Prophylaxe von postoperativer Übelkeit und Erbrechen durch Koreanische Handakupunktur bei Patientinnen nach laparoskopischen Unterbaucheingriffen

Zusammenfassung

In dieser prospektiven, placebo-kontrollierten, randomisierten Doppelblind-Studie wurden 50 gynäkologische Patientinnen, die sich einer laparoskopischen Operation unterzogen, untersucht. In der Verumgruppe wurde eine Akupressur des Punktes K-K9 der Koreanischen Handakupunktur (KHA) durchgeführt. In der Placebogruppe wurde das Samenkorn an einem in der KHA nicht definierten Punkt an der ulnaren Seite des fünften Fingers fixiert und ebenfalls 24 Stunden belassen. Die Operation wurde in Allgemeinnarkose durchgeführt.

Die Dokumentation der Untersuchungsparameter (Übelkeit und Erbrechen) erfolgte vom „geblindeten” Stationspflegepersonal.

Die statistische Analyse der Inzidenz von Übelkeit und Erbrechen erfolgte mit dem Fisher's exacter Test. Der ungepaarte Student t-test wurde zur Analyse der demographischen Daten herangezogen. Die demographischen Daten der Patientinnen zeigten keine signifikanten Unterschiede.

In der Gruppe mit Akupressur kam es bei 9 von 25 Patientinnen zu postoperativer Übelkeit und bei 4 zu postoperativem Erbrechen. In der Placebogruppe war die Inzidenz der postoperativen Übelkeit mit 17 Patientinnen (n = 25) und die des postoperativen Erbrechens mit 12 (n = 25) signifikant höher als in der Verumgruppe.

Fasst man die Ergebnisse dieser Untersuchung zusammen, so zeigt sich, dass die Akupressur von K-K9 eine effektive und kostensparende Methode zur Prophylaxe von postoperativer Übelkeit und Erbrechen (postoperative nausea and vomiting = PONV) bei gynäkologischen laparoskopischen Eingriffen darstellt.

Abstract

Postoperative nausea and vomiting (PONV) is one of the most frequent complications following laparoscopic surgery. Acupuncture of the Chinese acupuncture point P6 prevents PONV. In the present study we examined the antiemetic effect of a newer form of acupuncture, called Korean hand acupressure.

In this double-blind, prospective, placebo-controlled and randomized study we examined 50 female patients who were scheduled for laparoscopic gynaecological surgery. In group A acupressure was performed on KHA Point K-K9 on both hands on dig. IV, which remained for at least 24 hours. In group B placebo acupressure was carried out with the seed affixed to a point on the ulnar side of dig.V not specified in KHA, which also remained for 24 hours.

Laparoscopy was performed under general anaesthesia. The incidence of nausea and vomiting was recorded by the nursing staff on the ward, who where not informed of the reasons. Documentation followed over 24 hours after starting anaesthesia.

Fisher's exact test was used for the statistical analysis of the incidence of vomiting, and the unpaired Student's t-test to analyse demographic data.

Demographic data did not differ between the two groups. In comparison to the placebo group the incidence of nausea and vomiting was significantly lower in the acupressure group. In the first 24 hours after surgery nausea occurred in 9 (36 %) patients in the acupressure group and in 17 (68 %) of 25 women in the placebo group. Vomiting was seen in 4 (16 %) women in the acupressure group and in 12 (48 %) of 25 patients in the placebo group, significantly more than in the acupressure group.

To sum up the results of this investigation, acupressure of K-K9 with an acupressure seed reduces the incidence of PONV in female patients following laparoscopic gynaecological surgery. This procedure is painless, inexpensive and there are no known side-effects. Therefore, acupressure of K-K9 will be an excellent therapy for reducing postoperative vomiting and may be an adequate alternative to a pharmacological approach.

Schlüsselwörter

Koreanische Handakupunktur - Akupressur - Punkt K-K9 - postoperative Übelkeit und Erbrechen - Laparoskopie - gynäkologische Operation

Keywords

Korean Hand Acupressure - acupressure - point K-K9 - PONV - laparoscopic gynaecological surgery

