la acupuntura en la prevención y tratamiento de náuseas y vómitos

En la práctica diaria de acupuntura se observa los efectos específicos de ciertos puntos. Uno de ellos es el Neiguan (6MC) ubicado en la cara flexora del antebrazo, proximal al pliegue de la muñeca. Se han publicado numerosos estudios, que aconsejan su utilización tanto utilizando agujas de acupuntura como efectuando presión digital (dígitopuntura), siendo la primera forma más efectiva.

Recientemente la Fundación Cochrane ha publicado una Revisión Sistemática de 40 ensayos clínicos y 4.858 pacientes en los que se realizó acupuntura para la prevención de las náuseas y vómitos postoperatorios. La conclusión es la que sigue: la acupuntura redujo significativamente las náuseas y vómitos, y no hubo diferencias significativas con los antieméticos.

Este punto se usa especialmente para la prevención de náuseas-vómitos post-operatorios o post-anestesia, pero se han utilizado con muy buen resultado en pacientes que han recibido quimioterapia, radioterapia, vómitos del embarazo y en pacientes odontológicos en quienes la toma de impresiones para confeccionar prótesis desencadena el vómito.

En los pacientes que reciben quimioterapia y en los post-operatorios este tratamiento adquiere una gran relevancia. Son pacientes pluri medicados, los primeros con una enfermedad severa de base que además reciben un tratamiento muy agresivo, y que padecen además el desgaste del esfuerzo del vómito y la dificultad para ingerir líquidos y alimentos, con el agravante de suprimir la medicación oral, si es que la requiere.

La acupuntura no tiene efectos colaterales, y puede combinarse también con otros puntos de acupuntura de índole general para aumentar el estado inmunológico del paciente y regular además el Sistema Nervios Vegetativo.

En la biliografía se encuentran alrededor de doscientas cincuenta publicaciones. A continuación algunas citas significativas.

Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting

Lee A, Fan LTY

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Plain Language Summary

P6 acupoint stimulation prevents postoperative nausea and vomiting with few side effects

Postoperative nausea and vomiting (PONV) are two of the most common complications after anaesthesia and surgery. Drugs are only partially effective in preventing PONV and may cause adverse effects. Alternative methods, such as stimulating an acupuncture point on the wrist (P6 acupoint stimulation), have been studied in many trials. The use of P6 acupoint stimulation can reduce the risk of nausea and vomiting after surgery, with minimal side effects. The risks of postoperative nausea and vomiting were similar after P6 acupoint stimulation and antiemetic drugs.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 7, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

This record should be cited as: Lee A, Fan LTY. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003281. DOI: 10.1002/14651858.CD003281.pub3

Editorial Group: Anaesthesia Group

This version first published online: July 19. 2004
Last assessed as up-to-date: November 19. 2008

Abstract

Background

Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004.

Objectives

To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV.

Search strategy

We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), the National Library of Medicine publication list of acupuncture studies, and reference lists of articles.

Selection criteria

All randomized trials of techniques that stimulated the P6 acupoint compared with sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acu-stimulation device, and acupressure in patients undergoing surgery. Primary outcomes were the risks of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.

Data collection and analysis

Two review authors independently assessed trial quality and extracted the data. We collected adverse effect information from the trials. We used a random-effects model and reported relative risk (RR) with associated 95% confidence intervals (95% CI).

Main results

We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots.

Authors’ conclusions

P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.

Acupuncture and acupressure for the treatment of nausea and vomiting

Record Status

This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database.

Report may be purchased from http://www.hayesinc.com

Bibliographic details
Acupuncture and acupressure for the treatment of nausea and vomiting. Lansdale: HAYES, Inc.. 2010
Authors’ conclusions

Acupuncture and acupressure are used to stimulate specific acupuncture points with the goal of controlling nausea and vomiting associated with chemotherapy, radiation therapy, early pregnancy, general anesthesia, oocyte retrieval, postoperative pain medications, motion sickness, or myocardial infarction.

Original Paper URL
Indexing Status
Subject indexing assigned by CRD
MeSH
Acupressure; Acupuncture Therapy; Antiemetics; Humans; Nausea; Vomiting
Language Published
English
Address for correspondence
157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218 Email: mwinkler@hayesinc.com
AccessionNumber
32010001381
Database entry date
03/11/2010

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