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--- acupuncture:evaluation:soins peri-operatoires:07. nausees et vomissements post-operatoires [23 Apr 2021 06:52]
Nguyen Johan [4. Clinical Practice Guidelines]
+++ acupuncture:evaluation:soins peri-operatoires:07. nausees et vomissements post-operatoires [25 May 2025 11:26] (Version actuelle)
Nguyen Johan
@@ Ligne 6: / Ligne 6: @@
 ===== Systematic Reviews and Meta-Analysis=====
-| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
-| ☆☆ | Evidence for effectiveness of acupuncture |
-| ☆ |Limited evidence for effectiveness of acupuncture |
-| Ø |No evidence or insufficient evidence |
 ==== Generic Acupuncture ====
+=== Arslan 2024 ===
+Arslan HN, Çelik SŞ. Nonpharmacological Nursing Interventions in Postoperative Nausea and Vomiting: A Systematic Review. J Perianesth Nurs. 2024 Feb;39(1):142-154.  https://doi.org/10.1016/j.jopan.2023.06.096
+^Purpose| This study aims to assess the impact of nonpharmacological nursing interventions on postoperative nausea and vomiting (PONV).|
+^Design| This is a systematic review.|
+^Methods| MEDLINE, Web of Science, ScienceDirect, Tübitak-ULAKBİM, and TRDizin databases were searched for the following search terms, including "Postoperative Nausea and Vomiting," "Nurse," "Nursing," and "Nonpharmacological Interventions" to identify nonpharmacological nursing interventions for PONV. A systematic review of English and Turkish articles published in the period between January 1, 2012 and June 1, 2023 was conducted. The PICOT-SD method was used to determine the compatibility of the pieces with the eligibility criteria.|
+^Findings| Fifty-eight of 3,874 articles obtained from databases fulfilled the eligibility criteria. This study demonstrated that **acupuncture**, aromatherapy, the oral intake of ginger, listening to music, education, and visits to patients decreased the incidence of nausea and vomiting and increased the quality of life. Additionally, it was found that patients' quality of life tended to improve along with reductions in postoperative complications.|
+^Conclusions| The results of this study support previous findings in the literature and demonstrate that nonpharmacological nursing interventions help reduce and prevent PONV. Based on our results, we suggest that nonpharmacological nursing interventions can be employed for the management of PONV in patients undergoing surgery.|
 === Lederer 2018 ===
@@ Ligne 174: / Ligne 181: @@
 === Electro-acupuncture ===
+== Ge 2023 (gynecologic surgery )==
+Ge Y, Zheng J. The efficacy of transcutaneous electronic acupoint stimulation for improving postoperative recovery after gynecologic surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Sep 1;102(35):e34834.  https://doi.org/10.1097/MD.0000000000034834. https://pubmed.ncbi.nlm.nih.gov/37657060; PMCID: PMC10476788.
+^Background| This systematic review and meta-analysis aimed to evaluate the efficacy of transcutaneous electronic acupoint stimulation (TEAS) for improving postoperative recovery after gynecologic surgery.|
+^Methods| We performed a thorough search of 6 databases until March 2023, identifying 12 randomized controlled trials that met our predefined inclusion criteria and encompassed a total of 1510 patients. For continuous outcomes, we calculated the weighted mean difference (WMD), and for binomial outcomes, we used the risk ratio (RR). We evaluated heterogeneity among the included studies using Cochran I2 and Q statistics, utilizing a random-effects model when the I2 value exceeded 50%. To assess publication bias, we employed Egger test.|
+^Results| Our analysis found that **TEAS significantly reduced the risk of postoperative nausea (RR: 0.60, 95% CI: 0.43-0.83, P = .002) and postoperative vomiting (RR: 0.54, 95% CI: 0.43-0.67, P < .001)**, visual analogue scale (WMD: -0.47, 95% CI: -0.76 to -0.17, P = .002), as well as shortened the time to first bowel movement (WMD: -18.43, 95% CI: -20.87 to -15.99, P < .001) and time to first flatus (WMD: -8.98, 95% CI: -12.46 to -5.51, P < .001) compared to the conventional group.|
