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INCLEN XIX CHINA
RESEARCH AND TRAINING FOR IMPROVING EQUITY, EFFICIENCY AND QUALITY IN HEALTH
CARE
Dr. Li Lei M.D., M.Sc.
ORAL PRESENTATION 35
ACUPOINT INJECTION WITH 0.9% SALINE FOR THE
PREVENTING NAUSEA AND VOMITING AFTER TOTAL ABDOMINAL HYSTERECTOMY
1 Department of Nuclear
Medicine, Kunming Medical College,
Kunming, Yanna, P.R. of China
2 Department of Anesthesiology,
Faculty of Medicine, Chulalongkorn University, Thailand
3 Department of Radiology
and Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University, Thailand
4 Department of
Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University,
Thailand
Objective: To study the effectiveness of acupoint injection with 0.9% saline at the
four acupoints (both side of PC-6 and ST-36) for the prevention of nausea and
vomiting after total abdominal hysterectomy (TAH) under general anesthesia
(GA).
Design:
A
prospective, randomized, double-blinded, placebo-controlled trial.
Setting: This protocol was approved by Faculty of Medicine, Chulalongkorn
University ethics committee, and informed consent was obtained from all
patients in King Chulalongkorn Memorial Hospital, Thai Red Cross Society.
Participants: ASA physical status I-III, aging 20-60 years, weighing between 45-80
Kg, no carcinoma, scheduling for total
abdominal hysterectomy under general anesthesia. Sixty two cases entered the
study, sixty one patients finished the study, one case was excluded for
operative accidence. The eligible
patients were allocated into two groups by block randomization, placebo
group was 31 cases, acupoint group was 30 cases.
Interventions: Both groups of patients
were under the standard general anesthesia and total abdominal hysterectomy. At
the end of the operation, muscle relaxant was reversed, the patient was
extubated, the patient in the study
group received acupoint injection with 0.9% saline 2 ml into each PC-6 and 3 ml
into each ST-36, while the control group did not get any injection. Then
identical adhesive tapes were applied to the acupoints before patient was
transferred to the recovery room.
Outcome measures: Efficacy was assessed by measuring complete response rate (no nausea, no
vomiting and no rescue antiemetics) in both groups for the first 24 hours after
the operation as primary outcome, while the number of retching and
vomiting as well as antiemetic rescue used within 24 hours in both groups were
the secondary outcomes.
Results: 1. There was no
statistical significant difference in the complete response rate( % ) between
the two groups ( 43.3% in acupoint group, while 35.5% in control group ). 95%
CI of the difference is between -
0.167 to 0.323. 2. However, the
number of vomiting in acupoint group was significantly less than
control group (P =0.024) in first 24 hours, especially during 6-24 hours (P =
0.005).
Conclusion: Acupoint injection with normal saline does not reduce the overall
incidence of post operative nausea and
vomiting in 24 hours after total abdominal hysterectomy under general
anesthesia. However it does reduce the severity and intensity of PONV in terms
of number of retching and vomiting in first 24 hours after the operation.
Key words:
Acupoint injection, 0.9% saline, total abdominal hysterectomy, general
anesthesia, postoperative nausea and vomiting.