de vomissements ou de médication de secours pendant 24 h. Les résultats ont été analysés par régression logistique avec des indicateurs de traitements , le type d’intervention et le taux de risque de NVPO comme variables explicatives . RésultatsLa réponse complète a été plus fréquente avec l’acupression en P6 que chez les patientes témoins ( P = 0,0194 ) . Inversement , l’incidence de NVPO a été de 46 % dans le groupe de référence , 38 % après une pression de points non acupresseurs et 33 % après l’acupression en P6 . La diminution de 46 % à 33 % était significative . L’examen séparé des cas d’intervention vaginale indique une baisse des NVPO de 36 % à 20 % ( P = 0,0168 ) . La baisse correspondante de 59 % à 55 % dans les cas d’intervention laparoscopique n’était pas significative . Conclusion L’acupression en P6 représente une méthode non effractive de traitement antiémétique prophylactique qui peut avoir sa place pendant une intervention gynécologique BACKGROUND : In this study , we tested the efficacy of several neuromuscular monitoring modes at the P6 acupuncture point for preventing postoperative nausea and vomiting ( PONV ) . METHODS : In this prospect i ve , double-blind , r and omized , placebo-controlled trial , 264 women undergoing laparoscopic hysterectomy were evaluated for PONV . Neuromuscular blockade was monitored by acceleromyography with 1-Hz single twitch ( ST ) over the ulnar nerve ( n = 54 , control ) , and ST ( n = 52 ) , train-of-four ( n = 53 ) , double-burst stimulation ( n = 53 ) , or tetanus ( n = 52 ) over the median nerve stimulating at the P6 acupuncture point . RESULTS : The incidence of PONV ( P = 0.022 ) , the number of requests for patient-controlled analgesia ( P = 0.009 ) , and total patient-controlled analgesia volume ( P = 0.042 ) 6 hours after tetanic stimulation were significantly reduced in the treatment group compared with the control group . Overall , patients in the tetanus group were more satisfied with the management of PONV compared with patients in the control group . CONCLUSION : Tetanic stimulation applied to the P6 acupuncture point can reduce PONV after laparoscopic hysterectomy compared with ST stimulation of the ulnar nerve , result ing in a greater degree of patient satisfaction . None of the stimulations , ST , train-of-four , or double-burst , applied to the P6 acupuncture point significantly affected PONV Nausea and vomiting occur frequently during cesarean section under spinal anesthesia .  Metoclopramide reduces intraoperative nausea and vomiting , but not without potential side effects . Acupressure , a noninvasive variation of acupuncture that involves constant pressure on the wrist , has been suggested as an alternative method to prevent nausea and vomiting . The aim of this study was to compare acupressure and intravenous ( IV ) metoclopramide for the prevention of nausea and vomiting during  elective cesarean section  under spinal anesthesia . Seventy-five patients were studied in a r and omized , prospect i ve , double-blind comparative trial . Group I patients received acupressure b and s + 2 mL IV saline , Group II patients received placebo wrist b and s + 10 mg IV metoclopramide , and Group III patients received placebo wrist b and s + 2 mL IV saline . Patients who received either acupressure or metoclopramide prior to initiation of spinal anesthesia for cesarean section had much less nausea than patients in the placebo group . Acupressure is an effective , nonpharmacologic method to reduce intraoperative nausea during elective cesarean section in the awake patient . ( Anesth Analg 1997;84:342 - 5 UNLABELLED Nausea is the most common postoperative complication of anesthesia . Appropriately applied acupressure offers a safe and cost-effective nursing approach to the prevention of this problem . This study tested the effect of acupressure on the incidence of postoperative nausea in same-day surgery patients . METHODS Ninety outpatient surgery patients were r and omly assigned to one of three groups . The treatment group ( n = 30 ) received bilateral elastic b and s design ed to exert pressure on the appropriate location on the distal aspect of the wrist during the perioperative period . The placebo group ( n = 30 ) had elastic b and s incapable of acupressure placed on their wrists . The control group ( n = 30 ) received routine nursing and medical interventions for nausea and vomiting . Antiemetics were prescribed by the anesthesiologist and administered to patients in all three groups if nausea persisted and /or emesis occurred . The incidences of nausea or vomiting were tabulated separately for operating room , PACU phase I , and PACU phase II , and compared using Fisher 's Exact Test . RESULTS The incidence of nausea and vomiting did not differ overall in the OR or PACU phase I. However , in PACU phase II the incidence was 10 % in the treatment group , 20 % in the placebo group , and 50 % in the control group ( overall , P = .0001 ) . Treatment wrist b and s reduced the incidence of nausea and vomiting as compared with the control group ( P = .0001 ) , as did the placebo wrist b and s ( P = .0033 ) . The numerical trend suggests that the incidence is reduced by half . The incidence of nausea can be significantly reduced by the use of placebo and suggests that further reduction can be obtained by using acupressure Background and objective Postoperative nausea and vomiting causes discomfort in many patients despite both antiemetic prophylactics and improved anaesthetic techniques . Stimulation of acupoint P6 is described as an alternative method for prophylaxis of postoperative nausea and vomiting . In a r and omised , double-blinded study , we aim ed to investigate the effect of P6 acupoint stimulation on the incidence of postoperative nausea and vomiting within 24 h postoperatively with an acupressure wristb and : Vital-B and . Methods One hundred and thirty-four healthy , non-smoking women scheduled for breast surgery were r and omised either to P6 stimulation or to sham control . Wristb and s were applied and covered with a dressing before induction of anaesthesia . Follow-up was carried out three times within 24 h postoperatively . Primary outcomes were postoperative nausea and /or vomiting . Results One hundred and twelve patients completed the study . There were no statistically significant differences in the incidence of nausea [ P6 stimulation , 35.1 % ( 95 % confidence interval , CI 22.7–47.5 % ) versus sham control , 43.1 % ( 95 % CI 29.5–56.7 % ; P = 0.433 ) ] or vomiting [ P6 stimulation , 25.9 % ( 95 % CI 14.6–37.2 % ) versus sham control , 26.9 % ( 95 % CI 14.8–39.0 % ; P = 1.000 ) ] . Approximately , one third of the patients reported side effects caused by the wristb and , for example , redness , swelling and tenderness . Conclusion We did not find the Vital-B and effective in preventing either nausea or vomiting after operation in women undergoing breast surgery Background This study was design ed to evaluate transcutaneous electrical acupoint stimulation ( acustimulation ) using the ReliefB and ® compared with ondansetron for the treatment of established postoperative nausea and vomiting ( PONV ) after outpatient laparoscopic surgery . Methods After the authors obtained institutional review board approval and written informed consent , 268 out patients were enrolled in this r and omized , double-blind , placebo- and sham-controlled study . All patients received antiemetic prophylaxis with metoclopramide , 10 mg intravenously , or droperidol , 0.625 mg intravenously , after induction of anesthesia . A total of 90 patients developed PONV in the recovery units and were r and omized to one of three treatment groups : ( 1 ) the ondansetron group received 4 mg intravenous ondansetron and a sham ReliefB and ® ; ( 2 ) the acustimulation group received 2 ml intravenous saline and a ReliefB and ® ; and ( 3 ) the combination group received 4 mg intravenous ondansetron and a ReliefB and ® . A rescue antiemetic ( 10 mg intravenous metoclopramide ) was administered only if the PONV symptoms persisted for 15 min or longer after initiating the treatment . A blinded observer recorded the recovery times , emetic symptoms , rescue antiemetics , maximum nausea scores , complete response to study treatment , and time to achieve discharge criteria . Postdischarge side effects , as well as patient satisfaction and quality of recovery scores , were assessed at 24 and 72 h after surgery . Results The combination group had a significantly higher complete response rate than the acustimulation group ( 73%vs . 