Transcutaneous Electrical Stimulation of Neiguan Anti-emetic Acupuncture Point in Controlling Sickness following Opioid Analgesia in Major Orthopaedic Surgery

Despite the use of conventional anti-emetic therapy the incidence of emetic sequelae associated with the administration of postoperative opioid analgesia is regarded as presenting a major clinical problem. This study was designed to evaluate the benefit of using transcutaneous electrical stimulation (TCES) of the Neiguan acupuncture point, adjunct to standard anti-emetic drug therapy, in the control of nausea and vomiting in the first 24 hours post-operatively. A total of 230 patients, scheduled to undergo major orthopaedic surgery, were assigned randomly to one of four treatment regimens (which included a control group and a placebo treatment). Opioid analgesia was administered by standardised methods adopted in the unit. Prophylactic anti-emetics were administered to all patients, and rescue anti-emetics as required. Assessment of episodes of nausea, retching and vomiting was carried out at pre-determined time intervals in the initial 24-hour post-operative period. Results show the use of TCES to be an effective method of enhancing anti-emetic control following opioid analgesia, however, the effect was confined to female patients. Statistical analysis included a composite comparison across the four anti-emetic regimen groups using chi-squared (females χ 2 = 8.51, df = 3, p = 0.036; males χ 2 = 0.03, df = 3, p = 0.998). The technique was well accepted by the patients and the treatment regimen was easily established in the acute post-operative unit.