Beam et al.1 suggest that patients undergoing arm tucking are best served without the use of any hard device or objects which could exacerbate pressure when the arms are tucked.1 In clinical trials and current use at Mayo Clinic and several other hospitals, there have been no reported cases of adverse events with the use of the Pressure Right® (Pressure Point Inc., Grand Rapids, MI) product, an acupoint stimulation strip which has been cleared by the Food and Drug Administration for clinical use.
Regarding transient median neuropathy (which has not been previously reported with the use of acupressure devices), Beam et al.1 acknowledged that Pressure Right was not responsible for the transient injury associated with the patient’s median nerve in their single reported case.
Factors such as the surgical procedure requiring the patient’s arms be tucked along the body congruent with gel pads, IV tubing, connectors, and ports being securely wrapped against the patient’s body, were identified as paramount in creating additional force, presumably on the patient’s median nerve. In addition, based on the positioning of the palmaris longus tendon, which lies in close proximity to the median nerve, any prolonged additional force or pressure on this tendon might transiently impair function of the median nerve.2
Pressure Right is positioned on the lower forearm and wrist between the 2 central tendons. Based on the prescribed P6 pressure limits of between 5 and 7 pounds per square inch, Pressure Right has met the bench-testing requirements of the sanctioned per square inch measurement of pressure equivalence for safe and effective stimulation to the P6 acupoint which was part of the Food and Drug Administration’s requirement for approval.
Lee and Fan,3 in a 2009 Cochrane systematic review of P6 clinical trials, confirmed the clinical usefulness of P6 acupoint stimulation strategies and that it had minimal side effects.
Pressure Right’s frequently asked questions offer helpful information to ensure proper use of Pressure Right including the recommendation that additional bandaging in the wrist area should be avoided to reduce the likelihood of complications resulting from additional force being placed on the device.
We have already updated the product literature included with Pressure Right packages advising users that when patients are undergoing surgery that requires their arms be tucked along the body, the P6 stimulation strip should not be used until after the patient’s arms have been released from the tucking position so that Pressure Right may be used effectively.
Pressure Point Inc.
Grand Rapids, Michigan
1. Beam WB, Weingarten TN, Sprung J. Median neuropathy associated with acupoint stimulation strip. Anesth Analg. 2013;117:279
2. Netter FH Atlas of Human Anatomy. 19958th ed East Hanover, NJ Hoechstetter Printing Company
3. Lee A, Fan LT Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2009, April 15;(2):CD003281. doi: 10. 1002/14651858. CD 003281. pub 3.