Philip A.M. Rogers MRCVS

AP and the Digestive / Gastrointestinal Tract


Aglietti_L; Roila F; Tonato M; Basurto C; Bracarda S; Picciafuoco M; Ballatori E; Del Favero A (1990) A pilot study of metoclopramide, dexamethasone, diphenhydramine and AP in women treated with cisplatin. Cancer Chemother Pharmacol 26(3):239-240. Med Oncol Div, Ospedale Policlinico, Perugia, Italy. A total of 26 women who submitted to cisplatin chemotherapy received as antiemetic treatment a combination of metoclopramide, dexamethasone and diphenhydramine. AP according to TCM was also carried out. The results were compared with those obtained in a similar group of women with cancer, who were treated in the same setting with the same antiemetic combination but without additional AP. AP was shown to increase complete protection from nausea and to decrease the intensity and duration of nausea and vomiting. However, the difficulties of performing AP routinely in daily practice are a hindrance to its wider use.

Allen_DL; Kitching AJ; Nagle C (1994) PC06 acupressure and nausea and vomiting after gynaecological surgery. Anaesth Intensive Care Dec 22(6):691-693. Dept of Anaesthesia, Northampton General Hospital, UK. We studied the effect of PC06 acupressure on 46 women undergoing laparotomy for major gynaecological surgery who received patient-controlled analgesia. Half the patients received acupressure at the PC06 site, the remainder received acupressure at a "sham" site. There was a reduction in the requests for anti-emetic therapy in the group receiving PC06 acupressure but there was no difference in the incidence of nausea and vomiting. There was no difference in total morphine consumption between the two groups.

Belluomini_J; Litt RC; Lee KA; Katz M (1994) Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol Aug 84(2):245-248. Dept of Obstetrics and Gynaecology, California Pacific Med Centre, San Francisco. The effectiveness of acupressure in reducing nausea and vomiting of pregnancy was assessed. Symptomatic pregnant women were randomized to one of two acupressure groups: one treatment group using acupressure at PC06 and one sham control group using a placebo point. Subjects were blind to the group assignment. Each evening for 10 consecutive d, the subjects completed an assessment scale describing the severity and frequency of symptoms that occurred. Data from the first 3 d were used as pre-treatment scores. Beginning on the morning of the day 4, each subject used acupressure at her assigned point for 10 min 4 times/d. Data from day 4 were discarded to allow 24 h for the treatment to take effect. Data from d 5-7 were used to measure treatment effect. 60 women completed the study. There were no differences between groups in attrition, parity, fetal number, maternal age, gestational age at entry, or pre-treatment nausea and emesis scores. Analysis of variance indicated that both groups improved significantly over time, but that nausea improved significantly more in the treatment group than in the sham control group (F1,58=10.4, p=.0021). There were no differences in the severity or frequency of emesis between the groups. There was a significant positive correlation (r=.261, p=.044) between maternal age and severity of nausea. Acupressure at the PC06 was effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women.

Dundee_JW (1990) Belfast experience with PC06 AP antiemesis. Ulster Med J Apr 59(1):63-70. In a strictly controlled clinical situation, (postoperative sickness) where variables were reduced to a minimum, it was possible to show an effective prophylactic antiemetic action of AP at PC06. Manual AP- and EAP- stimulation of this point were equally effective. Non-invasive stimulation (TENS or acupressure) was effective in the early postoperative period, but the effect did not last as long as for invasive AP, although it was as good as standard antiemetics. Stimulation of a "dummy" AP point was ineffective, as was AP given after the emetic stimulus (opioid). This effect can be blocked by local anaesthesia at PC06. Acupressure at PC06 is moderately effective in reducing morning sickness, but here there is more of a psychological element as pressure on a "dummy" point gives some alleviation of symptoms. Given in conjunction with standard antiemetics, PC06 AP is a useful adjuvant in reducing sickness after cancer chemotherapy. This effect can be prolonged for 24 h by acupressure.

Dundee_JW1; McMillan CM (1990) Clinical uses of PC06 AP antiemesis. AETRIJ 15(3-4):211-215. We have seen pregnant women pressing PC06 to prevent morning sickness. Though this was effective, the pressure has to be applied for 5 min every 2 h. This probably has a large psychological element. We studied the antiemetic effects of stimulation of PC06 for 5-10 min by invasive (manual or EAP) or non-invasive (TENS or acupressure) AP. Well controlled studies showed that, when given before opioid premedication, AP significantly reduced postoperative sickness for 6-8 h. Non-invasive AP-methods had a shorter duration of effect, with nausea and/or vomiting often occurring after 2 h. Stimulation of a pseudo-point near the elbow was ineffective. To be effective, AP had to be given before the opioid. The antimentic effect of AP at PC06 can be abolished by local anaesthesia of the point. The most rewarding results were with PC06 stimulation used with standard antiemetics before cancer chemotherapy. Here also, invasive AP was more effective than non-invasive AP. Self-use of TENS was studied recently. Using a portable battery-operated square wave stimulator fixed at 10 Hz, TENS was used for 5 min every 2 h via a large EKG surface electrode on the PC06 point. Modern antiemetics can control vomiting, but they are relatively ineffective against nausea. Nausea and vomiting can be controlled effectively by regular use of TENS or AP. The combination of antiemetic drugs with invasive AP gives the best results in severe cases.