40 % , P < 0.01 ) . In addition , fewer patients ( 8 vs. 18 ) in the combination ( vs. acustimulation ) group experienced subsequent emetic events ( P < 0.03 ) . However , there were no significant differences between the three groups with respect to patient satisfaction and quality of recovery scores . Conclusions Acustimulation with the ReliefB and ® can be used as an alternative to ondansetron for the treatment of established PONV . However , the use of ondansetron ( 4 mg intravenously ) in combination with the ReliefB and ® device improved the complete response rate to the acustimulation therapy Many r and omised controlled trials have been conducted in China to evaluate the effectiveness of traditional Chinese medicine , but much of the information is inaccessible to Western doctors . We estimated the total number of r and omised controlled trials published in China and identified problems in applying such methodology to the evaluation of traditional Chinese medicine , which would serve as preparatory work for systematic review and dissemination of the r and omised evidence for such medicine . We r and omly selected 28 journals using stratified sampling from a total of 100 Chinese journals of traditional Chinese medicine ( 4 national , 10 university , 10 provincial or regional , and 4 specialist journals ) . After special training , eight fifth year medical students ( working in pairs ) h and search ed all the issues of the journals published before 1 January 1997 to identify r and omised controlled trials . Discrepancies were settled by one of the principal investigators ( S-YZ ) . Data on method ological quality of r and omised controlled trials were extracted from 414 full length articles BACKGROUND Post-operative nausea and vomiting is a common complication following general anaesthesia . Traditional Chinese medicine indicates that acupressure therapy may reduce nausea and vomiting in certain ailments . AIM ( S ) OF THE STUDY The aim of this study was to examine the effect of stimulating two acupressure points on prevention of post-operative nausea and vomiting . DESIGN AND METHODS A r and omized block experimental design was used . The Rhodes Index of Nausea , Vomiting and Retching ( INVR ) question naire was used as a tool to measure incidence . To control the motion sickness variable , the subjects who underwent functional endoscopic sinus surgery ( FESS ) under general anaesthesia were r and omly assigned to a finger-pressing group , a wrist-b and group , and a control group . There were 150 subjects in total with each group consisting of 50 subjects . The acupoints and treatment times were similar in the finger-pressing group and wrist-b and pressing group , whereas only conversation was employed in the control group . RESULTS Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure , wrist-b and , and control groups , with a reduction in the incidence rate of nausea from 73.0 % to 43.2 % and vomiting incidence rate from 90.5 % to 42.9 % in the former . The amount of vomitus and the degree of discomfort were , respectively , less and lower in the former group . CONCLUSION In view of the total absence of side-effects in acupressure , its application is worthy of use . This study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting The possible postoperative antiemetic effect of transcutaneous electrical nerve stimulation ( TENS ) on the P6 point ( on the Pericardium Channel of H and -Jueyin ) was evaluated in 103 women undergoing hysterectomy .  TENS on the P6 point was applied 30 - 45 min before induction of anesthesia in 51 patients and continued for 6 h postoperatively . The control group , 52 patients , was treated exactly in the same way but with the electrical stimulator turned off . Incidence of vomiting was assessed blindly 2 h , 4 h , 6 h , and 8 h postoperatively . The incidence of vomiting postoperatively was significantly less in the TENS-treated group when compared with the control group ( between 0 h and 2 h : 23 % vs 43 % , P < 0.05 ; between 2 h and 4 h : 27 % vs 50 % , P < 0.025 ; and between 4 h and 6 h : 31 % vs 67 % , P < 0.001 , respectively ) . Six hours postoperatively TENS was discontinued , and 8 h postoperatively the two groups did not differ significantly for incidence of vomiting ( between 6 h and 8 h : 51 % vs 65 % ) . The authors conclude that TENS reduces the incidence of vomiting after hysterectomy Background : Electrical stimulation of the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting ( PONV ) . Neuromuscular blockade during general anesthesia can be monitored with electrical peripheral nerve stimulation at the wrist . The authors tested the effect of neuromuscular monitoring over the P6 acupuncture point on the reduction of PONV . Methods : In this prospect i ve , double-blinded , r and omized control trial , the authors investigated , with institutional review board approval and informed consent , 220 women undergoing elective laparoscopic surgery anesthetized with fentanyl , sevoflurane , and rocuronium .  During anesthesia , neuromuscular blockade was monitored by a conventional nerve stimulator at a frequency of 1 Hz over the ulnar nerve ( n = 110 , control group ) or over the median nerve ( n = 110 , P6 group ) stimulating at the P6 acupuncture point at the same time . The authors evaluated the incidence of nausea and vomiting during the first 24 h. Results : No differences in demographic and morphometric data were found between both groups . The 24-h incidence of PONV was 45 % in the P6 acupuncture group versus 61 % in the control group ( P = 0.022 ) . Nausea decreased from 56 % in the control group to 40 % in the P6 group ( P = 0.022 ) , but emesis decreased only from 28 % to 23 % ( P = 0.439 ) . Nausea decreased substantially during the first 6 h of the observation period ( P = 0.009 ) . Fewer subjects in the acupuncture group required ondansetron as rescue therapy ( 27 % vs. 39 % ; P = 0.086 ) . Conclusion : Intraoperative P6 acupuncture point stimulation with a conventional nerve stimulator during surgery significantly reduced the incidence of PONV over 24 h. The efficacy of P6 stimulation is similar to that of commonly used antiemetic drugs in the prevention of PONV Background : Current rates of postoperative nausea and vomiting experienced by outpatient surgery patients are as high as 20 to 30 percent . Electroacustimulation therapy has been demonstrated to be effective in controlling these symptoms , but trials identifying its efficacy in the outpatient surgery population are lacking . Methods : One hundred twenty-two patients undergoing surgical procedures at an outpatient surgery center were r and omized to two treatment arms . The first arm received the st and ardized pharmacologic postoperative nausea and vomiting prevention typical for patients undergoing outpatient surgery , whereas in the second arm , the ReliefB and and pharmacologic measures were used . The ReliefB and is a U.S. Food and Drug Administration – approved electroacustimulation device . Electroacustimulation is a derivative of acupuncture therapy that uses a small electrical current to stimulate acupuncture points on the human body and is thought to relieve nausea , vomiting , and pain . Outcomes measured were pain and nausea symptoms , emetic events , the need for rescue medications , and the time to discharge . Results : The electroacustimulation arm reported statistically