+^Conclusions| Our findings suggested that TEAS may improve postoperative recovery following gynecologic surgery. However, to confirm these results, larger randomized controlled trials encompassing a more diverse range of patient populations are urgently required.|
+== Han 2023 ==
+Han Z, Zhang X, Yang H, Yuan P, Wang H, Du G. Suggested Electroacupuncture for Postoperative Nausea and Vomiting: A Comprehensive Meta-Analysis and Systematic Review of Randomized Controlled Trials. Med Sci Monit. 2023 Oct 18;29:e941262.  https://doi.org/10.12659/MSM.941262
+^Backgound| The purpose of this meta-analysis was to evaluate the effectiveness of electroacupuncture in preventing and treating postoperative nausea and vomiting (PONV) after general anesthesia. |
+^Material and methods| We searched for papers on randomized controlled trials on electroacupuncture for PONV prevention after general anesthesia published in PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) since October 1, 2016. Primary outcome was incidence of PONV; secondary outcomes were incidence of postoperative nausea (PON) at 6 h, postoperative vomiting (POV) at 6 h, and postoperative antiemetic requirement. Data were combined and analyzed using RevMan 5.4.1 software. |
+^Results| **Eight randomized controlled trials, with 899 total participants**, were included. Findings showed (1) there was no significant difference in occurrence rate of PONV between electroacupuncture and control groups (OR=0.31, 95% CI [0.06, 1.49], P=0.14, I²=82%); (2) electroacupuncture reduced incidence of PON at 6 h postoperatively, compared with controls (OR=0.43, 95% CI [0.27, 0.67], P=0.0002, I²=0%); (3) compared with control group, electroacupuncture reduced POV incidence 0-6 h postoperatively (OR=0.38, 95% CI [0.23, 0.63], P=0.0001, I²=0%); (4) electroacupuncture group demonstrated a significant reduction in postoperative requirement for antiemetic medications (OR=0.44, 95% CI [0.25, 0.78], P=0.005, I²=61%); (5) one study reported adverse reactions during observation, with 3 patients experiencing pain and itching at acupuncture site and 2 patients refusing a second acupuncture treatment; all symptoms lasted less than 2 h. |
+^Conclusions| Based on current evidence, electroacupuncture significantly reduces the occurrence rate of PON and POV at 6 h after surgery and the use of antiemetic medication postoperatively. However, more high-quality, large-sample randomized controlled trials are needed to further validate its efficacy.|
+== Lu 2023 ==
+Lu L, Xie C, Li X, Zhou Y, Yin Z, Wei P, Gao H, Wang J, Yong Y, Song J. Efficacy and safety of electrical acupoint stimulation for postoperative nausea and vomiting: A systematic review and meta-analysis. PLoS One. 2023 May 31;18(5):e0285943.  https://doi.org/10.1371/journal.pone.0285943
+^Background| Postoperative nausea and vomiting are typical postsurgical complications. Drug therapy is only partially effective. The goal of our meta-analysis is to systematically evaluate the efficacy and safety of electrical acupoint stimulation for postoperative nausea and vomiting and to score the quality of evidence supporting this concept.|
+^Methods| PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 19, 2020.|
+^Results| **Twenty-six studies (2064 patients)** were included. Compared with control treatment, electrical acupoint stimulation reduced the incidence of postoperative nausea and vomiting (RR 0.49, 95% CI 0.41 to 0.57, P < 0.001), postoperative nausea (RR 0.55, 95% CI 0.47 to 0.64, P < 0.001) and postoperative vomiting (RR 0.56, 95% CI 0.45 to 0.70, P < 0.001). Electrical acupoint stimulation also reduced the number of patients requiring antiemetic rescue (RR 0.60, 95% CI 0.43 to 0.85, P = 0.004). No differences in adverse events were observed. Subgroup analysis showed that both electroacupuncture (RR 0.58, 95% CI 0.46 to 0.74, P < 0.001) and transcutaneous electrical acupoint stimulation (RR 0.44, 95% CI 0.34 to 0.58, P < 0.001) had significant effects. Electrical acupoint stimulation was effective whether administered preoperatively (RR 0.40, 95% CI 0.27 to 0.60, P < 0.001), postoperatively (RR 0.59, 95% CI 0.46 to 0.76, P < 0.001), or perioperatively (RR 0.50, 95% CI 0.37 to 0.67, P < 0.001). The quality of evidence was moderate to low.|
