Combination of Pressure Right device and antiemetics effective in reducing PONV

May 9 2012

Pressure Point Inc. stated in a recent press release that in a peer reviewed research article appearing in the Anesthesia & Analgesia Journal last month entitled: Use of Disposable Acupressure Device, its Pressure Right® acustimulation disposable (adhesive) wrist device confirmed a positive advantage when used as part of a multimodal antiemetic regimen. The clinical effects of the Pressure Right® acupressure technique in a sham-controlled study comparison demonstrated a definite impact in reducing PONV. The study evaluated the antiemetic prophylaxis of Pressure Right® as an adjunct to routine antiemetics, i.e., 5-HT3 antagonist, ondansetron and dexamethasone, compared to the drug combination alone, in patients undergoing major laparoscopic surgery procedures.

Unfortunately, the use of acustimulation therapy in clinical practice for the prevention of PONV has been given little or no attention despite the high incidence of PONV in surgery patients.

According to published literature, an estimated 30% of surgery patients are still impacted by the effects of PONV even with the widespread use of various antiemetic prophylactic combinations. Within the last decade, much has been written by research experts and clinical practice organizations supporting the use of prophylactic antiemetic combinations and setting PONV management guidelines in an effort to improve patient outcomes relating to postoperative emetic symptoms. Based on published evidence to date, clinical practice uses of antiemetic drug combinations alone seem to have reached its maximum potential in PONV management effectiveness.

Hence, because of the current PONV problem a wider discussion on acustimulation techniques can now unfold, such as acupressure stimulation on the wrist point P6 may offer a viable solution to the current PONV management problem. In 2009, the editorial group, Cochrane Anaesthesia Group, headed by Dr. Anna Lee and Lawrence TY Fan, published their findings of a systematic review of MEDLINE research literature and others from 1966 to 2008 to appraise the quality of research evidence of acupuncture and acustimation (acupressure) studies.

The authors' conclusions were that P6 acupoint stimulation prevented PONV. In a posted online Science Daily article dated April 15, 2009, the authors concluded "That the use of stimulation on the P6 acupoint could be used as a suitable alternative or addition to antiemetic medications." Further, Dr Lee said, "Generally physicians and patients are not aware of this type of treatment for preventing postoperative nausea and vomiting and translating the evidence from this updated Cochrane review into clinical practice will take time." Based on the latest drug and acupressure device combination therapy results, the implementation of P6 stimulation therapy is expected to become mainstream in clinical practice in the months ahead.

Looking at the current PONV problem from several perspectives are as follows:

•Evidence-based research shows overall PONV to be representative in about 30% of all surgeries and patient populations, this according to academic literature provided by Kovac AL, 2000; Habib AS, Gan TG, 2004; and Apfel CC 2004.
•Outpatient PONV is prevalent in about 40% of patients treated at outpatient surgery centers, this according to Carroll NV, 1995.
•Breakthrough PONV is estimated to affect more than 30% of patients after receiving prophylactic antiemetics, according to Apfel CC, 2004.

Another complication following surgery is referred to as postdischarge nausea and vomiting or (PDNV) and generally occurs after a patient is discharged and goes home.

In 2009, the Apfel CC group confirmed from a review of postoperative data of 2,172 adult outpatients that the incidence of PDNV was as high as 37%. Previously, it was assumed that PDNV after the use of prophylactic ondansetron was expected to be at 15% based on a simulation study approach. The results of the review showed that more than one-third (1/3) of outpatients are vulnerable to PDNV following ambulatory surgeries. This fact is of a major concern to outpatients, since these individuals are no longer under the supervision of healthcare practitioners once they are discharged.

The facts are that the PONV and PDNV problem is far from being solved with only the use of various combinations of antiemetic prophylaxis drugs. Much long-acting techniques beyond antiemetics are needed, such as wrist acupressure stimulation with no adverse effects, which can help reduce the current PONV & PDNV crisis.

According to Dr. Lixing Lao, a licensed acupuncturist and director at the Center of Integrative Medicine at the University Of Maryland School Of Medicine, in the same Science Daily article, he describes how pressing down on the acupoint P6 with a device creates a stimulation treatment that works to prevent nausea.

Further, Dr. Lao is quoted in the article as saying, "After stimulation by acupressure of the acupuncture point, the nerve system is then activated to cause a signal to the brain to release certain chemicals known as neurotransmitters (serotonin, dopamine or endorphins); these then block the other chemicals that cause sickness of nausea and vomiting in this case (after surgery), in the central nerve system. He further said "therefore the patient won't feel that sick or nauseated."

Because of the multifactorial causes of PONV, the demand for combination antiemetic therapy has become common. Yet, PONV still remains a continuing concern especially for high-risk patients even after receiving antiemetic drug therapy, according research experts.

Clearly, current FDA 510(k) premarket notification clearance practices for acupressure devices now require an acceptable power analysis design study that will detect a significant absolute decrease of at least (i.e., 25% to 30%) in the number of patients experiencing PONV. Prior to 2007, this was not the case; however, under new FDA guidance standards the antiemetic value of pressure-based wrist devices that do qualify (i.e. Pressure Right®), which receive evidence-based clearance for relief of emetic (nausea and vomiting) symptoms after surgery, are likely to improve the current conditions surrounding PONV occurrences in patients.

New updates from institutional guideline organizations, such as ASA, ASPAN & SAMBA, who evaluate current medical literature on PONV, have not been forthcoming since 2007, according to published guideline literature.

It may be time for the institutional guideline organizations to seriously consider nonpharmacologic techniques and recommend Pressure Right® as an evidence-based reference tool for the management of patients undergoing surgery, which have been identified as at risk for PONV.