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PubMedDate not supplied

Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy.

OBJECTIVE: To determine the effect of continuous acupressure at P6 applied by Sea-Bands with acupressure buttons on the frequency and severity of nausea and vomiting of pregnancy during the 1 st trimester. DESIGN: A two-group, quasi-experimental, posttest-only and posttest-repeated measure. SETTING: Seventeen medical clinics or offices in southern Michigan. PARTICIPANTS: Convenience sample of English-speaking, healthy pregnant women in their 1 st trimester, who had at least one episode of nausea, vomiting, or both before their prenatal clinic/office visit where they were recruited. After being accepted for the study, the women were randomly assigned to treatment or placebo groups. INTERVENTION: Treatment group 1 applied SeaBands with acupressure buttons to both wrists for 4 days and removed the Sea-Bands for 3 subsequent days. Placebo group 2 applied the Sea-Bands without acupressure buttons to both wrists on the same time schedule as group 1. MAIN OUTCOME MEASURE: Self-report daily diaries of the number of times per day that participants experienced nausea, the severity of nausea, the number of vomiting episodes per day, and the severity of vomiting. RESULTS: Mann-Whitney U procedures revealed that the treatment group had significantly less frequency and severity of nausea and vomiting of pregnancy while wearing the Sea-Bands than did the placebo group. The treatment group also had significantly less frequency and severity of nausea and vomiting of pregnancy while wearing the SeaBands than when not wearing the Sea-Bands. CONCLUSIONS: Sea-Bands with acupressure buttons are a noninvasive, inexpensive, safe, and effective treatment for the nausea and vomiting of pregnancy.

Acupressure↗
PubMed2001

Prevention of vomiting after general anesthesia for pediatric ophthalmic surgery.

We evaluated the effectiveness of a multifaceted general anesthesia protocol designed to minimize postoperative vomiting after pediatric eye surgery. A convenience sample of 150 consecutive children, aged 2 weeks to 18 years, who received general anesthesia for pediatric ophthalmic surgery was studied. General anesthesia was administered with induction by mask for 82.7% of the children and intravenously using propofol in 17.3% of the children. Anesthesia was maintained using halothane or isoflurane, oxygen, and air mixture for all patients. Morphine sulfate was used for additional pain relief, up to 0.1 mg/kg. Gastric aspiration was performed after intubation for each child. Metoclopramide, 0.15 mg/kg, and 0.1 mg/kg of ondansetron were administered before the end of each operation. Postoperatively, patients were monitored for vomiting for 24 hours. Postoperative vomiting occurred in 11 (7.3%) of 150 cases. Acute elevation of intraocular pressure was found in 5 of the 11 children who vomited. This vomiting was unresponsive to intravenous rescue ondansetron, but responded to lowering the intraocular pressure. The incidence of postoperative vomiting after general anesthesia for pediatric eye surgery can be substantially decreased by adopting a protocol designed to lessen the emetic effects of general anesthesia. Limited use of nitrous oxide for mask induction only, gastric emptying, and administration of metoclopramide and ondansetron intravenously in combination proved effective in reducing the incidence of postoperative vomiting.

Adolescent↗
PubMed2002

[Vomiting].

Vomiting, the culminating sign of nausea, is primarily a protective reflex occurring in a wide variety of vertebrates. Even tough nausea and vomiting are among the most basic neural reflexes, they remain poorly understood. Poorly understood are the pathogenetic mechanisms from the anatomic receptor and neuroendocrine point of view. This is the reason why drugs are useful in some types of vomiting but not in others. The aim of this paper is to summarize current knowledge about anatomy of vomiting reflex, neurotransmitter receptor subtypes, agonists and antagonists of serotonin and substance P. Particularly in the treatment of post-chemotherapy and postoperative vomiting. It is pointed out that nausea an vomiting may be field of neurochemical and neuropharmacological research. Finally, in clinical research drugs for vomiting therapy may be useful in other pathologies (migraine, rheumatoid arthritis, bronchial asthma).

Humans↗
PubMed2003

A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy.

