The most commonly stated fear of patients prior to elective surgery is not death or a surgical mishap. It’s post-operative nausea and vomiting ( PONV ), and 25 to 40 percent of surgical patients are at risk. Defined as any episode of nausea, retching or vomiting in the 24 hours immediately following an operation, PONV negatively affects quality of life for patients already experiencing physical malady.
Clinical Studies Supporting Acupuncture for PONV Relief
In several recent studies, acupuncture has been proven to lessen PONV symptoms. An Australian study found that the insertion of just one needle in the P6 ( Neiguan ) point significantly reduces the likeliness of PONV after surgery. Another study conducted by Duke University Medical Center on breast surgery patients found positive results in the use of acupuncture to prevent occurrences of post-operative nausea and vomiting . It also stated that acupuncture increased general patient satisfaction post-op.
According to this study, 70 percent of women who undergo major breast surgery that requires general anesthesia experience PONV , making breast surgery the leading cause of nausea/vomiting post-op. However, 77 percent of the women who were treated with acupuncture suffered no PONV , nor did they require antiemetic drugs (anti- vomiting medication ). The women who received acupoint stimulation also had less post-surgical pain. Acupuncture’s ability to aid pain relief is related to the release of endorphins (pain dulling brain chemicals). While it is difficult to determine why acupuncture is successful in treating post-operative nausea and vomiting , studies are currently underway to get a clearer picture of the effects it has on post-operative patients.
Nausea and vomiting are basic human reflexes that protect against absorption of toxins in response to certain stimuli. Surgery, disrupting to the body by nature, is a major cause of nausea/vomiting . PONV is triggered by pre-operative factors such as young age, gender (women are three times more likely to suffer PONV ), prior experience leading to anxiety and a history of motion sickness. Inter-operative cause of nausea/vomiting includes type and duration of surgery and type of anesthetic used. Post-operation, it can be exacerbated by pain, opioid anesthesia and oral intake.
Comparing Acupuncture and Pharmacological Treatments for PONV
Currently, therapy for post-operative nausea and vomiting is most often some form of pharmacological intervention. These drugs block the four receptors that are responsible for nausea, but anti- vomiting medication can have upsetting side effects such as extrapyramidal effects (abnormal movement of hands, legs, face and tongue, i.e. tremor and twitching), sedation and hypotension.
Leader of the Duke study, Dr. Tong Joo Gan, said, “In the areas of PONV control, pain relief and general overall satisfaction, acupuncture appears to be more effective than the most commonly used [anit- vomiting ] medication , with few to no side effects.”
Many consider post-operative nausea and vomiting to be as debilitating as the pain associated with surgical procedure. Medical complications of PONV include possible wound disruption, oesophageal tears, gastric herniation, muscular fatigue, dehydration and electrolyte imbalance. PONV can also cause anxiety and depression, and left untreated, can delay recovery.
The side effects of PONV are more than physical. Delayed recovery, continued treatment, longer hospital stay, increased medical care and occasionally re-operation contribute to financial penalties. These cost implications can be serious. It is estimated to cost over $1.2 million per year in unanticipated hospital admissions for following day surgery, which represents only a small percentage of the incidence of PONV .
Other important cost factors include personnel time caring for PONV sufferers and material costs of disposable products, laundry, delayed discharge, anti- vomiting medication , unplanned admission leading to bed overcrowding and delayed surgical throughput.
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Additional Research on Acupuncture’s Effectiveness
Study after study has confirmed acupuncture works to prevent post-operative nausea and vomiting . A trial in 2004 was done to look at the effectiveness of acupuncture at P6 in 220 women undergoing gynecological or breast surgeries. The patients who received acupuncture showed a significant decrease in the incidence of PONV . Another study done in 1998 looked at the effectiveness of laser acupuncture ( applied heat at traditional acupuncture points with an infra-red laser ) at P6 for reducing PONV for 40 children undergoing strabismus surgery. P6 was stimulated 15 minutes before induction and 15 minutes after arriving in the recovery room. The incidence of vomiting was significantly lower for the laser group as opposed to the placebo group.
Surgery can be intimidating to even the strongest of people. The last thing on patients’ minds should be worry over post-operative sickness and the cause of nausea/vomiting . Acupuncture, with its proven ability to relieve pain and bring the body into balance, eases the difficult process of surgery and offers comfort and haste to recovery.
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