+^Conclusions| Electrical acupoint stimulation probably reduce the incidence of postoperative nausea and vomiting, postoperative nausea, postoperative vomiting, and reduce the number of patients requiring antiemetic rescue, with few adverse events. |
 == Chen 2020 ==
@@ Ligne 185: / Ligne 220: @@
 ^Conclusions|TEAS is a reasonable modality to incorporate into a multimodal management approach for the prevention of PONV, PON, POV and associated with lower numbers needing antiemetic rescue, lower incidence of adverse effects after general anesthesia. |
+=== Comparison of Acupuncture techniques ===
+== Zhou 2025 ==
+Zhou T, Hou H, Cairen Z, Wang Y, Wang P, Ge L, Wa M, Xu Z, Tang F, Wang C, Liu R, Li D, Xue J, Zhang S. Comparative effectiveness of acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: a network meta-analysis of randomized trials. Int J Surg. 2025 Jan 1;111(1):1330-1347.  https://doi.org/10.1097/JS9.0000000000001976
+^Objective| The objective was to systematically evaluate the effectiveness of different acupoint stimulation techniques in preventing postoperative nausea and vomiting (PONV) after general anesthesia.|
+^Methods| The authors searched PubMed, Cochrane Library, Web of Science, and Embase for relevant papers, about the effect of acupoint stimulation for preventing PONV from their inception to 31 July 2023. Two reviewers performed study screening, data extraction, and risk of bias assessment. The authors focused on patient important outcomes, including the incidence of PONV, postoperative nausea (PON), or postoperative vomiting (POV), and the number of patients requiring antiemetic rescue. The authors conducted network meta-analyses to estimate the relative effectiveness between different acupoint stimulation using Stata 17.0 and Revman 5.3 software.|
+^Results| The authors included **50 randomized trials** involving **7372 participants **(median age: 43.5 years, female: 73.3%). The network meta-analysis revealed that compared with the control (sham acupoint stimulation or blank control), antiemetic alone could significantly reduce the incidence of POV (RR 0.49, 95% CI: 0.36-0.69), but could not significantly reduce the incidence of PONV and PON (RR 0.49, 95% CI: 0.36-0.69; RR 0.81, 95% CI: 0.59-1.10; respectively); both TEAS and electroacupuncture alone significantly reduced the incidence of PONV, PON, and POV, and combined with antiemetic was usually more effective than single acupoint stimulation.|
+^Conclusions| Both TEAS and electroacupuncture, with or without antiemetic, could significantly reduce the incidences of postoperative nausea and vomiting after general anesthesia.|
 ==== Specific Clinical Forms  ====
@@ Ligne 239: / Ligne 281: @@
 ^ Results| Twenty studies with 2862 patients were included in this research. Pairwise meta analysis shows that compared with placebo, transcutaneous electric nerve stimulation had lower risk of postoperative nausea (PON) (odds ratio (OR) = 0.42, 95%confidence interval (CI): 0.30-0.60), postoperative vomiting (POV) (OR = 0.53, 95%CI: 0.36-0.78), PONVs (OR = 0.46, 95%CI: 0.31-0.68), and postoperative rescue (POR) (OR = 0.61, 95%CI: 0.41-0.90), Capsicum had lower risk of PON (OR = 0.16, 95%CI: 0.09-0.28), PONVs (OR = 0.23, 95%CI: 0.12-0.45), Acupressure had lower risk of POV (OR = 0.42, 95%CI: 0.25-0.70), POR (OR = 0.42, 95%CI: 0.27-0.64). In network meta analysis, compared with usual care, the probability rank suggested that Acupoint Injection showed lowest risk of PON (OR = 0.02, 95%CI: 0.00-0.11), POV (OR = 0.06, 95%CI: 0.01-0.49), Usual care for PONVs (OR = 0.31, 95%CI: 0.13-0.75), and Capsicum for POR (OR = 0.39, 95%CI: 0.07-2.33). Further study should be carried out to verify this result. |
