Description P6 acupoint on the dominant upper extremity
Experimental Description
264 women undergoing laparoscopic hysterectomy were evaluated for PONV. Neuromuscular blockade was monitored by acceleromyography with 1-Hz single twitch (ST) over the ulnar nerve (n = 54, control), and ST (n = 52), train-of-four (n = 53), double-burst stimulation (n = 53), or tetanus (n = 52) over the median nerve stimulating at the P6 acupuncture point.
Sample Count
264
Age
31-67
Control
Freq
group control(1-Hz single twitch stimulation over ulnar nerve)(n=54)
Experiment
group ST(1-Hz single twitch stimulation at P6 acupoint)(n=52);group TOF(train-of-four stimulation at P6 acupoint)(n=53);group DBS(double-burst stimulation at P6 acupoint)(n=53);group tetanus(50-Hz, 5-s tetanicstimulation at P6 acupoint)(n=52)
Indicator
Postoperative Nausea and Vomiting(PONV)Visual analog scale(VAS)
Auxiliary Medication
Without premedication, anesthesia was induced with 0.2 g/kg/min remifentanil injected IV over 120 seconds, followed by sodium thiopental 3 to 5 mg/kg and rocuro- nium 0.6 mg/kg. Anesthesia was maintained with sevoflu- rane (1.0%–1.5%) and remifentanil at a dose of 0.05 g/kg/min with nitrous oxide 50% in oxygen. Ventilation was controlled, and end-tidal Pco2 was maintained be- tween 35 and 40 mm Hg. Rocuronium was given intraop- eratively as required. A nasogastric tube was inserted stomach was emptied. At the end of anesthesia, the residual neuromuscular block was antagonized with glycopyrrolate 0.4 mg and neostigmine 2.5 mg IV as necessary.
In the postanesthesia care unit, analgesia was begun with an initial dose of fentanyl 50 g and ketorolac 30 mg IV in all patients. A PCA device (WalkMed PCA; McKinley Medical, Wheat Ridge, CO) was programmed to provide 1 mL/h as a basal infusion and a 1-mL bolus with a lockout interval of 15 minutes; the bolus contained fentanyl 12.5 g/mL and ketorolac 1.8 mg/mL with saline (total volume 60 mL).
Stimulation Method
TENS
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
TOF-Watch®
Organon Ltd., Dublin, Ireland
1 Hz in the ST group, every 15 seconds in the TOF group, every 20 seconds in the DBS group, 50 Hz for 5 seconds every 10 minutes in the tetanus group.
square wave
50 mA
Throughout anesthesia maintenance
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
-
-
-
Description In the treatment groups (ST, TOF, DBS, or tetanus), the same electrodes described above were used to stimulate the median nerve at the P6 acupoint on the dominant upper extremity before the anesthetic induction and removed after anesthesia at the operating room. The proximal positive electrode was placed between the tendons of the palmaris longus and the flexor carpi radialis 1 cm proximal to the P6 acupoint. The distal negative electrode was placed 2 cm distal to the P6 acupoint. This distal electrode acts as a skin surface electrode to allow electrical current through the P6 acupoint. Each electrode was connected to a peripheral nerve stimulator with the same square-wave pulses (0.2 millisecond), constant current (50 mA), and uncalibrated mode as the control group. Throughout anesthesia maintenance, we automatically applied ST stimulation at 1 Hz in the ST group, TOF stimulation every 15 seconds in the TOF group, DBS every 20 seconds in the DBS group, and tetanic stimulation at 50 Hz for 5 seconds every 10 minutes in the tetanus group.
The incidence of PONV (P = 0.022), the number of requests for patient-controlled analgesia (P = 0.009), and total patient-controlled analgesia volume (P = 0.042) 6 hours after tetanic stimulation were significantly reduced in the treatment group compared with the control group. Overall, patients in the tetanus group were more satisfied with the management of PONV compared with patients in the control group. Tetanic stimulation applied to the P6 acupuncture point can reduce PONV after laparoscopic hysterectomy compared with ST stimulation of the ulnar nerve, resulting in a greater degree of patient satisfaction. None of the stimulations, ST, train-of-four, or double-burst, applied to the P6 acupuncture point significantly affected PONV.
The efficacy of several neuromuscular monitoring modes at the P6 acupuncture point in preventing postoperative nausea and vomiting.
Abstract
BACKGROUND: In this study, we tested the efficacy of several neuromuscular monitoring modes at the P6 acupuncture point for preventing postoperative nausea and vomiting (PONV). METHODS: In this prospective, double-blind, randomized, placebo-controlled trial, 264 women undergoing laparoscopic hysterectomy were evaluated for PONV. Neuromuscular blockade was monitored by acceleromyography with 1-Hz single twitch (ST) over the ulnar nerve (n = 54, control), and ST (n = 52), train-of-four (n = 53), double-burst stimulation (n = 53), or tetanus (n = 52) over the median nerve stimulating at the P6 acupuncture point. RESULTS: The incidence of PONV (P = 0.022), the number of requests for patient-controlled analgesia (P = 0.009), and total patient-controlled analgesia volume (P = 0.042) 6 hours after tetanic stimulation were significantly reduced in the treatment group compared with the control group. Overall, patients in the tetanus group were more satisfied with the management of PONV compared with patients in the control group. CONCLUSION: Tetanic stimulation applied to the P6 acupuncture point can reduce PONV after laparoscopic hysterectomy compared with ST stimulation of the ulnar nerve, resulting in a greater degree of patient satisfaction. None of the stimulations, ST, train-of-four, or double-burst, applied to the P6 acupuncture point significantly affected PONV."
Souce
Anesth Analg. 2011 Apr;112(4):819-23. doi: 10.1213/ANE.0b013e31820f819e. Epub 2011 Mar 8.