Dundee_JW2; Yang J; McMillan C (1991) Non-invasive stimulation of the PC06 antiemetic AP point in cancer chemotherapy. J of the Royal Society of Med Apr 84(4):210-212. As an adjuvant to standard antiemetics, the beneficial effects of TENS of the PC06 antiemetic point was studied in >100 patients in whom antiemetics alone were inadequate to control chemotherapy-induced sickness. Although the results were not quite as good as with invasive AP, >75% patients achieved considerable benefit from what was a non-toxic procedure. The use of large diffuse low impedance electrodes simplifies the technique. Application of Sea Bands every 2 h prolongs the antiemetic action. Best results were obtained from self-use of 5 min of TENS (15 Hz) every 2 h at PC06 to activate a large, easy-to-place surface electrode and increasing the current until Deqi is elicited.

Dundee_JW3; Ghaly G (1991) Local anaesthesia blocks the antiemetic action of AP at PC06. Clinical Pharmacology and Therapeutics Jul 50(1):78-80. The incidence of postoperative illness was monitored for 6 h in 74 women premedicated with 10 mg nalbuphine, and undergoing short gynaecological operations of similar duration under methohexital-nitrous oxide-oxygen anaesthesia. At the time of premedication, each patient received AP for 5 min at PC06. In random order the site of the AP had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. Local anaesthesia of the point of stimulation can block the antiemetic action of AP at PC06 in a manner similar to that shown by others for APA.

Gieron_C; Wieland B; von der Laage D; Tolksdorf W (1993) Acupressure in the prevention of postoperative nausea and vomiting. Anaesthesist Apr 42(4):221-226. Klinik fur Anasthesiologie, Medizinische Fakultat, RWTH Aachen. Postoperative nausea and vomiting are still the side-effects most often mentioned even after modern anaesthesia. Acupressure is said to be a method of preventing these effects in minor gynaecological surgery. We studied its effectiveness in patients undergoing gynaecological operations of longer duration (6-8 h) in a real acupressure group compared to a placebo group. Before the main trial, we studied a control group to find out the frequency of emesis. In the worst case of nausea that we encountered, 80% in the 0-6 h postoperative period, the number of random samples for the acupressure and placebo groups was calculated (30 patients/group). The error for alpha was established at 5% and the reduction of nausea was 50%. The female patients were aged 18-65 yr (ASA group I and II). Acupressure at PC06 was via small metal bullets fastened to each forearm by an elastic bandage. The bullets were left there for 24 h. Premedication anaesthesia, postoperative analgesia and antiemetic treatment were standardized. During a 24-h period we studied the incidence of nausea and vomiting. The anthropometric data, the duration of surgery and the amount of postoperative analgesia were comparable between the 3 groups. In comparison with the placebo group, real acupressure gave a statistically significant and relevant reduction in nausea up to 6 h postoperative (p=.03). Nausea was reduced from 53% in the placebo group to 23% in the acupressure group. Acupressure was effective in preventing nausea and vomiting without any side-effects in this group of longer gynaecological surgery patients, as well as in chemotherapy-induced nausea and vomiting. It is a valuable addition to the prevention of postoperative nausea and vomiting. Further studies are needed.

Ho_RT; Jawan B; Fung ST; Cheung HK; Lee JH (1990) EAP and postoperative emesis [see comments]. Anaesthesia Apr 45(4):327-329. Dept of Anaesthesiol, Chang Gung Memorial Hospital, Taiwan, ROC. Unpremedicated female patients (n=100) of ASA grade 1 or 2 who underwent laparoscopy as outpatients were allocated randomly to one of 4 groups. All patients received general anaesthesia with fentanyl, thiopentone, halothane, nitrous oxide and oxygen; suxamethonium was given to facilitate tracheal intubation. In the recovery room, group 1 (control) received no treatment; group 2 received EAP at PC06 on the right side for 15 min, group 3 received TENS at the PC06 point on the right side for 15 min and group 4 received prochlorperazine 5 mg iv. Any act of vomiting, including dry retching, during the first 3 h after surgery was regarded as postoperative emesis. The incidence of postoperative emesis was 11/25 (44%) in group 1, 3/25 (12%, p <.05) in group 2, 9/25 (36%) in group 3, and 3/25 (12%, p <.05) in group 4. EAP was as effective as prochlorperazine, and may be better than TENS, in reducing postoperative emesis.

