The effects of acupuncture on nausea and vomiting and consumption of propofol in cesarean section performed with spinal anesthesia

Abstract

Objective: The incidence of hypotension is 50-60% in obstetric surgeries. The most frequent comorbid clinical case of hypotention is nausea and vomiting. In addition, the probability of vomiting and nausea is very high in the period in which the peritoneum is holden after the birth of newborn. We wanted to observe the effects on nausea and vomiting occuring due to both
spinal anesthesia and traction of peritoneum during caesarean section performed under spinal anesthesia by using conventional acupuncture techniques.

Material and Method: The study including 90 patients in the I-II risk groups of American Society of Anesthesiologists who will undergone caesarean section was planned. Acupuncture was performed for group A (n=45) by using acupuncture needles from the P6 acupuncture point. Similar application was performed for group P (n=45) by using acupuncture needles from a point 3 cm proximal to P6 point. In both practice, the needle was applied 20 mm depth of the skin and upholden for 30 minutes in the
application area. Formation of nausea, vomiting and amount of propofol used was recorded for each patient.

Results: The observation rate of nausea and vomiting in the group A was significantly lower (5, 33 (p<0.05); 2, 5 (p<0.05)).
Propofol consumption rate was also significantly lower (4.6±11.7, 63.0±9.4 mg (p<0.05)).

Conclusion: The acupuncture applied perioperatively on P6 point in order to prevent nausea and vomiting in the cesarean
section performed with spinal anesthesia is an effective method and also reduces the amount of propofol which will be used to
prevent intraoperative vomiting.

Keywords

• Acupuncture; Cesarean; Nause; Vomit; Propofol

Medical Science and Discovery

Öz

References

1. Noroozinia H, Mahoori A, Hasani E, Gerami-Fahim M, Sepehrvand N.Acupuncture techniques during caesarean section. Acta Med Iran. 2013; 52: 163-7.
2. Chattopadhyay S, Goswami S. Palonosetron Prophylaxis for Control of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia. J Obstet Gynaecol India 2015;65: 28-33.
3. Macario A, Weinger M, Camey S, Kim A. Which clinical anaesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652-8.
4. Arndt JO, Bömer W, Krauth J, Marquardt B. Incidence and time course of cardiovascular side effects during spinal anesthesia after prophylactic administration of intravenous fluids or vasoconstrictors. Anesth Analg. 1998; 87: 347–54.
5. Eldaba AA, Amr YM. Intravenous granisetron attenuates hypotension during spinal anesthesia in cesarean delivery: A double-blind, prospective randomized controlled study.J Anaesthesiol Clin Pharmacol. 2015; 31: 329-32.
6. Butterworth J. Physiology of spinal anesthesia: What are the implications for management? Reg Anesth Pain Med. 1998; 23: 370–3.
7. Tarhan O, Canbay O, Celebi N, Uzun S, Sahin A, Coşkun F, Aypar U.Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section. Minerva Anestesiol. 2007; 73: 629-33.
8. Norris MC. Spinal anesthesia for cesarean delivery. In: Norris MC, editor. Handbook of Obstetric Anesthesia. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2000. pp. 309–12.

9. Allen TK, Habib AS.P6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: a systematic review of randomized controlled trials. Anesth Analg. 2008; 107: 1308-12.
10. Kerger H, Turan A, Kredel M, Stuckert U, Alsip N, Gan TJ, et al. Patients' willingness to pay for antiemetic treatment. Acta Anaesthesiol Scand 2007; 51: 38-43.
11. Fujii Y, Numazaki M.Dose-range effects of propofol for reducing emetic symptoms during cesarean delivery.Obstet Gynecol. 2002; 99 :75-9.
12. Ezzo J, Stre,itberger K, Schneider A. Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. J Altern Complement Med 2006; 12: 489-95.
13. Lee A, Fan LT. Stimulation of the wirst acupuncture point 6 for preventing postoperative nausea and vomitting. Cochrane Database Syst Rev 2009:CD003281.
14. Gan TJ, Jiao KR, Zenn M, Georgiade G. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomitting. Anesth Analg 2004; 99: 1070-1075.
15. Wang XQ, Yu JL, Du ZY, Xu R, Jiang CC, Gao X. Electroacupoint stimulation for postoperative nausea and vomiting in patients undergoing supratentorial craniotomy.J Neurosurg Anesthesiol. 2010; 22:128-31.
16. El-Deeb AM, Ahmady MS. Effect of acupuncture on nausea and/or vomitting during and after cesarean section in comparison with ondansetron. J anesth 2011; 25: 698-703.
17. Agarwal A, Pathak A, Gaur A. Acupressure wristbands do not prevent postoperative nausea and vomiting after urological endoscopic surgery. Can J Anaesth. 2000; 47 :319-24.
18. Habib AS, Itchon-Ramos N, Phillips-Bute BG, Gan TJ; Duke Women's Anesthesia (DWA) Research Group.Transcutaneous acupoint electrical stimulation with the ReliefBand for the prevention of nausea and vomiting during and after cesarean delivery under spinal anesthesia.Anesth Analg. 2006 ; 102 :581-4.
19. Rasooli S, Moslemi F, Khaki A. Effect of Sub hypnotic Doses of Propofol and Midazolam for Nausea and Vomiting During Spinal Anesthesia for Cesarean Section.
20. Anesth Pain Med. 2014; 4: 19384.
21. -
22. Voigt M, Fröhlich CW, Hüttel C et.al. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Med Sci Monit. 2013; 19: 993-1000.
23. Hamzei A, Nazemi SH, Alami A, Davarinia Motlagh Gochan A, Kazemi A4.Comparing Different Epinephrine Concentrations for Spinal Anesthesia in Cesarean Section: A Double-Blind Randomized Clinical Trial.
24. Iran J Med Sci. 2015; 40: 302-8.
25. Schumann R, Polaner DM. Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg. 1999; 89: 796–7.
26. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004; 350: 2441–51.
27. Lussos SA, Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia. Reg Anesth. 1992; 17 :126–30.
28. Sane S, Hasanlui MV, Abbasivash R, Mahoori A, Hashemi ST, Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Adv Biomed Res. 2015 ;4: 230.
29. Numazaki M, Fujii Y.Subhypnotic dose of propofol for the prevention of nausea and vomiting during spinal anaesthesia for caesarean section. Anaesth Intensive Care. 2000; 28 :262-5.