PERICARDIUM-6 ACUPRESSURE FOR THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING Robert M. Woods APPROVED: _______________________________________ _______________ John P. McDonough, CRNA, Ed.D. Chair of Committee Approval Date _______________________________________ _______________ Robert Halliburton, CRNA, MHS Committee Member Approval Date _______________________________________ _______________ Eugene Levine, Ph.D. Committee Member Approval Date APPROVED: _______________________________________ _______________ F.G. Abdelah, Ed.D., ScD., RN, FAAN Approval Date Dean i Report Documentation Page Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 2. REPORT TYPE 3. DATES COVERED OCT 1999 N/A - 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER PERICARDIUM-6 ACUPRESSURE FOR THE PREVENTION OF 5b. GRANT NUMBER POSTOPERATIVE NAUSEA AND VOMITING 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Robert Michael Woods 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION Uniformed Services University of the Health Sciences REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release, distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Postoperative nausea and vomiting (PONV) are common problems after general anesthesia. Pharmacological advances have reduced the incidence of PONV however; nausea and vomiting remain the most common postoperative complications of anesthesia. Persistent nausea and vomiting may result in dehydration, electrolyte imbalance, and delayed discharge. Traditional western medicine has been unable to definitively explain why this phenomenon continues to occur. Acupressure at the pericardium-six meridian has been studied in various patient populations and found to be without side effects, however its effectiveness has not been shown. The purpose of this study was to set up a pilot study to retest the claim that acupressure at the pericardium-six meridian can reduce PONV. Ten patients undergoing laparotomy, laparoscopic, or general surgery for gynecological procedures were studied. Acupressure’s effectiveness was compared to sham acupressure of the control group. Patients, anesthesia providers, and data collectors were blinded to the control and study groups. Non-invasive acupressure wristbands were applied to both wrists prior to surgery and worn for 24 hours after. Post anesthesia care unit personnel recorded data while the patient was in the hospital. The patient’s recorded and quantified nausea and vomiting at home using a visual analogue scale. An anesthesia provider called the patient after surgery to collect data. All data were analyzed using SPSS 8.0. No statistical significance was found in nausea and vomiting scores between the two groups. 15. SUBJECT TERMS Acupressure; Postoperative Nausea and Vomiting; Pericardium-six Meridian; Alternative Medicine; Traditional Chinese Medicine 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a. NAME OF ABSTRACT OF PAGES RESPONSIBLE PERSON a. REPORT b. ABSTRACT c. THIS PAGE SAR 67 unclassified unclassified unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 DISCLAIMER STATEMENT Department of Defense This work was supported by the Uniformed Services University of the Health Sciences Protocol No. T06185. The opinions or assertion contained herein are the private opinions of the author and are not to be construed as official or reflecting their views of the Department of Defense or the Uniformed Services University of the Health Sciences. iii COPYRIGHT STATEMENT The author hereby certifies that the use of any copyrighted material in the thesis entitled: Pericardium-6 Acupressure for the Prevention of Postoperative Nausea and Vomiting beyond brief excerpts is with the permission of the copyright owner, and will save and hold harmless the Uniformed Services University of the Health Sciences form any damage which may arise from such copyright violations. iv ABSTRACT Postoperative nausea and vomiting (PONV) are common problems after general anesthesia. Pharmacological advances have reduced the incidence of PONV however; nausea and vomiting remain the most common postoperative complications of anesthesia. Persistent nausea and vomiting may result in dehydration, electrolyte imbalance, and delayed discharge. Traditional western medicine has been unable to definitively explain why this phenomenon continues to occur. Acupressure at the pericardium-six meridian has been studied in various patient populations and found to be without side effects, however its effectiveness has not been shown. The purpose of this study was to set up a pilot study to retest the claim that acupressure at the pericardium-six meridian can reduce PONV. Ten patients undergoing laparotomy, laparoscopic, or general surgery for gynecological procedures were studied. Acupressures effectiveness was compared to sham acupressure of the control group. Patients, anesthesia providers, and data collectors were blinded to the control and study groups. Non-invasive acupressure wristbands were applied to both wrists prior to surgery and worn for 24 hours after. Post anesthesia care unit personnel recorded data while the patient was in the hospital. The patients recorded and quantified nausea and vomiting at home using a visual analogue scale. An anesthesia provider called the patient after surgery to collect data. All data were analyzed using SPSS 8.0. No statistical significance was found in nausea and vomiting scores between the two groups. Key Words: Acupressure, Postoperative Nausea and Vomiting, Pericardium-six Meridian, Alternative Medicine, Traditional Chinese Medicine v PERICARDIUM-6 ACUPRESSURE FOR THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING by Robert Michael Woods THESIS Presented to the Graduate School of Nursing Faculty of the Uniformed Services University of the Health Sciences in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES OCTOBER 1999 vi FOREWORD This research was conducted to provide information to the anesthesia community on the use of acupressure for the prevention of postoperative nausea and vomiting. It was designed not only to inform anesthesia providers on the use of an alternative treatment method but also to aid in patient care and safety during anesthesia. vii DEDICATION I dedicate the creation of this thesis to my wife Danna who without her love, support and encouragement the creation of this thesis would not have been possible. viii TABLE OF CONTENTS Foreword.................................................................................................................. vii Dedication................................................................................................................viii CHAPTER I - INTRODUCTION........................................................................1 Background of the Problem............................................................................1 Purpose...........................................................................................................2 Statement of the Problem................................................................................4 Research Hypotheses......................................................................................5 Dependent Variables..................................................................................5 Independent Variable.................................................................................5 Definition of Terms........................................................................................5 Theoretical Framework...................................................................................6 Acupressure Theory........................................................................................7 Assumptions...................................................................................................9 Limitations.....................................................................................................9 Summary........................................................................................................9 CHAPTER II: REVIEW OF THE LITERATURE.............................................10 Factors Increasing Risk of PONV.................................................................10 Patient Factors.........................................................................................10 Surgical Factors.......................................................................................11 Anesthetic Factors...................................................................................12 Postoperative Factors...............................................................................14 Physiology of PONV....................................................................................14 ix