Stimulation of the wrist P6 acupoint to prevent postoperative nausea and vomiting: an update

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Anna Lee¹, Lawrence Fan1, Mary Done²

1Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
2Rural Clinical School, University of New South Wales, Albury, Australia

Purpose of Study

Systematic reviews of acupuncture have overstated effectiveness by including studies likely to be biased.1 We update our previous published Cochrane review in 20042 by applying a more rigorous inclusion criteria to determine the efficacy of P6 acupoint stimulation in preventing postoperative nausea and vomiting (PONV).

Method

Studies that met all of the following criteria were included in this systematic review: randomized, double-blinded (patient and outcome assessor), inclusion of an appropriate sham control group or antiemetic group, sample size > 100 patients and a control event rate > 20%. We performed the last search for trials using electronic databases (Cochrane Library, MEDLINE, EMBASE) in December 2006. The primary outcomes were incidences of nausea, vomiting and rescue antiemetic use. A random effects model was used and relative risk (RR) with associated 95% confidence intervals (95% CI) are reported.

Results: Seven trials (n=1243) were included. There were significant reductions in the risks of nausea (RR 0.82, 95% CI: 0.69 to 0.98), vomiting (RR 0.71, 95% CI: 0.58 to 0.88) and the need for rescue antiemetics (RR 0.75, 95% CI: 0.61 to 0.92) in the P6 acupoint stimulation group compared with the sham treatment group. There was a moderate degree of inconsistency in the results among trials for the nausea and vomiting analyses (I2 statistic were 45% and 33% respectively). The trial results for rescue antiemetics were consistent (I2 statistic was 0%). We found no large high quality trials comparing P6 acupoint stimulation with antiemetic drugs. The meta-analyses are unlikely to be affected by publication bias.

Conclusion

There is good evidence to support the use of P6 acupoint stimulation for preventing PONV in patients without antiemetic prophylaxis. More high quality trials are needed to support the use of P6 acupoint stimulation compared with antiemetic prophylaxis.

1. Derry CJ, Derry S, McQuay HJ, Moore RA. Systematic review of systematic reviews of acupuncture published 1996-2005. Clin Med 2006;6:381-6.
2. Lee A, Done ML. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2004;(3):CD003281

Time of Presentation
1030