significant lower nausea scores at 30 minutes and 120 minutes postoperatively ( p < 0.05 ) . In addition , subgroup analysis demonstrated significant findings in favor of the experimental group , with anatomical subsets of surgical patients requiring less pain medication and shorter times from surgery to discharge when compared with the st and ard treatment . However , electroacustimulation did not have a significant effect on the amount of pain experienced by patients in any group . Conclusion : The authors ' study demonstrates that electroacustimulation offers added protection against symptoms of postoperative nausea and vomiting in an outpatient cosmetic surgery population , representing a safe and cost-effective addition to current pharmacologic preventive measures BACKGROUND Electrical acustimulation can reduce  postoperative nausea and vomiting ( PONV ) . The primary purpose of this study was to investigate the effectiveness of acustimulation in relation to known risk factors for PONV . We also tested the secondary hypothesis that pre- or post-induction application of acustimulation results in differences in PONV reduction . METHODS Two hundred women undergoing vaginal hysterectomy were enrolled in this prospect i ve , observer-blind , r and omized controlled trial . Patients received r and omly for 24 h acustimulation ( n=101 ) , subdivided into groups of pre-induction ( n=48 ) and post-induction ( n=53 ) , or sham stimulation ( n=99 ) , subdivided into groups of pre-induction ( n=49 ) or post-induction ( n=50 ) . Nausea and vomiting/retching was recorded for 24 h after operation in the whole group and stratified by risk factors ( female gender , non-smoker , history of PONV/motion sickness , and postoperative morphine usage ) . RESULTS The incidence of PONV and need for rescue therapy was significantly lower in the acustimulation than in the sham group ( PONV , 33 % vs 63 % , P<0.001 ; rescue therapy , 39 % vs 61 % , P=0.001 ) . The risk ratio for acustimulation and PONV was 0.29 [ 95 % confidence interval ( CI ) 0.16 - 0.52 ] and for rescue therapy , it was 0.38 ( 95 % CI 0.21 - 0.66 ) . Subgroup analyses according to the simplified risk score by Apfel and colleagues revealed a reduction in high-risk patients , that is , when three or four risk factors were present . Binary logistic regression analysis revealed that no history of PONV and usage of acustimulation were independent predictors for risk reduction of all PONV qualities . No significant difference in PONV reducing effects could be detected between pre- and post-induction . CONCLUSIONS Continuous 24 h acustimulation decreases PONV , particularly in patients at high risk Background Electrical stimulation of acupuncture point P6 reduces the incidence of postoperative nausea or vomiting ( PONV ) in adult patients . However , acupressure , laser stimulation of P6 , and acupuncture during anesthesia have not been effective for reducing PONV in the pediatric population . The authors studied the effect of electrical P6 acupuncture in awake pediatric patients who had undergone surgery associated with a high incidence of PONV .  Methods Patients aged 4–18 yr undergoing tonsillectomy with or without adenoidectomy were r and omly assigned to acupuncture , sham acupuncture , or control groups . Acupuncture needles at P6 and a neutral point were placed while patients were anesthetized , and low-frequency electrical stimulation was applied to these points for 20 min in the recovery room while the patients were awake ( P6 Acu group ) . This treatment was compared with sham needles along the arm at acupuncture points not associated with antiemesis ( sham group ) and a no-needle control group . The arms were wrapped to prevent identification of treatment group , and anesthetic , analgesic , and surgical technique were st and ardized . Assessed outcomes were occurrence of nausea , occurrence and number of episodes of vomiting , time to vomiting , and use of antiemetic rescue medication . Results One hundred twenty patients were enrolled in the study , 40 per group . There were no differences in age , weight , sex , or opioid administration between groups . The PONV incidence was significantly lower with P6 acupuncture ( 25 of 40 or 63 % ; odds ratio , 0.135 ; number needed to treat , 3.3;P < 0.001 ) compared with controls ( 37 of 40 or 93 % ) . Sham puncture had no effect on PONV ( 35 of 40 or 88%;P = not significant ) . Occurrence of nausea was significantly less in P6 Acu ( 24 of 40 or 60 % ; odds ratio , 0.121;P < 0.01 ) , but not in the sham group ( 34 of 40 or 85 % ) compared with the control group ( 37 of 40 or 93 % ) . Vomiting occurred in 25 of 40 or 63 % in P6 Acu ; 35 of 40 or 88 % in the sham group , and 31 in 40 or 78 % in the control group ( P = not significant ) . Patients receiving sham puncture vomited significantly earlier ( P < 0.02 ) and needed more rescue treatment ( 33 of 40 or 83 % ; odds ratio , 3.48;P < 0.02 ) compared with P6 Acu ( 23 of 40 or 58 % ) and the control group ( 24 of 40 or 60 % ) . Conclusions Perioperative P6 electroacupuncture in awake patients significantly reduced the occurrence of nausea compared with the sham and control groups , but it did not significantly reduce the incidence or number of episodes of emesis or the use of rescue antiemetics . Sham acupuncture may exacerbate the severity but not the incidence of emesis . The efficacy of P6 acupuncture for PONV prevention is similar to commonly used pharmacotherapies . Its appropriate role in prevention and treatment of PONV requires further study The antiemetic action of stimulation of the P6 ( Neiguan ) acupuncture ( ACP ) point has been studied in women , premedicated with nalbuphine 10 mg , undergoing minor gynaecological operations under methohexitone-nitrous oxide-oxygen anaesthesia . Invasive ACP -- manual or electrical at 10 Hz -- applied for 5 min at the time of administration of the premedication markedly reduced the incidence of vomiting and nausea in the first 6 h after operation , compared with untreated controls . This did not occur with stimulation of a " dummy " ACP point outside the recognized ACP meridians . Non-invasive methods ( stimulation via a conducting stud or by pressure ) were equally as effective as invasive ACP  during the early postoperative period . However , both these non-invasive approaches were less effective than invasive ACP in the 1 - 6 h postoperative period , although each was as effective as two st and ard antiemetics ( cyclizine  50 mg , metoclopramide 10 mg ) . In view of the total absence of any side effects in more than 500 ACP procedures , the clinical applications of this finding are worthy of further study This r and omised , placebo‐controlled , patient and observer blinded trial was conducted to determine whether acupuncture at the acupuncture point P6 is effective in preventing postoperative nausea and vomiting ( PONV ) compared to placebo acupuncture .  