Comparison of P6 Acupoint Stimulation, Ondansetron and Dexamethasone for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Surgeries: A Randomised Clinical Study

Abstract

Introduction: Non pharmacological techniques have an established role in treatment of chronic pain and related conditions. A few non pharmacological techniques have been employed to avoid the adverse effects of drugs. They have also proven to be cost-effective. Liberal fluid administration is the most common non pharmacological methodology used for the prevention of PONV. However, the associated volume overload can be detrimental. Aim: To compare the efficacy of P6 acupoint stimulation, ondansetron and dexamethasone in the prevention of PONV in laparoscopic surgeries. Materials and Methods: This was a randomised clinical study, conducted in the Department of Anaesthesiology at a Tertiary Care Medical College and Hospital, India. The duration of the study was five months, from June 2022 to October 2022. A total of 120 patients posted for laparoscopic surgeries were divided randomly into three groups, group A, group O and group D. Patients were allocated by computer-generated randomisation. Patients in group A received capsicum plaster at P6 point. Patients in group O received 4 mg of ondansetron and patients of group D received 8 mg of dexamethasone. They were given 30 minutes before induction. Postoperatively, patients were extubated and shifted to postanaesthesia care unit for further monitoring. The demographic data, baseline vitals, surgical procedure, duration of surgery and duration of Carbon Dioxide (CO2 ) insufflation were noted intraoperatively. Additional fentanyl requirement, total analgesic requirement, postoperative heart rate, Mean Arterial Pressure (MAP), the incidence of PONV, nausea and vomiting score, number of episodes the requirement of rescue antiemetic, postoperative complication, adverse reactions and patient satisfaction score were all recorded postoperatively and was compared between the three groups using one-way Analysis of Variance (ANOVA). The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the study participants for group A was 40.42±11.05 years, group O was 40.92±10.49 years and group D was 40.30±10.01 years, respectively. The three groups were comparable with respect to the demographics, baseline vitals, surgical procedure, duration of surgery, duration of CO2 insufflation, additional fentanyl requirement, total analgesic requirement, postoperative heart rate, and MAP. The incidence of PONV was insignificant between the groups with p-value=0.866. The p-value of nausea and vomiting scores were insignificant. The number of episodes of nausea and vomiting was also comparable between the groups p-value=0.880 and 0.375, respectively. The requirement of rescue antiemetic vomiting was insignificant with p-value=0.810. Conclusion: Ondansetron, dexamethasone and P6 acupoint stimulation are equally effective as prophylaxis for the management of PONV. It can be concluded that, P6 acustimulation can be used as an alternative to pharmacological agents for the management of PONV.