Multimodal analgesia after laparoscopic cholecystectomy

Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2002

Purpose To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV). Methods One hundred and fifty ASA I–II, patients undergoing elective laparoscopic cholecystectomy were included in a randomized, prospective, double-blind and placebo-controlled study. Patients were divided into three groups of SO. Group I was the control; Group II received ondansetron 4 mgiv just prior to induction of anesthesia; in Group III acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I and II. The acupressure wrist bands were applied 30 min prior to induction of anesthesia and removed six hours following surgery. Anesthesia was standardized. PONV were evaluated separately as none, mild, moderate or severe within six hours of patients’ arrival in the postanesthesia care unit and then at 24 hr after surgery by a blinded observer. If patients vomited more than once, they were given 4 mg ondansetroniv as the rescue antiemetic. Results were analyzed by Ztest. AP value of < 0.05 was taken as significant. Results The incidence of PONV and the requirement of rescue medication were significantly lower in both the acupressure and ondansetron groups during the first six hours. Conclusion Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy, similar to that of ondansetron 4 mgiv. Objectif Comparer l’efficacité des bandes d’acupression et de l’ondansétron comme prévention des nausées et vomissements postopératoires (NVPO). Méthode Cent cinquante patients d’état physique ASA I– II devant subir une cholécystectomie laparoscopique ont été recrutés pour une étude prospective, randomisée et à double insu contre placebo. Ils ont été répartis en trois groupes de 50. Le groupe I a été le groupe témoin; les patients du groupe II ont reçu 4 mg iv d’ondansétron juste avant l’induction de l’anesthésie; chez les patients du groupe III, on a appliqué des bandes d’acupression aux point P6. Des bandes d’acupression ont été placées de façon inappropriée chez les patients des groupes I et II. Les bandes ont été appliquées 30 min avant l’induction et enlevées six heures après l’opération. Lanesthésie a été normalisée. Les NVPO ont été évalués séparément comme inexistants, légers, modérés ou sévères pendant les six premières heures en salle de réveil, puis 24 h après l’opération par un observateur impartial. Si les patients vomissaient plus d’une fois, ils recevaient 4 mg d’ondansétron iv comme antiémétique de secours. Les résultats ont été analysés avec le test Z. Une valeur de P < 0,05 était considérée significative. Résultats L’incidence de NVPO et les besoins de médication de secours ont été significativement plus faibles autant avec l’acupression qu’avec l’ondansétron pendant les six premières heures. Conclusion Lacupression en Pô réduit de façon significative l’incidence de NVPO et la nécessité d’antiémétique de secours pendant les six premières heures suivant la cholécystectomie laparoscopique. Son effet est donc similaire à celui de 4 mg iv d’ondansétron.

JPMA. The Journal of the Pakistan Medical Association, 2003

To evaluate the effectiveness of acupressure applied at meridian P6 point for prevention of nausea and vomiting in patients undergoing laparoscopic cholecystectomy. A randomized double blind study was performed in 50 ASA I and II patients scheduled for laparoscopic cholecystectomy. Patients were divided into two groups; control and placebo. In the control group acupressure was applied at P6 point half an hour before surgery while in the placebo group the acupressure band was tied on meridian P6 point but the plastic bead was placed on the dosum of right forearm away from meridian P6 point. Patients were assessed for nausea and vomiting for six hours after surgery. Anaesthetic technique and postoperative analgesia were standardized for all patients. Results showed that the incidence of postoperative nausea and vomiting was 36% in the treatment group and 40% in placebo group, which is statistically insignificant. Application of acupressure at P6 point half an hour before induction of ...