OBJECTIVE: To compare the efficacy of ginger to vitamin B6 in the treatment of nausea and vomiting of pregnancy. STUDY DESIGN: A randomized double-blind controlled trial. SETTING: The Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital. SUBJECTS: Women with nausea and vomiting of pregnancy at or before 16 weeks of gestation, who attended the antenatal care clinic. The subjects requested anti-emetics, had no medical complications, non-hospitalized and were able to attend a one week follow-up visit. From November, 1999 to November 2000, 138 women participated and gave consent for the study. METHOD: The subjects were randomly allocated into two groups to take either 500 mg of ginger orally or an identical 10 mg of vitamin B6 one capsule three times daily for three days. Subjects graded the severity of their nausea using visual analogue scales before treatment and recorded the number of vomiting episodes in the previous 24 hours and again during three consecutive days of treatment. MAIN OUTCOME MEASURES: The change of nausea scores and the number of vomiting episodes during three days of treatment. RESULTS: The 64 subjects in each group remained in the study. The demographic data were comparable in both groups. The ginger and vitamin B6 significantly reduced the nausea scores from 5.0 (SD, 1.99) to 3.6 (SD, 2.48) and 5.3 (SD, 2.08) to 3.3 (SD, 2.07) respectively, with p < 0.001. The mean score change after treatment with ginger was 1.4 (2.21), less than with vitamin B6, which was 2.0 (2.19) but with no statistically significant difference (95% CI -1.4 to 0.2, p = 0.136). The ginger and vitamin B6 also significantly reduced the number of vomiting episodes from 1.9 (2.06) to 1.2 (1.75) and 1.7 (1.81) to 1.2 (1.50) respectively, with p < 0.01. The mean number change after treatment with ginger was 0.7 (2.18), more than with vitamin B6, which was 0.5 (1.44) but with no statistically significant difference, (p = 0.498). There were some minor side effects in both groups such as sedation (26.6% vs 32.8%, p = 0.439), and heartburn (9.4% vs 6.3%, p = 0.510), a non-significant difference. CONCLUSION: The nausea score and the number of vomiting episodes were significantly reduced following ginger and vitamin B6 therapy. Comparing the efficacy, there was no significant difference between ginger and vitamin B6 for the treatment of nausea and vomiting during pregnancy.

Female↗
PubMed1992

Results of a compassionate-use program using intravenous ondansetron to prevent nausea and vomiting in patients receiving emetogenic cancer chemotherapy.

This study reports the effectiveness and side effects of intravenous ondansetron as a single-agent antiemetic therapy for patients receiving emetogenic cancer chemotherapy under a compassionate-use program for patients not enrolled in controlled clinical trials. Patients were > or = 7 years old and had uncontrolled nausea and vomiting or intolerable side effects with standard antiemetics administered with previous cancer chemotherapy. All patients received ondansetron 0.15 mg/kg every 4 hours x 3 daily doses beginning 30 minutes prior to emetogenic chemotherapy. Patients could receive ondansetron for up to 5 consecutive days of chemotherapy. One hundred ninety patients received ondansetron during chemotherapy treatments that were similar to previous cycles of chemotherapy during which the patients had received standard antiemetics (identical chemotherapy or differing only by addition/deletion of chemotherapy agents of low emetogenicity). Chemotherapy regimens included cisplatin (n = 99; 52%), doxorubicin (without cisplatin, n = 52; 27%), and other drugs (n = 39; 21%). Patient experiences with nausea and vomiting and side effects with ondansetron and with previous standard antiemetics were rated on a scale of 1 to 10 (1, did not experience; 10, as bad as could be). On the nausea and vomiting scale, 74% of patients improved on ondansetron relative to standard antiemetics. Mean nausea and vomiting scales were 3.9 for ondansetron and 7.7 for standard antiemetics (P < .001). On the side effects scale, 62% of patients improved with ondansetron. Mean side effect scores were 1.8 for ondansetron and 4.5 for standard antiemetics (P < .001). One hundred nine patients assessed the effect of nausea and vomiting on their quality of life by means of the Functional Living Index-Emesis. On a 100-point scale (100=best quality of life), quality of life scores were 65.5 for ondansetron and 39.5 for standard antiemetics (P < .01). Functional Living Index-Emesis scores were higher for 76% of patients during ondansetron treatment as compared with previous chemotherapy with standard antiemetic regimens. Twenty-eight patients (15%) were withdrawn from the study because of nausea and vomiting. Forty-four patients (23%) experienced other adverse effects (headache, 17 patients; diarrhea, eight patients; all other events occurred in two or fewer patients). Only six patients were withdrawn due to adverse effects. In conclusion, ondansetron therapy resulted in significantly improved control of nausea and vomiting, fewer side effects, and better quality of life than standard antiemetic therapy in the same patients receiving similar chemotherapy regimens.

