Preoperative chewing gum versus pericardial p6 point acupressure for attenuation of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy – A comparative evaluation

Abstract

: Preoperative use of non-pharmacological agents like chewing gum and acupressure at Pericardial p6 point in prevention on postoperative nausea and vomiting in patients posted for laparascopic cholecystectomy under general anaesthesia. The primary objective of the study was to compare the efficacy of preoperative chewing gum and pericardial P6 acupressure point application in reduction of postoperative nausea and vomiting. Secondary objective was to assess the anxiety and satisfaction scores of the patients in the study. In this Quasi experimental study,3 groups of 62 patients each, with intact mental status in the age group of 18-60 years of either gender posted for laparoscopic cholecystectomy under general anaesthesia, after obtaining written informed consent were included in the study.Group 1 patients received standard treatment, group 2 patients received standard treatment plus Wrigley’s extra sugar free chewing gum, group 3 patients received standard treatment plus bilateral p6 point acupressure by pressure right drug free single use pressure sensitive wrist strip."  Patients were assessed for anxiety in preoperative period, before and after the intervention. In postoperative period patients were assessed for nausea and vomiting, requirement of rescue antiemetic and patient satisfaction.The Chi-square test or Fischer’s exact test, as applicable was employed to compare the postoperative incidence of nausea and vomiting.Highly significant decrease in Amsterdam anxiety score in chewing gum group (p<0.001), followed by significant decrease in acupressure group (p=0.005). No significant change in nausea in all the groups, but in context of vomiting, both chewing gum and acupressure showed significant decrease in number of episodes in first 6 hrs (p=0.013). For rescue antiemetics in nausea, there was no significant variance in usage among the groups. However, for vomiting, a substantial decrease was found. Group 2 required significantly less (p=0.001) amount of antiemetics followed by group 3.The patients in the chewing gum group scored more in the satisfaction scoring index and this was found to be statistically significant (p = 0.010).  Bothchewing gum and acupressure reduced nausea and vomiting and the need for rescue antiemetics. However, chewing gum proved to be better among the two.