The effects of P6 electrical acustimulation on postoperative nausea and vomiting in patients after infratentorial craniotomy.
BACKGROUND
Postoperative nausea and vomiting (PONV) are frequent and harmful complications after neurosurgery. Current pharmacy-based treatment is the standard 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 prospective, blind, and randomized 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 χ 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.


CONCLUSIONS
Perioperative TEAS at P6 may be an effective adjunct to the standard antiemetic drug therapy for the prevention of PONV after infratentorial craniotomy.
Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
Ming
M
Xu
Shou-Jing
SJ
Zhou
Cheng-Chuan
CC
Jiang
Yi
Y
Wu
Wei-Ling
WL
Shi
Hua-Hua
HH
Gu
Hua-Di
HD
Cai
Xiao-Qiang
XQ
Wang
D015669:Acupuncture Points; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use; D003399:Craniotomy / Q000009:adverse effects*; D004311:Double-Blind Method; D015671:Electroacupuncture / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies
D000932:Antiemetics