Kocaeli tıp dergisi, 2022

GİRİŞ ve AMAÇ: Postoperatif bulantı kusma, genel anestezi sonrası görülen en sık ikinci komplikasyondur. Laparoskopik kolesistektomi vakalarında sık görülmekle birlikte postoperatif dönemde hasta memnuniyetini etkileyen önemli bir morbidite sebebidir. Çalışmamızda laparoskopik kolesistektomi vakalarında el bileğinde P6 akupunktur bölgesine akubasınç uygulama zamanının postoperatif bulantı kusma üzerine etkilerini prospektif olarak araştırmayı planladık. YÖNTEM ve GEREÇLER: 18 yaş üstü elektif laparoskopik kolesistektomi uygulanacak 150 hasta çalışmaya dahil edildi. Hastalar 50 hasta indüksiyon öncesi (grup 1), 50 hasta indüksiyon sonrası (grup 2), 50 hasta cerrahi sonrası (grup 3) olmak üzere randomize olarak 3 gruba ayrıldı. Grup 1' de hastalara anestezi indüksiyonundan önce P6 akubasınç bilekliği uygulanırken, aynı işlem grup 2' de indüksiyondan sonra, grup 3' te ise cerrahi bitiminde uygulandı. Postoperatif 24 saat boyunca postoperatif bulantı kusma sıklığı, şiddeti ve antiemetik ihtiyacı olup olmadığı kaydedildi. BULGULAR: Gruplar, bulantı skoru ve kurtarıcı antiemetik ihtiyacı yönünden değerlendirildiğinde, grup 2' de en düşük bulantı skoru olduğu gözlemlendi ve grup 3' e göre daha düşük değerler bulunmakla birlikte (p = 0,046, p = 0,021), grup 1' den farklı olmadığı gözlemlendi. Diğer saatlerde gruplar arasında bulantı skoru ve antiemetik ihtiyacı açısından farklılık gözlemlenmedi. Kusma, öğürme açısından gruplar arası farklılık gözlemlenmedi. TARTIŞMA ve SONUÇ: P6 akubasınç yönteminin ameliyat öncesinde uygulanmasının özellikle erken dönem postoperatif bulantı kusma kontrolünde daha etkin olduğu ve antiemetik tedavi ihtiyacını azaltmada etkili olduğu sonucuna varılmıştır. Anahtar Kelimeler: postoperatif bulantı kusma, sea band, laparoskopik kolesistektomi, akubasınç, akupunktur INTRODUCTION: Postoperative nausea and vomiting (PONV) are the second most common complications following general anesthesia. PONV has a high incidence rate in laparoscopic cholecystectomy cases and is an important cause of morbidity that significantly decreases patient satisfaction in the postoperative period. We prospectively investigated the effects of the ti ming of acupressure application to the P6 acupuncture point on the wrist for the prevention of PONV. METHODS: This study included 150 adults who were aged 18 years or older, who were scheduled for elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly assigned to three groups of 50 patients: pre-induction (group 1), post-induction (group 2), and post-operative (group 3). While the acupressure wristband was applied to the patients in Group 1 before anesthesia induction, the wristbands were applied to Group 2 and Group 3 after anesthesia induction and at the end of the surgery, respectively. During postoperative 24 hours, the incidence and severity of nausea/vomiting and the need for antiemetic therapy were recorded. RESULTS: The lowest median nausea score was found in group 2, which significantly differed from group 3 (p= 0.046), but not from group 1. This was also the case for the need for antiemetic therapy (p= 0.021). There were no differences among the groups at other specified time points. The incidence of retching or vomiting was similar across the groups. DISCUSSION AND CONCLUSION: Acupressure applied before surgery on the P6 point seems to be effe

International Journal of Research in Medical Sciences, 2016

Background: Postoperative nausea and vomiting (PONV) is common complication after general anesthesia and surgery. This randomized double-blind study was designed to compare the effects of acupressure wrist bands and palonosetron for the prevention of post-operative nausea and vomiting (PONV) in laparoscopic cholecystectomy under general anaesthesia.Methods: Sixty ASA I and II patients undergoing elective laparoscopic surgeries under general anaesthesia were divided into two groups. In Group A patients, acupressure wrist bands were applied on p6 point on both hands half an hour before induction. Group P patients received inj. palonosetron 0.075 m.g. i.v. just before induction. Anaesthesia technique was standardized. Post-operatively patients were monitored for nausea, retching or vomiting upto 24 hours. If patients vomited more than once, they were given inj. Metoclopramide 10mg as rescue antiemetic. Efficacy of drugs was compared using Chi square test. ‘p’ value of &lt;0.05 is consi...

The American Journal of Surgery, 2000

BACKGROUND: Postoperative nausea and vomiting is a common problem in patients undergoing laparoscopic cholecystectomy (LC). The purpose of this study was to evaluate the efficacy of ondansetron given at the induction of anesthesia in patients scheduled for ambulatory LC.

Journal of Evolution of Medical and Dental Sciences, 2019

BACKGROUND Postoperative nausea and vomiting (PONV) have been described as the "big little problem" 1,2 for anaesthesiology for laparoscopic surgery. Commonest cause of morbidity after aesthesia and surgery are pain and postoperative nausea vomiting. 3,4,5 METHODS Institutional ethical committee clearance and written informed consent were obtained from 60 female patients of American Society of Anaesthesiologists physical status I and II, aged between 18 to 65 years, weighing about 50-60 Kg., height 150 to 160 cm, scheduled for laparoscopic cholecystectomy (duration < 90 minutes) under general anaesthesia in this prospective, randomised, double blind controlled study. Patients coming to operation theatre were divided by computer generated randomization in to two groups of 30 each, Group-A (n=30) and Group-B (n=30). A person, who was blind to the randomisation schedule, was administered the study drug 1 minute prior to other I.V. drugs. One of the following regimens, for Group A patients: Ondansetron 4 mg in 2 ml or for Group B patients: Dexamethasone 8 mg in 2 ml were administered. After preoxygenation, general anaesthesia was administered, pneumoperitoneum created, laparoscopic cholecystectomy done, and anaesthesia reversed. For post-operative analgesia Paracetamol (1000 mg) I.V. was administered. All patients were observed post operatively by noting vital signs and complications, if any. All episodes of PONV (nausea, vomiting, retching) were recorded for 12 hrs post operatively. Rescue drug Inj. Metoclopramide 10 mg I.V. was given, if required. All data from each patient was obtained and tabulated. RESULTS The age, weight, height, ASA status and duration of surgery of the patients included in study group (p ≤0.05) were comparable and there was no significant statistical difference among the data collected during the study. Incidence of nausea is higher in both groups in the first hour though it is not statistically significant. Within 3-6 hours, patients receiving Dexamethasone had higher incidence of nausea, but it is not statistically significant. Incidence of retching is higher in both groups in the first hour. It is not statistically significant. Vomiting was more in the first 3 hours in both groups. It was not statistically significant. Need for rescue drug (Inj. metoclopramide 10 mg I.V.) was similar in both groups. CONCLUSIONS Ondansetron is as effective as Dexamethasone in reducing the incidence of nausea and vomiting in post-operative period of laparoscopic cholecystectomy and has minimal side effects.