Female patients ( n = 220 ) scheduled for gynaecological or breast surgery were r and omly assigned to two groups receiving either acupuncture ( n = 109 ) or placebo acupuncture ( n = 111 ) . Each group was stratified for type of surgery and included two subgroups receiving intervention either before or after induction of anaesthesia . The incidence of PONV and /or antiemetic rescue medication within 24 h after surgery was the main outcome measure which showed no statistically significant difference between groups ( 43.7 % acupuncture , 50.9 % placebo , p = 0.27 ) . The differences were more pronounced for patients having gynaecological surgery ( 48.9 % acupuncture , 67.6 % placebo , p = 0.07 ) than for those having breast surgery ( 38.7 % acupuncture , 40.3 % placebo , p = 0.86 ) . The secondary outcome , vomiting , was significantly reduced by acupuncture from 39.6 % to 24.8 % ( p = 0.03 ) . Subgroup analysis showed no difference between applications of acupuncture before compared to after induction of anaesthesia We r and omized 94 patients undergoing cesarean delivery with spinal anesthesia to receive transcutaneous acupoint electrical stimulation using the ReliefB and ® at the P6 point ( active group ) or an active ReliefB and ® applied to the dorsum of the wrist ( sham control group ) . The ReliefB and ® was applied 30–60 min preoperatively and left in place for 24 h. There was no statistically significant difference between the active and sham control groups in the incidence of intraoperative/postoperative nausea ( 30 % versus 43%/23 % versus 41 % ) , vomiting ( 13 % versus 9%/26 versus 37 % ) , need for rescue antiemetics ( 23 % versus 18%/34 % versus 39 % ) , or complete response ( 55 % versus 57%/51 % versus 34 % ) . There was also no difference between the two groups in nausea scores , number of vomiting episodes , or patient satisfaction with postoperative nausea and vomiting management Ann Saudi Med 28(4 ) July-August 2008 www.saudiannals.net 287 Nausea and vomiting almost always occur aft ter general and regional anesthesia . Despite minimally invasive surgical methods like lapt aroscopy and rapidt and shorttacting anesthesia , naut sea and vomiting after surgery remain a common probt lem.1t5 Nausea and vomiting can result in dehydration , electrolyte imbalance and delay in discharge from the hospital . Serious complications , such as pressure on the suture lines and venous hypertension , may also occur . The incidence of posttoperative nausea and vomiting ( PONV ) has been estimated as 60 % to 70 % following laparoscopic cholecystecomy.6t11 Various factors can int fluence PONV , such as the type of surgery , anesthesia technique , certain drugs , pain and vertigo upon walkt ing . In Chinese and acupuncture medicine , the P6 ( neit guam ) meridian point is recognized as a target point for reducing nausea and vomiting.12t17 Several studies have shown that stimulus of P6 results in a reduction in the incidence of nausea and vomiting after surgery.8,11t13 A Cochrane systemic review concluded that P6 acuprest sure point stimulation seems to reduce the risk of naut sea despite conflicting results in r and omized trials.18 Our study investigated the effect of placement of acut pressure wristb and s at the P6 point in decreasing naut sea and vomiting after laparoscopic cholecystectomy  in comparison with metoclopramide Purpose In a previous study we noticed that P6 acupressure ecreased postoperative nausea and vomiting ( PONV ) more markedly after discharge . As motion sickness susceptibility is increased by , for example , opioids we hypothesized that P6 acupressure decreased PONV by decreasing motion sickness susceptibility . We studied time to nausea by a laboratory motion challenge in a group of volunteers , during P6 and placebo acupressure . Methods 60 women with high and low susceptibilities for motion sickness participated in a r and omized and double-blind study with an active P6 acupressure , placebo acupressure , and a control group ( n = 20 in each group ) . The risk score for PONV was over 50 % . The motion challenge was by eccentric rotation in a chair , blindfolded and with chin to chest movements of the head . The challenge was stopped when women reported moderate nausea . Symptoms were recorded . Results Mean time to moderate nausea was longer in the P6 acupressure group compared to the control group . P6 acupressure = 352 ( 259 - 445 ) , mean ( 95 % confidence interval ) in seconds , control = 151 ( 121 - 181 ) and placebo acupressure = 280 ( 161 - 340 ) ; ( P = 0.006 ) . No difference was found between P6 and placebo acupressure or placebo acupressure and control groups . Previous severity of motion sickness did not influence time to nausea ( P = 0.107 ) . The cumulative number of symptoms differed between the three groups ( P < 0.05 ) . Fewer symptoms were reported in the P6 acupressure compared to the control group P < 0.009 . Overall , P6 acupressure was only marginally more effective than placebo acupressure on the forearms . Conclusion In females with a history of motion sickness  P6 acupressure increased tolerance to experimental nauseogenic stimuli , and reduced the total number of symptoms reported . RésuméObjectifNous avions expérimenté déjà que ľacupression en P6 diminuait davantage les nausées et les vomissements postopératoires ( NVPO ) après ľhospitalisation . Comme la susceptibilité au mal des transports est augmentée par les opioides , entre autres , nous avons pensé que ľacupression en P6 diminuerait les NVPO en réduisant la susceptibilité au mal des transports . Nous avons mesuré le temps écoulé avant les premières nausées lors de ďune épreuve de mouvement chez des volontaires pendant ľapplication ďacupression en P6 ou ďun placebo . MéthodeNotre essai r and omisé et à double insu a réuni 60 femmes , peu ou très sujettes au mal des transports , réparties en trois groupes :  avec acupression active en P6 , acupression placebo , ou groupe témoin ( n = 20 dans chaque groupe ) . Ľévaluation des risques de NVPO était de plus de 50 % . Ľépreuve de mouvement consistait en une rotation excentrique dans une chaise , les yeux b and és , et en des mouvements de la tête vers la poitrine . Ľépreuve était arrêtée qu and les femmes avaient des nausées modérées . Les symptômes étaient notés . RésultatsLe temps moyen écoulé avant ľapparition de nausées modérées a été plus long dans le groupe avec acupression en P6 comparé au groupe témoin . Acupression en P6 = 352 ( 259 - 445 ) , moyenne ( intervalle de confiance de 95 % ) en secondes , groupe témoin = 151 ( 121 - 181 ) et acupression placebo = 280 ( 161 - 340 ) ; ( P = 0,006 ) . Aucune différence n’a été trouvée entre les groupes ďacupression en P6 et placebo ou entre les groupes placebo et témoin . La sévérité du mal des transports préalable n’a pas eu ďinfluence sur le temps écoulé avant les nausées ( P = 0,107 ) . Ľensemble des symptômes diffère entre les trois groupes ( P < 0,05 ) . Moins de symptômes ont été rapportés chez les patientes soumises à ľacupression en P6 comparées aux témoins P < 0,009 . Sur ľensemble ,  ľacupression en P6  n’a été que marginalement plus efficace que le placebo appliqué sur les avant-bras . Conclusion Chez des femmes qui présentent des antécédents de mal des transports ,  ľacupression en P6  augmente la tolérance aux stimuli nauséogènes expérimentaux et réduit en nombre la fréquence des symptômes We investigated the effects of P6 acustimulation on the incidence of postoperative nausea and vomiting ( PONV ) , antiemetic requirements , and side effects in patients undergoing gynecological laparoscopy with a high risk of PONV . Sixty-two patients were divided into 2 groups r and omly : a ReliefB and group ( RB group ) and a sham ReliefB and group ( S group ) . The P6 acustimulation device ( ReliefB and Medical Technologies LLC , Chicago , Illinois ) was wrapped around the wrists of the patients 15 to 30 minutes before the operation and activated before the induction of anesthesia . The patients ' hemodynamic parameters , nausea scale ( verbal rating scale ) , pain scale ( visual analogue scale ) , PONV score , rescue antiemetics , analgesic requirements , adverse effects , and satisfaction scores in the first 24 hours were recorded . The verbal rating scale scores in the early postoperative period and 6 hours postoperatively were significantly higher in the RB group than in the S group . The PONV scores at 15 minutes and at 6 and 12 hours postoperatively were significantly higher in the S group than in the RB group . The verbal rating scale scores of the patients with higher Apfel risk scores ( 3 or 4 points ) in the early postoperative period and 6 hours postoperatively were significantly lower in the RB group than in the S group . The PONV scores of the patients with high Apfel risk scores at 15 minutes and at 6 and 12 hours postoperatively were significantly lower in the RB group than in the S group . The number of patients and doses of antiemetics required were significantly lower in the RB group than in the S group . Patient satisfaction