اثر طب فشاری در کاهش تهوع و استفراغ بعد از عمل جراحی آدنوتونسیلکتومی

    Background & Aim: Postoperative nausea and vomiting(PONV) is a common problem after surgery. Apart from increased patient dissatisfaction, PONV may lead to serious complications including disruption of surgical incisions and anastomosis, electrolyte imbalance, and delay in postoperative rehabilitation. The purpose of this study was to evaluate acupressure as a nonpharmacological alternative for the prevention of PONV in patients undergoing adenotonsilectomy. Patients & Method: We conducted a prospective, randomized, clinical trial to assess the efficacy of acupressure band in prevention of PONV after adenotonsilectomy. The band was placed on patients’ wrists after establishing invasive monitoring and before induction of anesthesia. In the band group, spherical beads of the acupressure band were in contact with the P6 point, which is located on the anterior surface of the forearm, 2 inches proximal to the distal wrist crease between the tendons of flexor carpi radialis and palmaris longus muscles. In the control group, an identical band with a head was placed in the opposite position. Patients with a previous history of congenital heart disease, severe pulmonary dysfunction, prolonged duration of operation due to the complication of anesthesia or surgery, and vomiting during operation were excluded from the study. A standard track for adenotonsilectomy anesthesia was employed. Postoperative pain relief was achieved with acetaminophen and standard pharmacological treatment of nausea and vomiting was applied. Data collection was performed within 6 hours after surgery. Results: 177 children ranging 5 to 10 years were studied in two groups(case-control). 22(24.7%) out of 89 patients in the case group presented with PONV, while 49(55.7%) out of 88 patients in the control group did so. There was no difference between the two groups with respect to demographic data, surgical characteristics, and analgesic requirements. Numerical and categorical data were analyzed by comparing two proportions(z-test) between two independent populations. Data was recorded as number of patients in percent. A Pvalue of less than 0.05 was considered statistically significant. Conclusion: Acupressure is a simple, noninvasive and cost-effective method in prevention of PONV and has been used successfully in different patient populations. Although in one study on the effects of acupressure on PONV in 100 patients undergoing adenotonsilectomy there was no significant difference between the case and control group, we found out that inter-group difference with respect to PONV was approximately 30%, which is suggestive of statistical significance(Pvalue<0.001). In conclusion, we recommend that acupressure be applied to decrease PONV after adenotonsilectomy.