Literatur

• 1 Andrews P. L.. Physiology of nausea and vomiting.  Br. J. Anaesth.. 1992;  69 2S-19S
• 2 Camu F., Lauwers M. H., Verbessem D.. Incidence and aetiology of postoperative nausea and vomiting.  Eur. J. Anaesthesiol.. 1992;  9 (Suppl. 6) 25-31
• 3 Hirsch J.. Impact of postoperative nausea and vomiting in the surgical setting.  Anaesthesia. 1994;  49 (Suppl.) 30-33
• 4 Kenn Y. G. N.. Risk factors for postoperative nausea and vomiting.  Anaesthesia. 1994;  49 (Suppl.) 6-10
• 5 Korttila K.. The study of postoperative nausea and vomiting.  Br. J. Anaesth.. 1992;  69 20S-23S
• 6 Koivuranta M., Laara E., Snare L., Alahuhta S.. A survey of postoperative nausea and vomiting.  Anaesthesia. 1997;  52 443-449
• 7 Lerman J.. Surgical and patient factors involved in postoperative nausea and vomiting.  Br. J. Anaesth.. 1992;  69 24S-32S
• 8 Rowbotham D. J.. Current management of postoperative nausea and vomiting.  Br. J. Anaesth.. 1992;  69 46S-59S
• 9 Watcha M. F., White P. F.. Postoperative nausea and vomiting. Its etiology, treatment, and prevention.  Anesthesiology. 1992;  77 162-184
• 10 al-Sadi M., Newman B., Julious S. A.. Acupuncture in the prevention of postoperative nausea and vomiting.  Anaesthesia. 1997;  52 658-551
• 11 Barsoum G., Perry E. P., Fraser I. A.. Postoperative nausea is relieved by acupressure.  R. Soc. Med.. 1990;  83 86-89
• 12 Dundee J. M., Milligan K. R.. Acupuncture as an antiemetic.  Br. Med. J.. 1988;  296 135
• 13 Dundee J. W., Ghaly R. G., Bill K. M., Chestnutt W. N., Fitzpatrick K. T., Lynas A. G.. Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting.  Br. J. Anaesth.. 1989;  63 612-618
• 14 Ghaly R. G., Fitzpatrick K. T., Dundee J. W.. Antiemetic studies with traditional Chinese acupuncture. A comparison of manual needling with electrical stimulation and commonly used antiemetics.  Anaesthesia. 1987;  42 1108-1110
• 15 Gieron C., Wieland B., von der Laage D., Tolksdorf W.. Acupressure in the prevention of postoperative nausea and vomiting.  Anaesthesist. 1993;  42 221-226
• 16 Schlager A.. Acupuncture in prevention of postoperative nausea and vomiting.  Wien Med. Wochenschr.. 1998;  148 454-456
• 17 Schlager A., Offer T., Baldissera I.. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery.   Br. J. Anaesth.. 1998;  81 529-532
• 18 White P. F.. Are nonpharmacologic techniques useful alternatives to antiemetic drugs for the prevention of nausea and vomiting?.  Anesth. Analg.. 1997;  84 712-714
• 19 Schlager A., Boehler M., Puhringer F.. Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery.  Br. J. Anaesth.. 2000;  85 267-270
• 20 Yoo T.-W.. Koryo Sooji Chim. 1 Ed. Eum Yang Mek Jin Publishing CoSeoul, Korea 1977
• 21 Larsson S., Lundberg D.. A prospective survey of postoperative nausea and vomiting with special regard to incidence and relations to patient characteristics, anesthetic routines and surgical procedures.  Acta Anaesthesiol. Scand.. 1995;  39 539-545
• 22 Allen D. L., Kitching A. J., Nagle C.. P6 acupressure and nausea and vomiting after gynaecological surgery.  Anaesth. Intensive Care. 1994;  22 691-693
• 23 Rusch D., Bernhardt J., Wulf H.. Prophylaxis of nausea and vomiting after pelviscopy. Dolasetron or MCP in comparison with placebo.  Anaesthesist. 1999;  48 705-712
• 24 Yang L. C., Jawan B., Chen C. N., Ho R. T., Chang K. A., Lee J. H.. Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecological laparoscopy.  Acta Anaesthesiol. Scand.. 1993;  37 192-194
• 25 Dundee J. W., McMillan C. M.. P6 acupressure and postoperative vomiting.  Br. J. Anaesth.. 1992;  68 225-226
• 26 Chestnutt W. N., Clarke R. S., Dundee J. W.. Comparison of nalbuphine, pethidine and placebo as premedication for minor gynaecological surgery.  Br. J. Anaesth.. 1987;  59 576-580
• 27 Chestnutt W. N., Dundee J. W.. The influence of cyclizine and perphenazine on the emetic effect of meptazinol.  Eur. J. Anaesthesiol.. 1986;  3 27-32
• 28 Isal J. P., Haigh C. G., Hellstern K., Inall F. C., Joslyn A. F., Kanarek B. K.. et al. . The clinical development of ondansetron for use in the prevention and treatment of postoperative nausea and vomiting.   Eur. J. Anaesthesiol.. 1992;  9 (Suppl. 6) 33-36
• 29 Joslyn A. F.. Ondansetron, clinical development for postoperative nausea and vomiting: current studies and future directions.  Anaesthesia . 1994;  49 (Suppl.) 34-37

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