scores were significantly higher in the RB group than in the S group . Acustimulation with the P6 ReliefB and decreased the severity of nausea , PONV scores , and antiemetic requirements in the early postoperative period of gynecological laparoscopy patients INTRODUCTION The use of acupressure is growing . Several studies have applied pressure to the P6 to reduce postoperative nausea , vomiting , and pain but have reported conflicting results . This study aim ed to investigate the effects of pressure to the P6 point on pain , nausea and vomiting after appendectomy . METHODS A single-blind , r and omized controlled clinical trial was conducted on 88 patients after appendectomy . The subjects were r and omly assigned to two groups . After the patients in the intervention group had regained their consciousness , pressure was applied to the P6 acupoint using special Acub and s. In the control group , the Acub and s were fastened loosely on the patients ' wrists . The bracelets were kept for seven hours and pain , nausea , and vomiting were measured hourly . Student 's t-test and chi-square test were used to analyze data . All analyses were performed in SPSS11.5 . RESULTS The two groups were not significantly different in terms of age , body mass index , duration of anesthesia , and length of incision . The mean pain intensity in the two groups was not significantly different at different times . Overall , 45.4 % of the P6 group and 47.7 % of the control group experienced postoperative nausea . The two groups were not significantly different in the mean intensity of nausea at different postoperative hours . In total , 12 patients in the P6 group and 18 in the control group had vomiting CONCLUSION Pressure to the P6 did not significantly reduce pain and nausea after appendectomy . However , the incidence of vomiting was less in the P6 group . This method can be used to reduce vomiting after appendectomy . Similar studies are suggested to apply pressure with the onset of pain or nausea and vomiting OBJECTIVE To determine whether the application of acupressure b and s would lead to a reduction in postoperative nausea and vomiting after cardiac surgery . DESIGN Prospect i ve , r and omized , double-blind clinical trial . SETTING University-affiliated tertiary care teaching hospital . PARTICIPANTS Adult patients undergoing cardiac surgery . INTERVENTIONS One hundred fifty-two patients were enrolled to receive either acupressure treatment ( n = 75 ) or placebo ( n = 77 ) . All patients had acupressure b and s placed on both wrists before induction of anesthesia ; those in the treatment group had a bead placed in contact with the P6 point on the forearm . MEASUREMENTS AND MAIN RESULTS Patients were assessed for nausea , vomiting , and pain scores during the first 24 hours of the postoperative period . The incidences of nausea , vomiting , pain scores , and analgesic and antiemetic requirements were similar between the 2 groups . A subgroup analysis by gender implied that acupressure treatment may be effective only in female patients . CONCLUSION Acupressure treatment did not lead to a reduction in nausea , vomiting , or antiemetic requirements in patients after cardiac surgery Two consecutive studies were undertaken to evaluate the effectiveness of acupuncture as an antiemetic used in addition to premedication with opioids in patients undergoing minor gynaecological operations . In the first study 25 of the 50 patients underwent acupuncture immediately after premedication with 100 mg meptazinol , the rest receiving the drug alone , and in the second 75 patients were allocated r and omly to one of three groups : a group receiving 10 mg nalbuphine and acupuncture , a group receiving premedication and dummy acupuncture , and a group receiving premedication alone . Manual needling for five minutes at the P6 acupuncture point ( Neiguan ) result ed in a significant reduction in perioperative nausea and vomiting in the 50 patients who underwent acupuncture compared with the 75 patients who received no acupuncture . These findings can not be explained , but it is recommended that the use of acupuncture as an antiemetic should be explored further One hundred unpremedicated female patients of ASA grade 1 or 2 who underwent laparoscopy as out patients were allocated r and omly to one of four groups . All patients received general anaesthesia withfentanyl , thiopentone , halothane , nitrous oxide and oxygen ; suxamethonium was given to facilitate tracheal intubation . In the recovery room , group I ( control ) received no treatment ; group 2 received electro‐acupuncture at the P6 point ( Neiguan ) on the right side for 15 minutes , group 3 received transcutaneous electrical nerve stimulation at the P6 point on the right side for 15 minutes and group 4 received prochlorperazine 5 mg intravenously . Any act of vomiting , including dry retching , during the first 3 postoperative hours was regarded as postoperative emesis . The incidence of postoperative emesis was 11/25 ( 44 % ) in group 1 , 3/25 ( 12 % , p > 0.05 ) in group 2 , 9/25 ( 36 % ) in group 3 , and 3/25 ( 12 % , p < 0.05 ) in group 4 . Our results suggest that electro‐acupuncture  is as effective as prochlorperazine  , and may be better than transcutaneous electrical nerve stimulation , in reducing postoperative emesis BACKGROUND Coronary artery bypass graft and cardiac valve surgeries are frequently performed in medical facilities in the United States , and postoperative nausea ( PON ) is a prevalent problem in this patient population . The purpose of this study was to evaluate the efficacy of a single preoperative acupuncture treatment in the prevention of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery , or both . METHODS Ninety participants presenting for coronary artery bypass graft or cardiac valve surgery , or both , were recruited for this study . Patients were r and omly assigned to receive either one preoperative acupuncture and st and ard postoperative care ( acupuncture group ) or solely st and ard postoperative care ( control group ) . Acupuncture was performed 0.5 to 3 hours before surgery . The PON incidence and severity on postoperative day ( POD ) 2 and POD 3 were measured with vali date d nausea tools . RESULTS The acupuncture group had a significantly lower incidence of nausea compared with the control group ( POD 2 , odds ratio [ OR ] , 0.38 ; p = 0.05 ; and POD 3 , OR , 0.26 ; p = 0.01 ) . The acupuncture group also had a significantly lower score of nausea severity than the control group ( POD 2 , OR , 0.29 ; p = 0.01 ; and POD 3 , OR , 0.25 ; p = 0.01 ) . No adverse effects due to acupuncture treatment were reported . Antiemetics , pain medications , and anesthetics administered intraoperatively did not differ between the two groups and did not influence study results . CONCLUSIONS A single preoperative acupuncture treatment decreased incidence and severity of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery , or both , and caused no adverse effects The incidence of postoperative illness was monitored for 6 hours in 74 women premedicated with nalbuphine , 10 mg , and undergoing short gynecologic operations of similar duration under methohexital‐nitrous oxide‐oxygen anesthesia .  Each patient received P6 acupuncture for 5 minutes at the time of administration of premedication . In r and om order the site of the acupuncture had been previously infiltrated with normal saline solution in half of the patients and 1 % lidocaine in the remaining patients . Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution . This demonstrates the ability of a local anesthetic administered at the point of stimulation to block the antiemetic action of  P6 acupuncture in a manner similar to that shown by others for analgesia PURPOSE This study was done to examine effects of Nei-Guan acupressure on nausea , vomiting and level of satisfaction for gynecological surgery patients who were using a patient-controlled analgesia ( PCA ) . METHODS For this study , 51 patients were assigned to one of three groups , a control group ( 17 patients ) , experimental group 1 ( finger acupressure group ) ( 17 patients ) , and experimental group 2  ( relief b and group ) ( 17 patients ) . The data were collected for 24 hr in the recovery room of a university hospital located in Seoul . The 6 hr-intervals including the time of leaving the recovery room were taken into consideration . RESULTS The occurrence of nausea between the experimental group with Nei-Guan acupressure treatment and the control group was different . However , there was no difference in nausea and vomiting control or level of patient satisfaction between the finger acupressure group and the relief b and group . CONCLUSION Nei-Guan acupressure is recommended for nursing practice as a way for alleviating the opioid-induced nausea and accelerating the recovery of patients who are using PCA after surgery One hundred and sixty-two general surgical patients were prospect ively r and omized to one of three treatments for postoperative nausea and vomiting : ( 1 ) acupressure using elasticated b and s containing a plastic button to apply sustained pressure at the P6 ( Neiguan ) point above the wrist , ( 2 ) control dummy b and s without the pressure button and ( 3 ) antiemetic injections of prochlorperazine with each opiate given and as required . All patients received papaveretum injections as required for pain , and additional prochlorperazine injections were prescribed if nausea was not controlled in groups 1 and 2 . The severity of nausea was assessed using a linear analogue scale and was significantly ( P=0.002 ) reduced by acupressure on both days 1 and 2 , in comparison to both controls and drug treated patients . The incidence of postoperative vomiting , and the need for unplanned antiemetic injections was also reduced by acupressure but this was not statistically significant . Acupressure can work and should be investigated in other clinical situations OBJECTIVE To observe the clinical efficacy of transcutaneous acupoint electrical stimulation ( TAES ) combined intravenous injection and /or Neiguan ( P6 ) injection with droperidol in preventing and treating post-operative nausea and vomiting ( PONV ) after thyroid tumor surgery . METHODS Recruited were 120 female patients who underwent selective thyroid tumor surgery were r and omly assigned to the control group , the TAES group , the IV group ( intravenous injection of droperidol ) , and the P6 group [ Neiguan point ( P6 ) injection of droperidol ] , respectively , 30 cases in each group . Thirty min before anesthesia induction , 2 mL 0.9 % normal saline injection was intravenously injected to those in the control group . Patients in the TAES group received TEAS at bilateral P6 points . 2.5 mg ( 1 mL ) droperidol added in 1 mL 0.9 normal saline was intravenously injected to those in the IV group and injected at bilateral P6 points of those in the P6 group . The occurrence and severity of PONV were observed within 0 - 6 h and within 6 - 24 h after operation in each group . RESULTS Compared with the control group , the incidence and the severity of PONV within 0 - 6 h and within 6 - 24 h after thyroid surgery were significantly reduced in the three treatment groups ( P < 0.05 ) . There was no statistical difference in the incidence or the severity of PONV among the TAES , IV and P6 groups ( P > 0.05 ) . CONCLUSIONS TEAS at P6 could dramatically reduce the occurrence and the severity of PONV after thyroid tumor surgery . Besides , it got equivalent effect to that by intravenous injecting droperidol or by injecting droperidol at P6 Postoperative nausea and vomiting are still common problems after general anesthesia , especially in ambulatory surgery . Drug therapy is often complicated with central nervous system symptoms . We studied a nonpharmacological method of therapy-acupressure-at the Pericardium 6 ( P.6 ) ( Nei-Guan ) meridian point . Two hundred consecutive healthy patients undergoing a variety of short surgical procedures were included in a r and omized , double-blind study : 108 patients were in the acupressure group ( Group 1 ) and 92 patients were in the control group ( Group 2 ) .  Spherical beads of acupressure b and s were placed at the P.6 points in the anterior surface of both forearms in Group 1 patients , while in Group 2 they were placed inappropriately on the posterior surface . The acupressure b and s were placed before induction of anesthesia and were removed 6 h postoperatively . They were covered with a soft cotton wrapping to conceal them from the blinded observer who evaluated the patients for presence of nausea and vomiting and checked the order sheet for any antiemetics prescribed . In both groups , the age , gender , height , weight , and type and duration of surgical procedures were all comparable without significant statistical difference . In Group 1 , only 25 of 108 patients ( 23 % ) had nausea and vomiting as compared to Group 2 , in which 38 of 92 patients ( 41 % ) had nausea and vomiting ( P = 0.0058 ) . We concluded that acupressure at the P.6 ( Nei-Guan ) point is an effective prophylaxis for postsurgical nausea and vomiting and therefore a good alternative to conventional antiemetic treatment . ( Anesth Analg 1997;84:821 - 5 Despite modern anaesthetic procedures , postoperative nausea and vomiting are still the side-effects most often mentioned : acupressure is reported to be an additional method of preventing these effects in minor gynaecological surgery . We investigated the effectiveness of acupressure in patients undergoing gynaecological operations of longer duration ( 6 - 8 h ) in a verum acupressure group compared to a  placebo group . Before beginning the study we investigated a control group to find out the frequency of emesis . In the worst case of nausea that we encountered , 80 % in the 0 - 6 h postoperative period , the number of r and om sample s for the acupressure and placebo groups was calculated ( 30 patients in each group ) . The error for alpha was established at 5 % and the reduction of nausea was 50 % . METHODS . The female patients were 18 to 65 years old ( ASA group I and II ) . Acupressure was carried out by fastening small metal bullets at the point P 6 to each forearm by means of an elastic b and age . The bullets were left there for 24 h. The premedication anaesthesia , postoperative analgesia , and antiemetic treatment were st and ardized . During a 24-h period we investigated the incidence of nausea and vomiting . RESULTS . The anthropometric data , the duration of surgery and the amount of postoperative analgesia were comparable between the three groups . Verum acupressure obtained a statistically significant and relevant reduction in nausea up to the 6th postoperative hour in comparison with the placebo group ( P = 0.03 ) . Nausea was reduced from 53 % in the placebo group to 23 % in the acupressure group . CONCLUSION . As demonstrated in this group of longer gynaecological surgery patients as well as in chemotherapy-induced nausea and vomiting , we were able to demonstrate that acupressure is an effective method of preventing nausea and vomiting without any side-effects . It is a valuable addition to the prevention of postoperative nausea and vomiting . Further studies should be conducted to investigate this possibility further The efficacy of currently available antiemetics remains poor . Concern with their side effects and the high cost of the newer drugs has led to renewed interest in non-pharmacological methods of treatment . We have studied the efficacy of acupressure at the P6 point in the prevention of nausea and vomiting after laparoscopy , in a double-blind , r and omized , controlled study of acupressure vs placebo . We studied 104 patients undergoing laparoscopy and dye investigation . The anaesthetic technique and postoperative analgesia were st and ardized . Failure of treatment was defined as the occurrence of nausea and /or vomiting within the first 