 ^ Conclusion|Both pairwise and network meta analysis showed acupuncture therapy was superior to placebo and usual care. Different acupuncture therapy regimens may have advantages in different aspects. And compared with POV, PON seems easier to control. |
+=== Laparoscopic surgery ===
+== Tang 2025 ==
+Tang X, Qu S. The Impact of Acupuncture on Pain Intensity, Nausea, and Vomiting for Laparoscopic Cholecystectomy: A Meta-analysis Study. Surg Laparosc Endosc Percutan Tech. 2025 Feb 1;35(1):e1349.  https://doi.org/10.1097/SLE.0000000000001349
+^Backgound| Acupuncture may have some potential in pain relief after laparoscopic cholecystectomy, and this meta-analysis aims to explore the impact of acupuncture on pain intensity, nausea and vomiting for patients undergoing laparoscopic cholecystectomy.|
+^Methods| PubMed, EMbase, Web of science, EBSCO, Cochrane library databases, CNKI, VIP, and Wangfang were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of acupuncture on pain control for laparoscopic cholecystectomy.|
+^Results| **Five RCTs and 366 patients** were included in the meta-analysis. Overall, compared with control intervention for laparoscopic cholecystectomy, acupuncture was associated with significantly reduced pain scores at 6 hours [mean difference (MD)=-0.86; 95% CI=-1.37 to -0.34; P =0.001, 2 RCTs) and pain scores at 8 to 10 hours (MD=-0.71; 95% CI=-1.13 to -0.28; P =0.001, 2 RCTs), decreased incidence of nausea (odds ratio=0.10; 95% CI=0.03-0.34; P =0.0003, 3 RCTs), and vomiting (odds ratio=0.11; 95% CI=0.01-0.85; P =0.03, 3 RCTs), but demonstrated no obvious impact on pain scores at 12 to 24 hours (MD=-0.38; 95% CI=-1.02 to 0.27; P =0.25, 2 RCTs).|
+^Conclusions| Acupuncture may be effective to reduce pain intensity, nausea, and vomiting for laparoscopic cholecystectomy.|
+== Huang 2023 ==
+Huang WH, Zhang J, Ding SS, Xue JJ. Efficacy of acupuncture for nausea and vomiting after Huang WH, Zhang J, Ding SS, Xue JJ. Efficacy of acupuncture for nausea and vomiting after laparoscopic surgery: A systematic review and meta-analysis. Asian J Surg. 2023 Oct;46(10):4462-4464.  https://doi.org/10.1016/j.asjsur.2023.04.107
+[letter]
+=== Colorectal cancer resection ===
+== Qi 2023 ==
+Qi L, Shi H, Zhang Y, Zhang X, Jia H, Tian H. The effect of acupuncture on recovery after colorectal cancer resection: A systematic review meta-analysis of randomized controlled trials. Medicine (Baltimore). 2023 Sep 1;102(35):e34678.  https://doi.org/10.1097/MD.0000000000034678
+^Background| To evaluate the efficacy and safety of acupuncture by systematically reviewing the literature on colorectal cancer resection. |
+^Methods| Seven electronic databases were searched from inception to February 28, 2023. Randomized controlled trials on acupuncture in patients after CRC resection were included. Two reviewers independently selected relevant trials, extracted data, and assessed the risk of bias. A random-effects meta-analysis model was used to obtain summary effect estimates. The data were pooled and analyzed using RevMan 5.3. The heterogeneity of selected studies was evaluated by evaluating the I-squared (I2) statistics. |
+^Results| **Twenty-two studies with 1878 patients** were included. Results of the meta-analysis showed there was a low level evidence that acupuncture may improve early postoperative symptoms, such as time to first flatus (n = 876, MD -0.77h, 95% CI -1.22 to -0.33 h, I2 = 89%), time to first bowel movement (n = 671, MD -1.41h, 95% CI -2.20 to -0.63 h, I2 = 95%), time to first defecation (n = 556, MD -1.03h, 95% CI -1.88 to -0.18 h, I2 = 95%), and **nausea/vomiting** (n = 1488, RR 0.72, 95% CI 0.59-0.89, I2 = 49%) compared with usual care and sham acupuncture. However, there were no statistically significant differences in postoperative pain (n = 1188, MD-0.21, 95% CI -0.59 to 0.17, I2 = 74%). And there was no sufficient evidence of improving long-term functional outcomes. There was substantial heterogeneity across trials. The adverse events associated with acupuncture stimulation were minor in include studies. |
