Complementary Approaches to Postoperative Pain, Nausea, and Vomiting
Researchers at the University of Chicago Hospitals recently published results from a national survey of patients who had undergone surgical procedures.1 Patients were asked about the severity of postsurgical pain, treatment, satisfaction with pain medication, patient education, and perceptions about postoperative pain and pain medications. Of the 250 patients surveyed, approximately 80% experienced acute pain after surgery. Of these patients, 86% reported moderate, severe, or extreme pain, with more patients experiencing pain after discharge than before discharge.
Experiencing postoperative pain was the most common concern (59%) among patients. Almost 25% of patients who received pain medications experience adverse effects; however, nearly 90% of them were satisfied with their pain medications. Approximately two-thirds of patients reported that a health care professional talked with them about their pain.
In addition to postoperative pain, many patients suffer from postoperative nausea and vomiting. A 1994 study found the incidence of postoperative nausea and vomiting to be 37% and 20%, respectively. 2
Despite an increased focus on pain management programs, development of new standards for pain management, and efforts to reduce postoperative nausea and vomiting, many patients continue to suffer from pain, nausea, and vomiting after surgery. Several complementary therapies increasingly are being employed to meet patients’ postoperative needs.
Music therapy and guided imagery
A Swedish study compared the effect of intra-operative to postoperative music on postoperative pain in a controlled trial.3 A total of 151 patients undergoing day case surgery for inguinal hernia repair or varicose vein surgery under general anaesthesia were randomly assigned to one of three groups: Group 1 listened to music intra-operatively; group 2 listened to music postoperatively; and group 3, the control group, listened to white noise. Results showed that patients exposed to music intra-operatively or postoperatively reported significantly lower pain intensity at hours 1 and 2 postoperatively and patients in the postoperative music group required less morphine at hour 1 compared to the control group.
In an experimental pilot study, researchers examined the effects of music therapy, guided imagery, and standard care on postoperative pain, postoperative nausea and vomiting, and length of stay for gynecologic laparoscopic patients.4 Results indicated that patients in both the music therapy and guided imagery groups had significantly less pain on discharge than the patients in the standard care group.
Ginger (Zingiber officinale)
Researchers from Thailand recently published the results of a randomized, controlled clinical trial assessing the efficacy of ginger to prevent nausea and vomiting after outpatient gynecological laparoscopy.5 Eighty patients were randomly assigned to group A (n = 40) or group B (n = 40). Group A received 2 capsules of ginger (1 capsule contained 0.5 g of ginger powder) one hour before the procedure while the patients in group B received placebo. Visual analogue nausea scores (VANS) and vomiting times were evaluated at two, four, and 24 hours after the operation.
There was a significant difference in the incidence of nausea between group A (12, 30%) and group B (24, 57.5%). The VANS was lower in group A than in group B at two and four hours (P < 0.05), but no difference was found at 24 hours. Incidence and frequency of vomiting in group A were lower than group B, but this result did not reach statistical significance.
A study from the University of Exeter assessed the effectiveness of continuous PC6 acupressure as an adjunct to anti-emetic drug therapy in the prevention and control of nausea and vomiting in the first 24 hours after myocardial infarction.6 A total of 301 consecutive patients (205 males, 96 females) were included in this study: The first 125 patients received no additional intervention. Subsequent patients were randomized to receive either continuous PC6 acupressure or placebo acupressure.
There were no significant differences between the groups for the whole 24-hour treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20 hours (18%) compared with the placebo (32%) or control (43%) groups (P < 0.05). The severity of symptoms and the need for anti-emetic drugs also were reduced in the acupressure group, but these differences were not statistically significant.
Researchers from South Korea recently conducted a study on the effect of auricular acupuncture on postoperative nausea and vomiting.7 One hundred female patients undergoing transabdominal hysterectomy were entered into the study. The patients were divided into two groups (auricular acupuncture treatment group and non-treatment group) in order to test the effectiveness of auricular acupuncture. There was no significant difference in age, weight, height, or duration of anesthesia among the two groups of patients.
There was a significant difference between the control and auricular acupuncture treatment groups in the incidence of vomiting 12 hours after surgery (68% and 30%, respectively, P < 0.01). No noteworthy side effects from treatment were observed.
In another study, researchers compared acupuncture to sham acupuncture in arthroscopic acromioplasty subjects to determine whether they would manifest significantly better recovery as demonstrated by: UCLA shoulder scale, improved range of motion, diminished pain, decreased need and duration of analgesic use, and enhanced patient satisfaction.8
Thirty-five subjects completed the four-month study. Real acupuncture subjects scored significantly better on UCLA shoulder scale (P < 0.000); pain intensity (P < 0.022); self-reported analgesic use (P < 0.008); angles of abduction (P < 0.046); and in six of eight health status questionnaire components. The authors concluded that acupuncture offered significantly greater improvement with regard to: pain level, analgesic use, range of motion, and patient satisfaction.
1. Apfelbaum JL, et al. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-540.
2. Quinn AC, et al. Studies in postoperative sequelae. Nausea and vomiting—Still a problem. Anaesthesia 1994;49:62-65.
3. Nilsson U, et al. A comparison of intra-operative or postoperative exposure to music—A controlled trial of the effects on postoperative pain. Anaesthesia 2003; 58:699-703.
4. Laurion S, Fetzer SJ. The effect of two nursing interventions on the postoperative outcomes of gynecologic laparoscopic patients. J Perianesth Nurs 2003;18: 254-261.
5. Pongrojpaw D, Chiamchanya C. The efficacy of ginger in prevention of post-operative nausea and vomiting after outpatient gynecological laparoscopy. J Med Assoc Thai 2003;86:244-250.
6. Dent HE, et al. Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: A partially randomised, placebo-controlled trial. Complement Ther Med 2003; 11:72-77.
7. Kim Y, et al. Clinical observations on postoperative vomiting treated by auricular acupuncture. Am J Chin Med 2003;31:475-480.
8. Gilbertson B, et al. Acupuncture and arthroscopic acromioplasty. J Orthop Res 2003;21:752-758.
Complementary approaches to postoperative pain, nausea, and vomiting. Altern Med Alert 2003;6(10 suppl):S1-S2.
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