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Does 1 hour pre-treatment with P6 stimulation further reduce intra-cesarean nausea and vomiting when compared with application of P6 immediately prior to CSE?
Abstract Number: T2H-330
Abstract Type: Original Research
Approximately 80% of parturients experience nausea and vomiting (N&V) during cesarean section (CS) when no prophylactic antiemetic treatment is given. While IV antiemetic medications have been advocated to prevent intraoperative N&V during CS, they are not entirely effective and may carry multiple adverse effects. In our recent randomized clinical trial, we found that a non-pharmacological method, P6 stimulation, reduces intraoperative N&V, without any side effects. We conducted a 3.5 year retrospective review to evaluate whether a 1-hour pre-treatment with P6 stimulation prior to the initiation of combined spinal epidural anesthesia (CSE) could further reduce the rate of intraoperative N&V.
Following IRB approval, we identified 171 parturients scheduled for elective CS with CSE who had: group I (n=67) received P6 stimulation on the right wrist 1 hour prior to induction of CSE and throughout the CS, group II (n=44) received P6 stimulation immediately prior to CSE administration and throughout the CS, and group III (n=60) did not receive P6 stimulation. The P6 stimulator was turned on gradually to the highest level of intensity tolerated by the Pt. Evidence of N&V was collected intraoperatively. Excel was utilized for Chi-squared test, T-test, and ANOVA analyses.
Baseline characteristics were similar between the 3 groups. Markedly fewer Pts experienced intraoperative vomiting in the P6 group (18.2%) than in the 1hr P6 pretreatment group (31.4%, P=0.04). Pts in the P6 group tolerated a significantly lower level of P6 stimulation (36.9±11.5mA) than in the 1-hr P6 pretreatment group (42.7±9.6mA, P<0.005). Furthermore, fewer Pts experienced intraoperative N&V in each of the treatment groups than in the control group (P<0.05).
When Pts received the P6 stimulation 1hr prior to the initiation of CSE, they had more time to get used to the stimulator and tolerated a higher voltage of P6 stimulation. However, the extended exposure to the higher P6 stimulation voltage did not further reduce the incidence of N&V in our Pts. P6 stimulation continues to be a simple, non-invasive, effective prophylactic alternative antiemetic treatment that could be of great interest to Pts and obstetric anesthesiologists who prefer less invasive care with fewer side effects for CS performed under CSE.
1. Lussos SA, et al. Reg Anesth. 1992;17(3):126.
2. Griffiths JD, et al. Cochrane Database Syst Rev. 2012(9):CD007579.