Hyde_E (1989) Acupressure therapy for morning sickness: a controlled clinical trial. Journal of Nurse Midwifery Jul-Aug 34(4):171-178. A prospective, controlled clinical trial examined the efficacy of acupressure therapy for morning sickness, using a two group, random assignment, crossover design. Subjects in Group 1 (n=8) used acupressure wristbands for five days, followed by five days without therapy. Subjects in Group 2 (n=8) had no therapy for five days, followed by five days use of wristbands. The Multiple Affect Adjective Checklist and Sickness Impact Profile were used, and extent of nausea was assessed at baseline, day five, and day ten. Use of acupressure wristbands relieved morning sickness for 12/16 subjects (x2=5.31 with Yates' correction factor, df=1, p <.025). Acupressure therapy resulted in statistically significant (p <.05) reductions in anxiety, depression, behavioral dysfunction and nausea. Limitations of the study and suggestions for future research are presented.

McConaghy_P; Bland D; Swales H (1996) AP in the Management of Postoperative Nausea and Vomiting in Patients Receiving Morphine via a Patient-Controlled Analgesia System. Adapted from WWW. A single-blind, randomised, controlled trial was done in patients receiving parenteral morphine via a Patient-Controlled Analgesia System (PCAS), to assess the efficacy of AP at the PC06 in the management of PONV (postoperative nausea and vomiting). 80 patients were recruited on the first postoperative day; 30 were treated with AP after developing PONV lasting >10 min. Patients were randomly allocated to receive AP bilaterally at either PC06 or at a pseudo-point near the elbow, with manual stimulation for a total of 4min. Only patients naive to AP antiemesis were studied; each patient was thus unaware of the group to which they were allocated. The mean VAS for nausea improved more in patients treated with AP at PC06.

Yang_LC; Jawan B; Chen CN; Ho RT; Chang KA; Lee JH (1993) Comparison of PC06 AP point injection with 50% glucose in water and iv droperidol for prevention of vomiting after gynaecological laparoscopy. Acta Anaesthesiol Scand Feb 37(2):192-194. Dept of Anaesthesiology, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, ROC. Postoperative vomiting causes patients distress and delays discharge after outpatient surgery. Although EAP at PC06 is known to have antiemetic effects, its inconvenient instrumentation may limit its clinical applicability. The purpose of this study was to explore a simple and effective alternative method for control of postoperative vomiting in outpatient surgery. We prospectively compared the effect of point injection with 0.2 ml 50% glucose in water (G/W) at PC06 and iv injection of 20 ug/kg droperidol for prevention of vomiting in 120 consecutive outpatients undergoing gynaecological laparoscopy with general anaesthesia. Patients were randomly allocated to receive AP point injection, iv droperidol, or nothing as control group. Both AP point injection and iv droperidol 20 ug/kg had a significant antiemetic effect when compared with the control group. Point injection of 50% glucose solution at PC06 is simple and effective in reducing the incidence of postoperative emesis in outpatient surgery.

Yentis_SM1; Bissonnette B (1991) Oriental concepts of AP: AP at PC06 and postoperative vomiting after tonsillectomy in children [see comments]. Br J Anaesth Dec 67(6):779-780. Dept of Anaesthesia, Hospital for Sick Children, Univ of Toronto, Ontario, Canada. The effect of AP at PC06 on postoperative vomiting in 45 children undergoing tonsillectomy was studied. After induction of anaesthesia and before the start of surgery, 50% of the patients received AP at PC06 for 5 min. There was no difference in the incidence of vomiting between the AP (39%) and non-AP (36%) groups. When given after induction of anaesthesia, AP at PC06 was not effective in reducing vomiting after tonsillectomy in children.

Yentis_SM2; Bissonnette B (1992) Ineffectiveness of AP and droperidol in preventing vomiting after strabismus repair in children. Can J Anaesth Feb 39(2):151-154. Dept of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada. The antiemetic effects and side-effects of P6 AP and droperidol pre-treatment were evaluated in a randomized, patient- and observer-blinded study. 90 unpremedicated children of ASA physical status I or II undergoing outpatient strabismus repair, and aged > 1 yr, were studied. All received iv thiopentone 5 mg/kg, atropine 0.02 mg/kg and succinylcholine 1.5 mg/kg, and the trachea was intubated. Patients then received either iv droperidol 0.075 mg/kg, droperidol plus 5 min' P6 AP, or AP alone. Anaesthesia was maintained with nitrous oxide 66% and halothane 1.5-2.0% in oxygen with spontaneous ventilation. There was no difference in the incidence of vomiting in the droperidol group (17% before discharge from hospital and 41% up to 48 h after discharge), combined treatment group (17% and 34% respectively) and AP group (27% and 45% respectively). Corresponding figures for the incidence of vomiting before discharge were 17%, 17% and 27% respectively; these values were also not different. The incidence of restlessness was significantly greater in children receiving droperidol (63%) or both treatments (67%) than in those receiving AP alone (30%; p=.007). P6 AP and droperidol are equally ineffective in preventing vomiting within 48 h of paediatric strabismus repair. Droperidol is associated with increased incidence of postoperative restlessness.