Adolescent↗
PubMed1991

[Comparison of methylprednisolone and droperidol in the prevention of nausea and vomiting following major gynaecological surgery].

The efficacy of methylprednisolone (MP) (500 or 250 mg) or droperidol 2.5 mg administered i.v., was studied in 200 women undergoing major gynaecological surgery. Following a standardised general anaesthesia technique with intrathecal morphine, the incidence of nausea and vomiting was assessed. The frequency of postoperative nausea and vomiting in the non-treated group was 59% and 35%; the group of MP 500 mg has a significant reduction of nausea and vomiting to 21% and 13%. Droperidol 2.5 mg decreased the incidence of postoperative nausea alone (nausea: 36%, vomiting: 19%). MP 250 mg was not effective in reducing either nausea or vomiting (nausea: 44%, vomiting: 38%). It was concluded that, of the drugs studied, MP 500 mg was most effective in preventing nausea and vomiting after major gynaecological surgery.

Adult↗
PubMed1991

[The regulating effect of electroacupuncture on gastroenteric electric activity in guinea pigs of peripheral vomiting].

Acute experiments were performed on 20 guinea pigs. The animals were divided at random into four groups of five each: the non-acupuncture group for control and three electroacupuncture groups (EA-I, EA-II, EA-III). Four pairs of platinum-wire electrodes were implanted under serosa of the antrum and corpus, duodenum, jejunum. The gastroenteric electric activity (GEA) was recorded in conscious and fasting state. Needling was applied at position 1 cm below the knee, corresponding to Zusanli. The peripheral vomiting model was established by infusion of CuSO4 into the stomach. Observation was made with regard to latency of vomiting induced by infusion of CuSO4, duration of the symptom, number of fits in the first five minutes after the attack began, and the variation of amplitude and frequency of GEA. The results were as follows: (1) The GEA of normal guinea pigs showed regular cyclic changes. After latency of 3.7 seconds following the infusion, symptom of vomiting began appear. The GEA returned to normal after latency of 60 minutes. (2) During vomiting, the GEA was characterized by a series of spikes which were seen more obviously in the antrum and corpus; during serious fits of vomiting, duodenum and jejunum were involved. The GEA showed disordered and quicker rhythm with higher amplitude and frequency. (3) EA could not affect the latency of the peripheral vomiting, but it could shorten the duration of the symptom. Results of group EA-II (p less than 0.001) showed EA could reduce the number of fits during the first five minutes; results of group EA-I (p less than 0.01) showed that EA could lower the amplitude and frequency of the GEA (p less than 0.05) that rose during vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Acupuncture Therapy↗
PubMed1990

[The value of alizapride in the treatment of vomiting in infants and children].

An open, three-day trial was carried out in 49 infants and children with vomiting related to an acute gastrointestinal or ENT infection (63.3% of cases), a gastroesophageal reflux (20.4%), or an attack of malaria (14.3%). Mean age of patients was 21.9 months. Number of episodes of vomiting exceeded six per day in 89.8% of patients. Alizapride (Plitican) was given as oral drops in a dosage of 3 mg/kg/d. Five patients were prematurely withdrawn from the trial for clinical deterioration requiring discontinuation of enteral nutrition. Under treatment, vomiting resolved completely in 35 patients, i.e. 71.4% of the initial study group. Six patients exhibited incomplete improvement of vomiting and eight (including the 5 dropouts) continued to have a significant number of episodes of vomiting. Overall effectiveness evaluated on the frequency of episodes of vomiting, weight changes, and the investigator's clinical judgement was considered as excellent or good in 81.6% of cases. No significant adverse effects were recorded but the product's bitter taste was involved in the persistence of vomiting in one of the dropouts and in the development of moderate nausea in another patient who was able to continue treatment. The therapeutic value of alizapride, evaluated using an analog scale, proved significant in this indication.

