Electrical Acupuncture--Another Option to Reduce PONV Effect of P6 Acustimulation on Post-Operative Nausea and Vomiting in Patients Undergoing a Laparoscopic Cholecystectomy

Background: Postoperative nausea and vomiting (PONV) is one of the most frequent complaints that leads to delay in discharge and sometimes warrants admission to a medical facility. Various pharmacologic therapies have been tried and are being used today. P6 acustimulation (electrical acupuncture) has been used with good results, but the timing of its use is still debatable. Objective: To study the effects of reduction in PONV using P6 acustimulation and the timing of its application (preinduction vs postinduction) in patients undergoing laparoscopic cholecystectomy. Design/Methods: This was a randomized double blind controlled study conducted in 200 patients. They were divided into 4 groups: 57 patients having acustimulation before induction; 44 patients having acustimulation after induction; 55 patients having sham acustimulation before induction; and 44 having sham acustimulation after induction. The acustimulation was in the form of a relief band, which is portable, noninvasive, battery operated, and supplies stimulus in the form of current of 31 Hz up to 35 mA to the skin by metal electrodes and the current is transcutaneously applied on the wrist between tendons of flexor carpi radialis and palmaris longus. Data collection included demographics and risk factors for PONV preoperatively. Patients were evaluated at 2, 6, and 24 hours for nausea, vomiting, and retching. Results: 260 patients were evaluated. The incidence of PONV was significantly lower in the acustimulation group up to 2 hours versus placebo. No significant difference was noted in the 6to 24-hour period for either nausea or vomiting. There was definitely a risk reduction of 33.9% in early nausea with acustimulation in patients with 3 to 4 risk factors. Discussion: This study showed that the relative risk reduction of PONV after acustimulation was 31% as compared to other studies of 25%. This was apparent only in the early period of 2 hours irrespective of whether the patients were in the preinduction or postinduction group, while no effect was seen later. This was seen with a maximum of ≥3 risk factors. The limitations of this study were that the patients with active Reliefband® observed some degree of tingling in the hands, which could have led to patient bias, despite the fact that all patients were counseled. Also, there was no difference in the preand postinduction groups. Conclusions: Acustimulation by Reliefband reduces PONV in the early postoperative period with ≥3 risk factors for PONV. Reviewer's Comments: This is an interesting study showing that technologies other than drugs can reduce PONV in laparoscopic cholecystectomy and can be of help in the early postoperative period. (Reviewer-Sunita Goel, MD).