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The Use of Nonpharmacologic Techniques to Prevent Postoperative Nausea and Vomiting: A Meta-Analysis

Lee, Anna PhD, MPH; Done, Mary L. FANZCA

doi: 10.1213/00000539-199906000-00031
General Articles

We assessed the efficacy of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV) by systematic review.These studies included acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation, and acupressure. Of the 24 randomized trials retrieved by a search of articles indexed on the MEDLINE and EMBASE databases (1980-1997), 19 were eligible for meta-analysis. The primary outcomes were the incidence of nausea, vomiting, or both 0-6 h (early efficacy) or 0-48 h (late efficacy) after surgery. The pooled relative risk (RR) and numbers needed to treat (NNT) were calculated. In children, no benefit was found. Some results in adults were significant. Nonpharmacologic techniques were similar to antiemetics in preventing early vomiting (RR = 0.89 [95% confidence interval 0.47-1.67]; NNT = 63 [10-[infinity]]) and late vomiting (RR = 0.80 [0.35-1.81]; NNT = 25 [5-[infinity]]) in adults. Nonpharmacologic techniques were better than placebo at preventing early nausea (RR = 0.34 [0.20-0.58]; NNT = 4 [3-6]) and early vomiting in adults (RR = 0.47 [0.34-0.64]; NNT = 5 [4-8]). Nonpharmacologic techniques were similar to placebo in preventing late vomiting in adults (RR = 0.81 [0.46-1.42]; NNT = 14 [6-[infinity]]). Using nonpharmacologic techniques, 20%-25% of adults will not have early PONV compared with placebo. It may be an alternative to receiving no treatment or first-line antiemetics. Implications: This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children.

(Anesth Analg 1999;88:1362-9)

Department of Anaesthetics, Division of Critical Care, Liverpool Hospital, New South Wales, Australia.

Accepted for publication November 11, 1998.

Address correspondence to Dr. Anna Lee, Centre for Kidney Research, The New Children's Hospital, Parramatta, NSW 2124, Australia. Address e-mail to

© 1999 International Anesthesia Research Society