Antiemetics↗
PubMedDate not supplied

Effects of fluid manipulation on the incidence of vomiting during outpatient cisplatin infusion.

The influence of fluid intake and hydration rate on the frequency of vomiting was evaluated during 254 outpatient cisplatin infusions administered to 60 patients. The basic antiemetic regimen was consistent and used metoclopramide hydrochloride (Reglan) 2 mg/kg/dose (means = 150 mg) starting 30 minutes before cisplatin for a total of three doses; dexamethasone (Decadron) mean - 15 mg - and lorazepam (Ativan) 1 mg intravenous bolus before cisplatin, along with thiethlperazine maleate (Torecan) given routinely throughout the treatment beginning the evening before. Only 20% (38/192) of patients experienced symptoms of vomiting when hydrated at a rate of greater than 333 cc/hour as opposed to 44% (27/62) patients hydrated at a rate of 300 cc/hour or less (p = 0.01). Patients whose oral intake ranged from 400 cc to 1000 cc experienced noticeably less vomiting (14%) than patients who either refused fluids (39%, p = 0.001) or exceeded 1000 cc oral intake (36%, p less than 0.05) during treatment. Manipulation of total fluid intake (IV plus oral), although not statistically significant, seemed to affect the incidence of vomiting. By maintaining a positive intake/output ratio greater than 1, patients were able to decrease their vomiting episodes. Patients who gained weight during the treatment experienced significantly fewer episodes of vomiting (29%) than those who either lost or maintained their weight (71%). Findings suggest that manipulating both oral and IV fluid intake as well as the IV fluid rate may reduce symptoms of vomiting in the outpatient cisplatin setting.

Adult↗
PubMed1987

Acute radiation-induced vomiting in area postrema-ablated cats.

A dose-response relationship was established in normal unanesthetized cats for emetic incidence, latency to onset of vomiting, and duration of emetic activity over a period of 24 h after whole-body exposure to 60Co radiation at selected doses between 7.5 and 90 Gy. Each episode of vomiting, i.e., retching and expulsion, was recorded oscillographically as its characteristic intrathoracic pressure waveform by means of a catheter inserted some days before into the superior vena cava. The gamma-radiation dose of 45 Gy evoked vomiting optimally with an incidence of 92% and an average onset time of 98 min. When administered to animals prepared chronically with surgical ablation of the area postrema, the same dose of radiation evoked vomiting in four of five test cases and with an average time to onset that was not by either measure significantly different from normal. Vomiting was also elicited in all of six normal cats exposed to an intestinal dose of 45 Gy X radiation with the head shielded. The same form of irradiation evoked vomiting in two of three chronically postremectomized cats. Successful ablation of the area postrema was determined functionally by emetic refractoriness to an injection of digitalis and confirmed for completeness by histological examination. It is concluded that the area postrema is not an essential element in the reflex mechanism of radiation-induced vomiting and, therefore, no physiological basis exists for dependence on a centrally acting chemogenic factor in radioemesis.

Animals↗
PubMed1985

Epidemiology of vomiting in early pregnancy.

Factors associated with early pregnancy vomiting were investigated in 9098 first-trimester registrants in the Collaborative Perinatal Project. Vomiting in the absence of hyperemesis or gastroenteritis was noted in 56% of all women, and was more common among primigravidas (P = .002), younger women (P less than .001), women with less than 12 years of education (P less than .001), nonsmokers (P less than .001), and women weighing 77.1 kg (170 lb) or more (P = .003). Adjustment for confounders did not change these associations. Women reporting vomiting were less likely to experience miscarriage or stillbirth (P = .002) and delivery before 37 weeks' gestation (P = .004), but there was no difference in infant birth weight between mothers with and without vomiting (P = .48). Women who vomit in one pregnancy are more likely to vomit in subsequent pregnancies than are comparable women who did not vomit.