24 h after anaesthesia . The use of acupressure reduced the incidence of nausea or vomiting from 42 % to 19 % compared with placebo , with an adjusted risk ratio of 0.24 ( 95 % CI 0.08 - 0.62 ; P = 0.005 ) . Other variables were similar between groups Background : Nausea and vomiting are important side effects following administration of epidural morphine for post‐Cesarean section pain relief . Stimulation of the P‐6 ( Neiguan ) acupoint is a traditional Chinese acupuncture modality used for antiemetic purpose ; it has been found to be effective . The aim of this study was to evaluate the antiemetic effect of P‐6 acupressure in parturients given epidural morphine  for post‐Cesarean section pain relief A prospect i ve , double-blind study was conducted to compare the effect of pressure at the P6 ( Neikuan ) point with placebo as an antiemetic in children . Sixty-six patients , ages 3 - 12 yr , undergoing outpatient surgery for correction of strabismus , were allocated r and omly to receive either bilateral P6 acupressure or placebo during the perioperative period . The study was design ed to detect a 50 % difference in the incidence of postoperative vomiting between the two groups , with a 90 % power of achieving a statistically significant result at the 5 % level ( two-tailed ) . The incidence of postoperative vomiting for the placebo group was 58 % before discharge from hospital , 73 % at home and 82 % in the first 24 h after surgery . The corresponding results for the acupressure group were 58 % before discharge , 71 % at home and 94 % in the first 24 h. These differences were not significant ; P6 acupressure did not reduce the incidence of postoperative vomiting in children undergoing strabismus surgery The antiemetic effects and side-effects of P6 acupuncture and droperidol pre-treatment were evaluated in a r and omized , patient- and observer-blinded study . Ninety unpremedicated children of ASA physical status I or II undergoing outpatient strabismus repair , and aged over one year , were studied . All patients received intravenous thiopentone 5 mg · kg−1 , atropine 0.02 mg · kg−1 and succinylcholine 1.5 mg · kg−1 , and the trachea was intubated . Patients then received either intravenous droperidol 0.075 mg · kg−1 , droperidol plus five minutes ’ P6 acupuncture , or acupuncture alone . Anaesthesia was maintained with nitrous oxide 66 % and halothane 1.5–2.0 % in oxygen with spontaneous ventilation . There was no difference in the incidence of vomiting in the droperidol group ( 17 % before discharge from hospital and 41 % up to 48 hours after discharge ) , combined treatment group ( 17 % and 34 % respectively ) and acupuncture group ( 27 % and 45 % respectively ) . Corresponding figures for the incidence of vomiting before discharge were 17 % , 17 % and 27 % respectively ; these values were also not different . The incidence of restlessness was significantly greater in children receiving droperidol ( 63 % ) or both treatments ( 67 % ) than in those receiving acupuncture alone ( 30 % ; P = 0.007 ) . P6 acupuncture and droperidol are equally ineffective in preventing vomiting within 48 hours of paediatric strabismus repair . Droperidol is associated with increased incidence of postoperative restlessness . RésuméLes effets antiémétiques et les effets secondaires de l’acupuncture P6 et d’un prétraitement au dropéridol ont été évalués lors d’une étude à double insu et au hasard . Quatre-vingt-dix enfants non prémédiqués , classés ASA I ou II , devant subir une chirurgie pour strabisme en cas d’un jour et ågés de plus d’un an , ont été étudiés . Tous les patients ont reçu du thiopental 5 mg · kg−1 , de l’atropine 0,02 mg · kg−1 et de la succinylcholine 1,5 mg · kg−1 iv et la trachée a été intubée . Par la suite , les patients ont reçus soit une dose intraveineuse de dropéridol de 0,075 mg · kg−1 , soit du dropéridol et 5 minutes d’acupuncture P6 , ou seulement de l’acupuncture . L’anesthésie était maintenue à l’aide de protoxyde d’azote 66 % et d’halothane 1,5 à 2 % avec oxygène , sous ventilation spontanée . Il n’y avait aucune différence dans l’incidence de vomissements chez le groupe  dropéridol  ( 17 % avant le congé de l’hôpital et 41 % jusqu’à 48 heures après le congé ) , le groupe avec traitement combiné ( 17 % et 34 % respectivement ) et le groupe acupuncture ( 27 % et 45 % respectivement ) . Les figures correspondantes pour l’incidence de vomissements avant le congé étaient de 17 % , 17 % et 27 % respectivement ; ces valeurs n’étaient également pas différentes . L’incidence d’agitation était significativement plus élevée chez les enfants recevant du dropéridol ( 60 % ) ou les deux traitements ( 67 % ) que chez ceux recevant seulement l’acupuncture ( 30 % ; P = 0,007 ) . L’acupuncture P6 et le dropéridol sont tous les deux inefficaces dans la prévention des vomissements , dans les premières 48 heures d’une chirurgie pédiâtrique pour le strabisme . Le dropéridol est associé à une incidence augmentée d’agitation postopératoire Postoperative nausea and vomiting ( PONV ) is one of the most common postoperative complications . Aside from pharmacological interventions , other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes . This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and /or relieve nausea and vomiting in the Cesarean section ( C/S ) under spinal anesthesia . In a prospect i ve r and omized clinical trial , 152 patients who were c and i date for elective C/S under spinal anesthesia were evaluated in two groups ( acupressure vs control groups ) . Subjects in the acupressure group received constant pressure by a specific wrist elastic b and ( without puncture of the skin ) on the Nei-Guan acupuncture point , 30 min prior to spinal anesthesia . The incidence of PONV was assessed during the surgery , at recovery room and at 1st , 2nd and 3rd two hours after the surgery . Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups , with a reduction in the incidence rate of nausea from 35.5 % to 13.2 % . The amount of vomitus and the degree of discomfort were , respectively , less and lower in the study group . In view of the total absence of side-effects in acupressure , its application is worthy . Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting , when applied 30 minutes prior to surgery We conducted a double-blind , r and omized , placebo-controlled study to investigate the effectiveness of P6 acupuncture on postoperative vomiting in children undergoing strabismus surgery . Acupuncture was performed by laser stimulation with a low-level laser . Laser stimulation of P6 was administered 15 min before induction of anaesthesia and 15 min after arriving in the recovery room . In the laser stimulation group , the incidence of vomiting was significantly lower ( 25 % ) than that in the placebo group ( 85 % ) Background P6 acupuncture in adults is reported to be an effective preventive treatment for postoperative nausea and vomiting ( PONV ) . It is not clear , however , whether this technique is effective as a preventive treatment for  PONV in children . Methods Children undergoing anesthesia and surgery were r and omized to four groups : ( a ) intravenous saline + bilateral P6 acupoint injections ( n = 50 ) ; ( b ) intravenous droperidol + bilateral P6 sham acupuncture ( n = 49 ) ; ( c ) intravenous saline + bilateral sham point injections ( n = 43 ) ; ( d ) intravenous saline + bilateral P6 sham acupuncture ( n = 45 ) . The perioperative anesthetic technique was st and ardized in all subjects . The incidence of postoperative nausea and vomiting ( PONV ) was evaluated in postanesthesia care unit ( PACU ) and 24 h after surgery . Results Incidence of nausea in the PACU was significantly lower in the acupoint group as compared with the sham point group ( 32%vs . 56 % , P = 0.029 ) and P6 sham group ( 32%vs . 64 % , P = 0.002 ) but not as compared with the droperidol group ( 32%vs . 46 % , P = ns ) . Similarly , subjects in the acupoint group had a significantly lower incidence of vomiting in the PACU as compared with the sham point group ( 12%vs . 