Acupressure reportedly prevents nausea and vomiting during spinal anesthesia for cesarean delivery, although the evidence is limited. Because of the limitations of intrathecal fentanyl for postoperative analgesia, bupivacaine and morphine anesthesia was used in this study of the effect of acupressure on nausea and vomiting during and after cesarean delivery. A prospective, randomized, double-blind design was used. Ninety-four women (ASA class I) ranging in age from 18 to 40 years who were scheduled for operative delivery, had no history of postoperative nausea, and had not previously undergone acupressure or acupuncture were enrolled. Actively treated patients had an acupressure band placed at the P6 (pericardium) point on the anterior forearm surface; the same site was subject to placebo stimulation in control patients. Postoperative analgesia included morphine, diclofenac, and codeine.
T4 to T5 block was consistently achieved. Hypotension developed in roughly 40% of patients in each group. Nausea and vomiting occurred during surgery in 23% of acupressure patients and 53% of the control group, a significant difference (P = 0.002). Nearly twice as many control patients had nausea or vomiting 14 hours after delivery (66 vs. 36%, P = 0.011). The need for opioids during and after surgery was similar in both groups, but significantly less antiemetic medication (Ondansetron) was required by patients treated with acupressure. Acupressure remained protective after exclusion of patients who received an antiemetic during surgery. After adjusting for age and hypotension, the odds ratio for nausea or vomiting during cesarean delivery in acupressure patients, as compared with control women, was about 0.3. Acupressure seems to be an effective nonpharmacologic means of preventing nausea and vomiting during and after cesarean delivery performed with spinal anesthesia. It is a simple, economical measure with no major side effects.