Adolescent↗
PubMed1995

[Pharmacokinetic investigation of 5-day multiple dose of tropisetron capsule in patients who had received cisplatin and the usefulness of tropisetron capsule in the treatment of nausea and vomiting].

We have investigated the pharmacokinetics of a 5-day multiple oral dose of 5 mg tropisetron capsule in patients with malignant tumour who had received cisplatin single administration. Its anti-emetic effects on acute and delayed emesis and vomiting were also investigated. During the 5 days after this administration, changes in the release and metabolism of serotonin were investigated. The results may be summarized as follows: 1) The pharmacokinetic parameters of tropisetron revealed no significant change in the data between day 1 and day 5. Also, the parameters were almost similar to those observed in healthy adult males (clinical phase I study); Cmax. T1/2 and AUC 0-24 hrs on day 1 were 9.1 +/- 2.1 ng/ml, 12.5 +/- 4.2 hrs, 85.5 +/- 22.7 ng.hr/ml, respectively. The urinary excretion of the parent drug up until 24 hours after administration on day 1 was 3.8% of the dose administered and 2.9% of the total dose after the last administration; no difference in the urinary excretion rate was observed in healthy subjects. It was thus suggested that hydration accompanied by cisplatin administration did not affect the pharmacokinetics of tropisetron. 2) The changes in the amount of urinary excretion of 5-hydroxy-indoleacetic acid (5-HIAA) during 5 days after cisplatin administration were observed; urinary excretion of 5-HIAA increased 2.3 times (1.3-5.4 times) the baseline on the average during 6 to 12 hours on day 1. In 6 out of 10 patients, the increases in urinary excretion of 5-HIAA showed double or more the baseline during 2 to 5 days after cisplatin administration. Serotonin was thus deemed to be related to the development of delayed emesis. 3) The anti-emetic effects of tropisetron on acute and delayed emesis and vomiting were rated as "markedly effective" in 6 out of 11 patients (54.6%) and "effective" in 1 out of 11 patients (9.1%) on day 1; vomiting did not occur in any of these 7 patients. Tropisetron also controlled emesis and vomiting during days 2-5, and was rated as "almost favorable" in 6 out of 11 patients (54.5%). Further, in 4 out of 6 patients, in whom the urinary excretion of 5-HIAA was increased on day 2 onwards, vomiting did not occur during the time when the urinary excretion of 5-HIAA was increasing. On the basis of the above results, tropisetron is deemed to have certain antiemetic effects on delayed vomiting as well. Its 5-HT3 receptor mediated mechanism was similarly seen to inhibit acute nausea and vomiting.

Adult↗
PubMed1995

[Clinical phase III study of tropisetron capsule in the treatment of nausea and vomiting induced by carboplatin or non-platinum anti-cancer drugs].

A clinical phase III study of tropisetron capsule was conducted to assess its efficacy, safety and usefulness on nausea and vomiting induced by carboplatin or non-platinum anti-cancer drugs. The study was conducted in patients who experienced vomiting on previous chemotherapy. Tropisetron 5 mg capsule was given to patients once 2 hours prior to the first administration of either carboplatin or non-platinum anti-cancer drugs; the patients were then observed for nausea and/or vomiting during 24 hours after the first administration. Some 56.7% (17/30) of the patients did not vomit after tropisetron administration, and the frequency of vomiting was significantly reduced compared with that during the previous chemotherapy. Further, in the clinical efficacy ratings, in which the efficacy was assessed on the basis of the nausea and vomiting data, 83.3% (25/30) of cases were rated as "effective or better". Adverse events observed were 3 cases of mild headache, but these were not clinically problematic. The above results reveal that tropisetron capsule is significantly effective and safe in the treatment of nausea and vomiting induced by carboplatin or non-platinum anti-cancer drugs; in addition, tropisetron proved to be highly useful for its convenience as an oral agent.