33 % , P = 0.026 ) and P6 sham group ( 12%vs . 31 % , P = 0.029 ) but not as compared with the droperidol group ( 12%vs . 18 % , P = ns ) . The combined incidence of early PONV was also lower in the acupoint group as compared with the sham point group ( P = 0.045 ) and P6 sham group ( P = 0.004 ) but not as compared with the droperidol group ( 42%vs . 51 % , P = ns ) . Finally , significantly fewer subjects in the acupoint group required intravenous ondansetron as an initial rescue therapy ( P = 0.024 ) . At 24 h after surgery , however , the incidence of late PONV was similar among the four study groups ( P = ns ) . Conclusion In children , P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting Purpose : To evaluate the efficacy of acupressure wristb and s in the prevention of postoperative nausea and vomiting ( PONV ) . Methods : Two hundred ASAI - II patients undergoing elective endoscopic urological procedures were included in a r and omized , prospect i ve , double blind , placebo-controlled study . Spherical beads of acupressure wristb and s were placed at the P6 points in the anterior surface of both forearms in Group 1 patients ( acupressure group , n=100 ) whereas , in Group 2(control group , n=100 ) they were placed inappropriately on the posterior surface . The acupressure wristb and s were applied 30 min before induction of anesthesia and were removed six hours postoperatively . Anesthesia was induced with thiopental and maintained with nitrous oxide and oxygen , fentanly , isoflurane and vecuronium . The tracheas were extubated on the operation table after patients received neostigmine and atropine . Post operative nausea and vomiting were evaluated separately as none , mild , moderate or severe at the time of patient ’s arrival in PACU , then at six hours and twenty-four hours after surgery by a blinded observer . Results : In the acupressure group , 25 patients had PONV compared with 29 patients in the control group ( P = NS ) . Conclusion : Application of acupressure wristb and s at the P6 of both forearms 30 min before induction of anesthesia did not decrease the incidence of PONV in patients undergoing endoscopic urological procedures .RésuméObjectif : Évaluer l’efficacité de bracelets d’acupression utilisés pour la prévention des nausées et des vomissements postopératoires (NVPO).Méthode : Deux cents patients , ASA I – II , devant subir une intervention urologique endoscopique planifiée ont participé à l’étude r and omisée , prospect i ve et à double insu contre placebo . Des bracelets de billes d’acupression ont été placés aux points P6 de la face antérieure des deux avant-bras des patients du Groupe 1 ( groupe d’acupression , n=100 ) t and is que dans le Groupe 2 , ( groupe témoin , n=100 ) , ils l’ont été , de façon inappropriée , sur la face postérieure . On les a appliqués 30 min avant l’induction de l’anesthésie et retirés six heures après l’opération . L’anesthésie comportait du thiopental , à l’induction , et du protoxyde d’azote , de l’oxygène , du fentanyl , de l’isoflurane et du vécuronium . L’extubation trachéale a eu lieu à la salle d’opération après l’administration de néostigmine et d’atropine . Un observateur objectif a évalué les nausées et les vomissements postopératoires comme absents , légers , modérés ou sévères au moment où le patient est arrivé à la salle de réveil , puis six et vingt-quatre heures après l’opération . Résultats : Dans le groupe d’acupression , 25 patients ont eu des NVPO , comparativement à 29 patients du groupe témoin ( P = NS ) . Conclusion : L’application de bracelets d’acupression en P6 aux deux avant-bras , 30 min avant l’induction de l’anesthésie , n’a pas diminué l’incidence de NVPO chez des patients qui subissent une intervention urologique endoscopique INTRODUCTION Approximately 50 % of women experience nausea or vomiting during labour .  P6 acupoint stimulation reduces postoperative nausea and vomiting in early pregnancy and after chemotherapy . The aim of this r and omised , double-blinded , placebo-controlled trial was to determine whether P6 acupressure prevented nausea and vomiting during labour and delivery . METHODS After ethical approval and informed consent , women admitted for induction of labour , or in spontaneous labour , were r and omised to receive either acupressure b and s ( Pressure Right ) ( Group A ) or sham placebo b and s ( Group P ) applied to each wrist . Exclusions included recent nausea or vomiting . RESULTS We consented 365 women and r and omised 340 ( 170 per group ) . The groups had similar patient and labour characteristics . The incidence of nausea and /or vomiting did not significantly differ ( Group A 53 % vs. Group P 50 % , P=0.58 ) . There was no significant difference between groups ( A vs. P , respectively ) in the incidence of nausea ( 52 % vs. 45 % ) , vomiting ( 27 % vs. 28 % ) , rescue antiemetic treatment ( 27 % in both ) , severity of nausea or vomiting , satisfaction with control of nausea or ratings of inconvenience or discomfort from the b and s ( 10 % vs. 11 % ) . Factors significantly associated with emetic symptoms were smoking ( OR 2.16 , 95 % CI 1.07 - 4.37 ) , opioid analgesia ( OR 1.95 , 95 % CI 1.06 - 3.59 ) , history of motion-induced or postoperative nausea and vomiting ( OR 1.85 , 95 % CI 1.17 - 2.94 ) and higher body mass index ( OR 1.07 , 95 % CI 1.01 - 1.12 ) . CONCLUSION In this study acupressure wristb and s applied bilaterally did not reduce the incidence of nausea and vomiting during labour and delivery Background : Postoperative nausea and vomiting ( PONV ) are frequent and harmful complications after neurosurgery . Current pharmacy-based treatment is the st and ard of care ; it , however , lacks efficiency . Invasive and noninvasive acupuncture at the P6 meridian point has been shown to be effective in the prevention of PONV . We evaluated the effectiveness of transcutaneous electrical acupoint stimulation ( TEAS ) at P6 for the prophylaxis of PONV in patients undergoing infratentorial craniotomy . Methods : In this prospect i ve , blind , and r and omized study , patients received TEAS at P6 on the dominant side starting 30 minutes before the induction of anesthesia and up to 24 hours after surgery or sham acustimulation at P6 . The anesthesia was maintained with sevoflurane/remifentanil and intermittent fentanyl/cisatracurium . Antiemetics with 4 mg ondansetron and 10 mg dexamethasone were administered intraoperatively . Data documenting postoperative episodes of nausea and vomiting and the need for  antiemetic rescue  ( 10 mg metoclopramide intramuscularly ) were collected . Statistical analysis was performed using the & khgr;2 test . P<0.05 was considered to be significant . Results : Of the 130 patients enrolled , 119 patients completed the study . The 24-hour cumulative incidence of vomiting was significantly lower in the TEAS group than in the control group ( 22 % vs. 41 % , P=0.025 ) . The cumulative incidences of nausea at 6 hours ( 27 % vs. 47 % , P=0.019 ) and 24 hours ( 33 % vs. 58 % , P=0.008 ) after surgery were also significantly lower in the TEAS group compared with the control group . The overall requirements of rescue antiemetics were similar between the groups . Conclusion : Perioperative TEAS at P6 may be an effective adjunct to the st and ard antiemetic drug therapy for the prevention of PONV after infratentorial craniotomy
BACKGROUND Postoperative nausea and vomiting ( PONV ) are common complications following surgery and anaesthesia .
Antiemetic drugs are only partially effective in preventing PONV .
An alternative approach is to stimulate the PC6 acupoint on the wrist .
This is an up date of a Cochrane review first published in 2004 , up date d in 2009 and now in 2015 .
OBJECTIVES To determine the effectiveness and safety of PC6 acupoint stimulation with or without antiemetic drug versus sham or antiemetic drug for the prevention of PONV in people undergoing surgery .