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Apurva Agarwal*, Rupam Jha, Shaily Agarwal, Chitra Tyagi, Renu Gupta and
Anurag Agarwal


Introduction: Obstetric surgery places the patient at a high risk for Intra Operative Nausea and Vomiting (IONV), as well as Postoperative nausea and vomiting (PONV). Thus, PONV prophylaxis is an important component in providing safe anesthesia for these patients. Pharmaceutical interventions like metoclopramide and 5-HT3 antagonists are the current treatment of choice for PONV prophylaxis. However newer drugs are less easily available and more expensive and there is always a concern regarding the effects on fetus. There is a renewed interest in a non-pharmaceutical intervention that can be easily available and simple to use even at remote centers in the country. Aims and objectives: This study attempts to evaluate and compare efficacy of antiemetic effects of P6 acupressure point with metoclopramide and palonosetron for PONV prevention in obstetric surgery. Material and methods: A randomized control trial was done on 300 patients with ASA grade I-II, between ages of 18-45 undergoing obstetric surgery under spinal anesthesia at a tertiary care center. The patients were randomly allocated in four groups using a random sequence. In group I, 98 patients received metoclopramide 0.2 mg.kg intravenous (IV) 5 minutes prior to induction of anesthesia. In group II, 102 patients received 75 μg palonosetron IV 5 minutes prior to induction. Group IIIA contained 51 patients in acupressure (wrist band) group. Group IIIB included 49 patients in acupressure with capsaicin paste. All patients were followed till 24 hours post surgery and incidence of PONV was recorded intra-operative and till 30 minutes, at 2 hours, 6 hours and 24 hours post surgery. The results were analyzed using SPSS software. Results: The incidence of nausea was higher in patients administered metoclopramide as compared to palonosetron or acupressure. The patients in wristband group had significantly lower (p=0.0316) incidence of nausea as compared to metoclopramide. The wristband group had 3% lower incidence of nausea as compared to palonosetron (p=0.32). Acupressure wristband can be considered as effective as palonosetron in prevention of nausea. The incidence of nausea was significantly lower in palonosetron group as compared to metoclopramide group (p= 0.0353). The cost analysis signifies the advantage of acupressure methods. Conclusion: Acupressure wristband is a safe and highly effective method to prevent PONV, even in emergency settings and highrisk patients. The acupressure wristband can help in bringing down cost and can be easily made at the small primary healthcare centers and trained midwifes, hence circumventing the issue of drug availability and economic burden.

Keywords: P6 acupressure point, PONV, metoclpramide, 5 HT3 Antagonist, palonosetron.

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