Adult↗
PubMed1996

[The development of a new QOL Questionnaire on chemotherapy - induced emesis and vomiting--investigation of reliability and validity. Group for Investigation of QOL Questionnaire for Anti-Emetics Used in Cancer Chemotherapy. Joint Research Group for Tropisetron Double-Blind Comparative study].

A new questionnaire on QOL of patients with chemotherapy-induced emesis and vomiting was developed, and its reliability and validity were investigated in the present multi-center clinical trial. The questionnaire consisted of 15 items which included descriptive questions on appetite, feeling, sleep, mental fatigue, anxiety, pain, sputum, respiratory distress, nausea, vomiting, abdominal condition, daily life in a hospital and relationship with family, a linear analogue scale representing influence of nausea and vomiting on patient's life during 24 hours, and a face scale as the global scale. Data from 98 patients with cancer were analyzed by principal component analysis and correlation analysis. The results were summarized as follows: 1) Recollect rate was 78.1% and complete response rate was 86.0% in this QOL measurement. 2) A clear correlation was observed between appetite, feeling, nausea, vomiting and the physiological scale, between sleep, mental fatigue, anxiety, pain, abdominal condition and the psychological scale, between sputum, respiratory distress and the respiratory condition related scale, between daily life in hospital and the active scale, between relationship with family and the social relation scale. These results satisfied internal consistency. 3) As for test-retest reliability, the total score of 13 descriptive items between the day before and two days before the start of chemotherapy showed no significant difference. 4) The 13 items were grouped into physiological, the psychological, the respiratory condition related, the active and the social relation scales, and these scales belonged to a different dimension. 5) The linear analogue scale, the face scale and the total scores of 13 descriptive items correlated respectively with all of items except item of, relationship with family. 6) As for concurrent validity, vomiting frequency, severity of nausea and anorexia correlated with the physiological scale. Severity of nausea and anorexia also correlated with the psychological and active scales. 7) As a result of investigation of sensitivity, the total score of the 13 descriptive items, the linear analogue scale representing influence of nausea and vomiting on patient's life during 24 hours and the face scale revealed the poorest levels 2-3 days after chemotherapy but recovered thereafter. The aggravation of QOL of patients treated with chemotherapy was reduced in the anti-emetic administration group compared with the placebo administration group. These results suggested that this new questionnaire developed for chemotherapy-induced emesis and vomiting had sufficient validity and reliability to reflect the effects of anti-emetic drug.

Aged↗
PubMed1998

Post operative nausea and vomiting in Nigerians.

A retrospective survey of postoperative nausea and vomiting (PONV) in the recovery room over a five year period was conducted, followed by a prospective study of 200 adult patients to estimate the incidence and predisposing factors to nausea and vomiting during the first 24 hours after anaesthesia and surgery in Nigerians. In the retrospective study only records of 61 patients (0.79%) out of the 7714 post anaesthetic recovery room charts reviewed revealed documentation of vomiting. These were 20 males (32.8%) and 41 females (67.2%). In the prospective study, the incidence of post operative nausea and vomiting within twenty four hours of surgery was 41.6% and 19.6%, respectively. But only two out of 39 patients (one per cent) vomited within the first three hours in postoperative period. The frequency of vomiting varied from one to 15 times and women had significantly more emetic symptoms than men (p < 0.05). Preoperative administration of pethidine and morphine was associated with postoperative nausea and vomiting. It is suggested that Nigerian women should be considered for prophylactic anti-emetic therapy, especially when narcotic analgesic are to be employed in their anaesthetic management.

Adult↗
PubMed1984

A prospective assessment of chemotherapy-related nausea and vomiting in children with cancer.

The purpose of this study was to determine if cancer chemotherapy invariably produces nausea and vomiting, if the extent of emesis is influenced by the number of drugs in a regimen, and if children's patterns of symptoms remain stable during repeated courses of the same agents. Forty-nine children with cancer (ages 5-21) prospectively rated (1-10 scale) their nausea and vomiting within 3-5 days after the administration of each course of chemotherapy. Chemotherapy courses which included antiemetics were eliminated from the analysis. No agents were found which never or always produced nausea and vomiting. No systematic increases or decreases in vomiting occurred as agents were added or subtracted from chemotherapy regimens and there was no association between the number of agents in a regimen and the extent of nausea and vomiting. Most patients' symptoms fluctuated widely. Only 4/49 patients (8%) had minimal symptoms (ratings of 1s and 2s) during chemotherapy and there were no patients who always had nausea and vomiting (ratings greater than or equal to 3s) with every course. The data suggest that nondrug variables influence chemotherapy-associated nausea and vomiting in children.

