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Effectiveness of Transcutaneous Point P6 Stimulation for the Reduction of Rescue Anti-emetics during Cesarean Section under Combined Spinal Epidural. Randomized Controlled Clinical Trial.
Abstract Number: O2-5
Abstract Type: Original Research
Obstetric patients who receive combined spinal-epidural (CSE) anesthesia for elective cesarean section frequently experience intraoperative nausea and vomiting (N&V)1. Prophylactic therapy with antiemetic agents can carry multiple adverse effects to the mother and baby. A non-pharmacological method, P6 acupoint stimulation, has been found to be effective in reduction of the need for intraoperative rescue antiemetics2. However, several other studies did not find P6 stimulation to be effective for this purpose3,4. We conducted a randomized controlled clinical trial to determine the need for rescue antiemetics in parturients who received P6 stimulation compared to those that did not receive P6 stimulation.
Following IRB approval and informed consent, 120 patients were randomized into two groups. Group I (n=60) received transcutaneous point P6 stimulation on the right wrist and group II (n=60) did not receive P6 stimulation. Evidence of N&V was collected intraoperatively. Satisfaction scales for N&V treatment and overall satisfaction were recorded, where 0 is no satisfaction and 10 is complete satisfaction. Parturients that experienced intra-CS N&V had the opportunity to request rescue antiemetic medications. IBM SPSS Statistics V22.0 was used for Chi-squared test, Fisher’s exact test, ANOVA, and Odds ratio analysis of our data.
Baseline characteristics were similar between the two study groups. Parturients in the P6 stimulation group required significantly less total rescue antimetic medications (53.8%) than parturients in the control group (73.3%, 95% CI 0.0897-0.4273; P < 0.0001).
We confirmed that P6 stimulation reduced the need for rescue antiemetics during CS under CSE. P6 stimulation is a simple, non-invasive, effective prophylactic alternative antiemetic treatment that could be of great interest to patients and obstetric anesthesiologists who prefer less invasive care with fewer side effects for CS performed CSE.
1. 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(3):126-130.
2. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Br J Anaesth. 2000;84(4):463-467.
3. Habib AS, Itchon-Ramos N, Phillips-Bute BG, Gan TJ. 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(2):581-584.
4. Ho CM, Tsai HJ, Chan KH, Tsai SK. P6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery. Anesth Analg. 2006;102(3):900-903.