OBJECTIVE:The purpose of this study was to compare the aromatherapy treatment effects on PONV patients using ginger, lavender and rose oils and a placebo.

DESIGN:A randomized 4-armed placebo controlled study.

SETTING:Gaziosmanpasa University, School of Medicine, Health Research and Application Center.

INTERVENTION:The total of 184 patients were randomized into 4 groups: Aromatherapy with lavender essential oil (Lavender group), with rose essential oil (Rose group), with ginger essential oil (Ginger group) or with pure water (Placebo group).

MAIN OUTCOME MEASURES:Postoperative nausea (0-3 Likert type; 0=no nausea, 1=some, 2=a lot, 3=severe) and vomiting scores (0-3 Likert type; 0=no vomiting, 1 = 1 time, 2 = 2 or 3 time, 3 = 4 times and up) and antiemetic medication requirement.

RESULTS:The nausea scores at 15 min were statistically significantly different between the groups (p = 0.00). The postoperative nausea scores improved in 20 (43.5%) subjects in the placebo group, 38 (82.6%) subjects in the lavender group, 22 (47.8%) subjects in the rose group and 30 (65.2%) subjects in the ginger group (p = 0.00). There were statistically significant differences between the groups with regard to the vomiting and antiemetic drug requirements (p = 0.00).

CONCLUSION:The aromatherapy can be used as an alternative or complementary method for managing PONV. Specifically, the ginger and lavender essential oils were superior to the rose oil and pure water for the aromatherapy treatments. However, further studies with larger sample sizes are necessary to confirm these results.

INTRODUCTION:Successful antiemesis contributes significantly to quality, safety, and patient satisfaction. Patients undergoing general anesthesia often experience postoperative nausea and vomiting (PONV). Acupressure offers a side effect-free alternative to common first-line antiemetics. Because the patient may perceive needle acupuncture as uncomfortable, acupressure is a desirable alternative for the prevention of PONV.

METHODS:This study was a randomized, prospective, double-blinded clinical trial investigating the effect of acupressure in patients with a history of PONV and motion sickness. The three auricular acupressure points chosen were shen men, point zero, and the subcortex point. Rescue treatment for PONV with 4 mg intravenous ondansetron was used if the patient reported persistent nausea. A blinded observer recorded antiemetic rescue data, and postoperative analgesic use was recorded over 24 hours. Nausea, vomiting, and retching were assessed in the post-anesthesia care unit (PACU).

RESULTS:Using univariate analysis, we ruled out the null hypothesis of equal means as a function of intervention group (p = 0.001). Pair-wise comparisons revealed a difference between placebo and test groups (p = 0.000) and also sham and test groups (p = 0.033) where age (p = 0.048) and gender (p = 0.003) were significant covariates.

DISCUSSION:Our data reveal that auricular acupressure significantly decreases nausea during the PACU stay and within the 24 hours postoperatively. It is not clear whether the intervention decreases nausea as a primary effect or as a secondary result by decreasing narcotic requirements. Also, perception of nausea may be in part subjective. This is evidenced by our results in which subjects who received sham points fared better than the placebo subjects.

BACKGROUND: Coronary artery bypass graft and cardiac valve surgeries are frequently performed in medical facilities in the United States, and postoperative nausea (PON) is a prevalent problem in this patient population. The purpose of this study was to evaluate the efficacy of a single preoperative acupuncture treatment in the prevention of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both. METHODS: Ninety participants presenting for coronary artery bypass graft or cardiac valve surgery, or both, were recruited for this study. Patients were randomly assigned to receive either one preoperative acupuncture and standard postoperative care (acupuncture group) or solely standard postoperative care (control group). Acupuncture was performed 0.5 to 3 hours before surgery. The PON incidence and severity on postoperative day (POD) 2 and POD 3 were measured with validated nausea tools. RESULTS: The acupuncture group had a significantly lower incidence of nausea compared with the control group (POD 2, odds ratio [OR], 0.38; p = 0.05; and POD 3, OR, 0.26; p = 0.01). The acupuncture group also had a significantly lower score of nausea severity than the control group (POD 2, OR, 0.29; p = 0.01; and POD 3, OR, 0.25; p = 0.01). No adverse effects due to acupuncture treatment were reported. Antiemetics, pain medications, and anesthetics administered intraoperatively did not differ between the two groups and did not influence study results. CONCLUSIONS: A single preoperative acupuncture treatment decreased incidence and severity of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both, and caused no adverse effects.

BACKGROUND: Coronary artery bypass graft and cardiac valve surgeries are frequently performed in medical facilities in the United States, and postoperative nausea (PON) is a prevalent problem in this patient population. The purpose of this study was to evaluate the efficacy of a single preoperative acupuncture treatment in the prevention of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both. METHODS: Ninety participants presenting for coronary artery bypass graft or cardiac valve surgery, or both, were recruited for this study. Patients were randomly assigned to receive either one preoperative acupuncture and standard postoperative care (acupuncture group) or solely standard postoperative care (control group). Acupuncture was performed 0.5 to 3 hours before surgery. The PON incidence and severity on postoperative day (POD) 2 and POD 3 were measured with validated nausea tools. RESULTS: The acupuncture group had a significantly lower incidence of nausea compared with the control group (POD 2, odds ratio [OR], 0.38; p = 0.05; and POD 3, OR, 0.26; p = 0.01). The acupuncture group also had a significantly lower score of nausea severity than the control group (POD 2, OR, 0.29; p = 0.01; and POD 3, OR, 0.25; p = 0.01). No adverse effects due to acupuncture treatment were reported. Antiemetics, pain medications, and anesthetics administered intraoperatively did not differ between the two groups and did not influence study results. CONCLUSIONS: A single preoperative acupuncture treatment decreased incidence and severity of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both, and caused no adverse effects.