Adolescent↗
PubMed2006

Metaanalyses of acustimulations: effects on nausea and vomiting in postoperative adult patients.

OBJECTIVE: Using metaanalysis to examine the effects of acustimulations on nausea and vomiting symptoms (NVS) in postoperative adult populations. METHODS: Metaanalyses of effects of various acupoints stimulations (AS) (including acupuncture, acupressure, and electrical stimulation) on NVS in postoperative adult populations were performed. Thirty-three quality randomized controlled trials (RCT) published over the past three decades were identified by evaluating the quality of randomization and treatment methods, and results were pooled using a fixed effects model. RESULTS: Twenty-four trials were pooled for nausea, 29 trials for vomiting, and 19 trials for rescue antiemetics, with AS compared with placebo or controls. Two additional trials did not have control groups but compared AS to medication groups. Compared with the controls, AS (all modalities) reduced nausea (relative risk [RR] = 0.60, 95% confidence interval [CI]: 0.54-0.67, P < .0001), vomiting (RR = 0.51, 95% CI: 0.45-0.57, P < .0001), and use of rescue antiemetics (RR = 0.63, 95% CI: 0.54-0.74, P < 0001). All AS modalities were effective in reducing NVS. Korean hand acupressure stimulations (two trials) had the best impact on reducing vomiting. There were no significant differences on pooled RRs for nausea (five trials) and vomiting (eight trials) between medication and AS groups, but medication groups had increased use of rescue antiemetics (two trials, RR = 2.27, 95% CI: 1.48-3.49, P = .0002). There was a placebo effect when compared with controls in reducing nausea (four trials, RR = 0.67, 95% CI: 0.50-0.90, P = .0069) and vomiting (three trials, RR = 0.39, 95% CI: 0.19-0.80, P = .0106). CONCLUSIONS: This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations.

Acupressure↗
PubMed1994

The addition of ondansetron to the combination of metoclopramide, dexamethasone, and lorazepam did not improve vomiting prevention in patients receiving high-dose cisplatin.

BACKGROUND: Serotonin has been shown to be an important mediator of chemotherapy-induced vomiting. Ondansetron is a potent and highly specific antagonist of the 5-HT3 serotonin receptor. The objective of the current trial was to determine if the addition of ondansetron to the combination of metoclopramide, dexamethasone, and lorazepam (MDL) could improve the control of vomiting in patients receiving high-dose cisplatin. The three-drug MDL antiemetic regimen has been shown to prevent vomiting in 67% of patients receiving high-dose cisplatin. METHODS: Thirty-two patients receiving initial cisplatin (greater than or equal to 100 mg/m2) were given intravenous lorazepam, 1.5 mg/m2 (maximum dose, 3 mg), one dose 45 minutes before cisplatin; metoclopramide, 3 mg/kg 40 minutes before and 90 minutes after cisplatin; ondansetron, 0.3 mg/kg 25 minutes before and 3.5 hours after cisplatin; and dexamethasone, 20 mg, one dose 10 minutes before cisplatin. Patients were followed for 24 hours after cisplatin administration. RESULTS: Vomiting was prevented in 67% of patients (95% confidence interval, 47-83%). Adverse effects were mild and transient and included sedation, headache, serum aspartate transaminase, and alanine transaminase elevations, akathisia, and hiccups. CONCLUSIONS: Vomiting was prevented in two thirds of patients treated with MDL plus ondansetron, a result similar to that observed in earlier trials of MDL alone. The lack of improvement in emetic control by the addition of ondansetron suggests that vomiting mediated through 5-HT3 receptors is already effectively blocked. Emesis that occurs despite pretreatment with MDL is likely mediated by other mechanisms.

Adult↗