Acupuncture And Sham Acupuncture For Gynecologic Laparoscopic Surgery On Prevention And Treatment Of Postoperative Nausea And Vomiting:a Clinical Study

Objective:This study researched the effect of acupoint stimulation on postoperative nausea and vomiting after gynecological laparoscopic surgery by application of perioperative acupuncture and compared it to placebo effect,which provided evidence for postoperative nausea and vomiting in acupuncture and rapid recovery after surgery.Methods:176 gynecological patients scheduled to undergo laparoscopic surgery from July 2017 to December 2017 in our hospital were taken into experiment.They were divided into four groups according to the random number table:sham acupuncture group(group A),blank group(group B),preoperative acupuncture group(group C),postoperative acupuncture(group D).All group members were given 4mg ondansetron at the end of the surgery.In this condition,Group A,as sham acupuncture group,was affixed with a white opaque infusion patch at the acupoint.When the Steward's awakening score was greater than 4 points after the operation,the patients were informed at the end of acupuncture.Group B,as a blank group was not given interference.In group C,patients were performed acupuncture on both sides of Hegu,Neiguan,Taichong,and Qiu Xu acupoints 30 minutes before surgery when they were sober.Group D were given acupuncture on both sides of Hegu,Neiguan,Taichong and Qiu Xu acupoints when their Steward's recovery scores were above 4.These research acupuncture groups were treated once for 30 minutes while they are not interfered in observation.On recording the general information of each group and the relevant information,this study adopted three types of assessments on measuring the situations of nausea and vomiting after 0-6 hours,6-24 hours,and 24-48 hours postoperatively,which includes visual scoring scales(VAS),WHO grade 4 criteria,and PONV severity scores.Secondary observations included:VSA pain scores at each postoperative phrase,recovery quality scale(QOR-40)(one preoperative day,24 postoperative hours,48 postoperative hours respectively),postoperative gastrointestinal function recovery(including first aerofluxus,defecation,ingestion),hospital stay(in total and postoperatively).Variance analysis and Kruskal-Wallis rank sum test were applied to continuous data while discrete data was testified by 2-test and Kruskal-Wallis rank sum test according to their ordering properties and repeated measurement by repeated variance test in SPSS.Results:This trial was mainly completed at Guangdong Hospital of Traditional Chinese Medicine.176 patients were studied and 12 cases were not accepted.Among them,1 case was discharged without treatment;3 were operated more than 5 hours;3 had unqualified BMI;and 5 were changed anesthesia drugs.Age,height,weight,and BMI were not statistically significant(P>0.05)in all these four groups.In the patient-related?anesthesia-related?surgery-Related factors of nausea and vomiting,there are not statistically significant(P>0.05).It' s not statistically significant in scores of preoperative QOR-40,physical fitness,emotional state,self-care ability,psychological support,pain,and total(P>0.05).The difference between the chance of postoperative nausea and vomiting between the sham acupuncture group and blank group(50%and 55%respectively)and the preoperative acupuncture group and postoperative acupuncture group(27%and 32%respectively)was statistical significant(P<0.05).It' s not statistical significant in the chance(18%,14%,10%,and 12%respectively)of serious nausea and vomiting among the four groups(P>0.05).It's also statistically significant in the difference of degree of nausea and vomiting and the WHO classification among the four groups(P<0.05).According to the postoperative recovery quality scale table,due to the postoperative trauma,the scores of 24 hours before surgery,24 hours after surgery,and 48 hours after surgery were significantly different in time(P<0.05)as well as the difference of amplitudes within each group as time goes(P<0.05).According to the QOR-40,the scores had a similar declining-then-increasing behavior at different time.According to the record taken 24 hours and 48 hours after operation,scores of physical fitness,emotional state,self-care ability,psychological support,and QOR-40,the acupuncture group scored higher than the sham acupuncture group or the blank group,which was statistical significant(P<0.05).In the assessment of the function of gastro intestine recovery,it' s not statistically significant in the time of the first discharge among the four groups(P>0.05).But it' s statistically significant in the first defecation and first ingestion(P<0.05).The postoperative acupuncture group clearly had a shorter time comparing with the sham acupuncture group and blank group.There was no significant difference in hospital stay among the four groups(P>0.05),both in total and postoperatively.Conclusion:1.Preoperative or postoperative acupuncture can reduce the incidence of nausea and vomiting after 48 hours of gynecological laparoscopic surgery.2.Postoperative acupuncture can help the recovery of gastrointestinal function and shorten the time for the first bowel movement and the first ingestion.3.The acupuncture group has a higher score than the sham acupuncture group or blank group in physical comfort,emotional state,self-care ability,psychological support and QOR-40.It shows that the recovery quality of acupuncture group is better.