PURPOSE:The purpose of this study was to determine if using essential oil products for adult patients reduced the need for antiemetics for postoperative nausea and vomiting (PONV).

DESIGN:A prospective and retrospective cross-sectional design using a convenience sample.

METHODS:Double blinded to the type of essential oil, subjects randomly selected a nasal inhaler containing peppermint, ginger, or a combination of both. A prophylactic dose was given preoperatively, and during the postoperative period nausea was assessed using verbal descriptive scale.

FINDINGS:Overall 322 same day surgical patients were analyzed (control group [n = 179] and intervention group [n = 143]). The intervention group had a greater history of PONV but received fewer doses of antiemetics postoperatively compared with the control group. There was no significant difference in the effectiveness of the three types of inhalers.

CONCLUSIONS:Aromatherapy demonstrated a statistically significant (P<.05) reduction in the need for antiemetics to treat PONV.

PURPOSE:This study examined the effect of peppermint spirits on postoperative nausea in women following a scheduled C-section.

DESIGN:A pretest-posttest research design with three groups was used. The peppermint group inhaled peppermint spirits, the placebo aromatherapy control group inhaled an inert placebo, green-colored sterile water, and the standard antiemetic therapy control group received standard antiemetics, usually intravenous ondansetron or promethazine suppositories.

METHODS:Women were randomly assigned to a group on admission to the hospital. If they became nauseated, nurses on the mother-baby unit assessed their nausea (baseline), administered the assigned intervention, and then reassessed participants' nausea 2 and 5 minutes after the initial intervention. Participants rated their nausea using a 6-point nausea scale.

FINDINGS:Thirty-five participants became nauseated post-operatively. Participants in all three intervention groups had similar levels of nausea at baseline. The nausea levels of participants in the peppermint spirits group were significantly lower than those of participants in the other two groups 2 and 5 minutes after the initial intervention.

CONCLUSIONS:Peppermint spirits may be a useful adjunct in the treatment of postoperative nausea. This study should be replicated with more participants, using a variety of aromatherapies to treat nausea in participants with different preoperative diagnoses.

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004. OBJECTIVES: To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), the National Library of Medicine publication list of acupuncture studies, and reference lists of articles. SELECTION CRITERIA: All randomized trials of techniques that stimulated the P6 acupoint compared with sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acu-stimulation device, and acupressure in patients undergoing surgery. Primary outcomes were the risks of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the data. We collected adverse effect information from the trials. We used a random-effects model and reported relative risk (RR) with associated 95% confidence intervals (95% CI). MAIN RESULTS: We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots. AUTHORS' CONCLUSIONS: P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004. OBJECTIVES: To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), the National Library of Medicine publication list of acupuncture studies, and reference lists of articles. SELECTION CRITERIA: All randomized trials of techniques that stimulated the P6 acupoint compared with sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acu-stimulation device, and acupressure in patients undergoing surgery. Primary outcomes were the risks of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the data. We collected adverse effect information from the trials. We used a random-effects model and reported relative risk (RR) with associated 95% confidence intervals (95% CI). MAIN RESULTS: We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots. AUTHORS' CONCLUSIONS: P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.

BACKGROUND:: Current rates of postoperative nausea and vomiting experienced by outpatient surgery patients are as high as 20 to 30 percent. Electroacustimulation therapy has been demonstrated to be effective in controlling these symptoms, but trials identifying its efficacy in the outpatient surgery population are lacking. METHODS:: One hundred twenty-two patients undergoing surgical procedures at an outpatient surgery center were randomized to two treatment arms. The first arm received the standardized pharmacologic postoperative nausea and vomiting prevention typical for patients undergoing outpatient surgery, whereas in the second arm, the ReliefBand and pharmacologic measures were used. The ReliefBand is a U.S. Food and Drug Administration-approved electroacustimulation device. Electroacustimulation is a derivative of acupuncture therapy that uses a small electrical current to stimulate acupuncture points on the human body and is thought to relieve nausea, vomiting, and pain. Outcomes measured were pain and nausea symptoms, emetic events, the need for rescue medications, and the time to discharge. RESULTS:: The electroacustimulation arm reported statistically significant lower nausea scores at 30 minutes and 120 minutes postoperatively (p<0.05). In addition, subgroup analysis demonstrated significant findings in favor of the experimental group, with anatomical subsets of surgical patients requiring less pain medication and shorter times from surgery to discharge when compared with the standard treatment. However, electroacustimulation did not have a significant effect on the amount of pain experienced by patients in any group. CONCLUSION:: The authors' study demonstrates that electroacustimulation offers added protection against symptoms of postoperative nausea and vomiting in an outpatient cosmetic surgery population, representing a safe and cost-effective addition to current pharmacologic preventive measures.