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      The Effect of Acupressure at PC6 and REN12 on Vomiting in Patients Undergoing Inguinal Hernia Repair: A Double-Blind Randomized Clinical Trial

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          Inguinal hernia surgery is one of the most commonly performed surgeries with complications such as postoperative nausea and vomiting (PONV).


          This study aimed to evaluate the effect of acupressure at PC6 and REN 12 points on vomiting of patients undergoing inguinal hernia repair.


          This is a double-blind, randomised clinical trial performed on 60 patients undergoing inguinal hernia repair. Using permutation blocks, patients were allocated in two groups (acupressure at PC6 and REN12 points). After the surgery and full patient consciousness, acupressure was applied on PC6 and REN 12 points separately in each group for 5 minutes; 2, 4 and 6 hours later, acupressure was repeated on those points. Two hours after each acupressure, frequency and severity of vomiting were determined.


          The results showed that there was no significant difference between the frequency of vomiting before the intervention and 2 hours after the intervention in the two intervention groups (P ≥ 0.05). Additionally, none of the two intervention groups experienced vomiting at 4, 6, and 8 hours after the intervention.


          It seems that acupressure at PC6 and REN 12 points are not effective in reducing the frequency and severity of vomiting in patients after inguinal hernia surgery.

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          Most cited references 39

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          Risk factors for postoperative nausea and vomiting.

           Tong Gan (2006)
          Knowledge of postoperative nausea and vomiting (PONV) risk factors allows anesthesiologists to optimize the use of prophylactic regimens. Modern PONV risk research began in the 1990s with publication of studies using logistic regression analysis to simultaneously identify multiple independent PONV predictors and publication of meta-analyses and systematic reviews. This literature shows that female gender post-puberty, nonsmoking status, history of PONV or motion sickness, childhood after infancy and younger adulthood, increasing duration of surgery, and use of volatile anesthetics, nitrous oxide, large-dose neostigmine, or intraoperative or postoperative opioids are well established PONV risk factors. Possible risk factors include history of migraine, history of PONV or motion sickness in a child's parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, decreased perioperative fluids, crystalloid versus colloid administration, increasing duration of anesthesia, general versus regional anesthesia or sedation, balanced versus total IV anesthesia, and use of longer-acting versus shorter-acting opioids. Early-phase menstruation, obesity and lack of supplemental oxygen are disproved risk factors. Current risk scoring systems have approximately 55%-80% accuracy in predicting which patient groups will suffer PONV. Further research examining genetic and under-investigated clinical patient characteristics as potential risk factors, and involving outpatients and children, should improve predictive systems.
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            Acupuncture analgesia: a review of its mechanisms of actions.

            The mechanism of acupuncture analgesia (AA) has been widely explored since the 1970s. Early studies investigated the relationship between acupuncture and endogenous opiates (beta-endorphin, enkephalin, endomorphin and dynorphin). Before the 1990s, most experts agreed on the concept that in normal animal models, lower frequency electroacupuncture (EA) stimulates the release of beta-endorphin, enkephalin and endomorphin, which in turn activates the mu- and delta-opioid receptors, and that higher frequency EA stimulates dynorphin which activates the kappa-opioid receptor. Besides endogenous opiates, our studies have focused on serotonin. The serotoninergic descending inhibitory pathway is suggested to be an important mechanism of acupuncture analgesic, collaborating with endogenous opiates. Many efforts have been made to clarify these mechanisms, but to date no satisfactory consensus has been reached. In the late 1990s, researchers began to focus on the different analgesic effects of EA between normal and hyperalgesic animal models. Published data from these studies imply that normal and hyperalgesic animals respond differently to EA. Results from experiments on the anti-hyperalgesia effect of EA have raised a new issue about the influences of EA on receptors to excitatory amino acid in the spinal cord level. Results from various studies have shown that these receptors play a role in the mechanism of AA. Recently, research on the autonomic nervous system (ANS) seem to indicate its connection with acupuncture. The inflammatory reflex (via the ANS) might be a crucial part of anti-hyperalgesia elicited by acupuncture, and this reflex, which regulates the immune system in the organism, can elucidate not only the mechanism of AA but also the mechanism of acupuncture applied to other inflammatory conditions. Innovation of functional image study enables us to analyze the responses of cortex on living human body to acupuncture. However, results of these experiments are still controversial. After 30 years of acupuncture research, there are still many puzzles left to be solved regarding the mechanism of AA.
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              The mechanism of acupuncture and clinical applications.

              This study presents the result of the studies explaining the effects of acupuncture on various systems and symptoms. It has been determined that endomorphin-1, beta endorphin, encephalin, and serotonin levels increase in plasma and brain tissue through acupuncture application. It has been observed that the increases of endomorphin-1, beta endorphin, encephalin, serotonin, and dopamine cause analgesia, sedation, and recovery in motor functions. They also have immunomodulator effects on the immune system and lipolithic effects on metabolism. Because of these effects, acupuncture is used in the treatment of pain syndrome illnesses such as migraine, fibromyalgia, osteoarthritis, and trigeminal neuralgia; of gastrointestinal disorders such as disturbance at gastrointestinal motility and gastritis; of psychological illnesses such as depression, anxiety, and panic attack; and in rehabilitation from hemiplegia and obesity.

                Author and article information

                Open Access Maced J Med Sci
                Open Access Maced J Med Sci
                Open Access Macedonian Journal of Medical Sciences
                Republic of Macedonia (ID Design 2012/DOOEL Skopje )
                15 May 2019
                10 May 2019
                : 7
                : 9
                : 1461-1465
                [1 ]Student Research Committee, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
                [2 ]Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Social Development and Health Promotion Center, Gonabad University of Medical Sciences, Gonabad, Iran
                [3 ]Clinical Specialist in Chinese Medicine, Specialized Clinic of Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
                Author notes
                [* ] Correspondence: Mohammad Mojalli. Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Social Development and Health Promotion Center, Gonabad University of Medical Sciences, Gonabad, Iran. E-mail: mohammadmojali@ 123456yahoo.com
                Copyright: © 2019 Seyyed Roohollah Najjari, Habib Shareinia, Seyyed Javad Mojtabavi, Mohammad Mojalli.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                Clinical Science


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