+^Conclusion subsections| There is currently low-level evidence supporting the use of acupuncture on postoperative symptoms for patients after colorectal cancer resection. More investigations should be established based on the STRICTA statement strictly. |
@@ Ligne 281: / Ligne 354: @@
 ^Objectives & methods| A systematic search was performed by using Cochrane Controlled Trials Register, MEDLINE and EMBASE to identify double-blind, randomized, placebo-controlled trials of prophylactic anti-emetic interventions in children undergoing tonsillectomy, with or without adenoidectomy. The outcome of interest was POV in the first 24 h. Summary estimates of the effect of each prophylactic anti-emetic strategy were derived using fixed effect meta-analysis. Where appropriate, dose-response effects were estimated using logistic regression and 22 articles were identified. |
 ^Results| Good evidence was found for the prophylactic anti-emetic effect of dexamethasone [odds ratio (OR) 0.23, 95% CI 0.16-0.33], and the serotinergic antagonists ondansetron (OR 0.36, 95% CI 0.29-0.46), granisetron (OR 0.11, 95% CI 0.06-0.19), tropisetron (OR 0.15, 95% CI 0.06-0.35) and dolasetron (OR 0.25, 95% CI 0.1-0.59). Metoclopramide was also found to be efficacious (OR 0.51, 95% CI 0.34-0.77). **There is not sufficient evidence** to suggest that dimenhydrinate, perphenazine or droperidol, in the doses studied, are efficacious, nor were gastric aspiration or **acupuncture**. In conclusion, dexamethasone and the anti-serotinergic agents appear to be the most effective agents for the prophylaxis for POV in children undergoing tonsillectomy. |
 === Cesarean ===
+== Griffiths 2021 ==
+Griffiths JD, Gyte GM, Popham PA, Williams K, Paranjothy S, Broughton HK, Brown HC, Thomas J. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev. 2021;5(5). [220029]. [[https://doi.org/10.1002/14651858.cd007579.pub3|doi]]
+^ Background| Nausea and vomiting are distressing symptoms which are experienced commonly during caesarean section under regional anaesthesia and in the postoperative period. |
+^Objectives|To assess the efficacy of pharmacological and non-pharmacological interventions versus placebo or no intervention given prophylactically to prevent nausea and vomiting in women undergoing regional anaesthesia for caesarean section. |
+^Methods| Search methods: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (16 April 2020), and reference lists of retrieved studies. Selection criteria: We included randomised controlled trials (RCTs) of studies and conference abstracts, and excluded quasi-RCTs and cross-over studies. Data collection and analysis: Review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Our primary outcomes are intraoperative and postoperative nausea and vomiting. Data entry was checked. Two review authors independently assessed the certainty of the evidence using the GRADE approach. |
+^Main results| Eighty-four studies (involving 10,990 women) met our inclusion criteria. Sixty-nine studies, involving 8928 women, contributed data. Most studies involved women undergoing elective caesarean section. Many studies were small with unclear risk of bias and sometimes few events. The overall certainty of the evidence assessed using GRADE was moderate to very low. 5-HT3 antagonists: We found intraoperative nausea may be reduced by 5-HT3 antagonists (average risk ratio (aRR) 0.55, 95% confidence interval (CI) 0.42 to 0.71, 12 studies, 1419 women, low-certainty evidence). There may be a reduction in intraoperative vomiting but the evidence is very uncertain (aRR 0.46, 95% CI 0.29 to 0.73, 11 studies, 1414 women, very low-certainty evidence). There is probably a reduction in postoperative nausea (aRR 0.40, 95% CI 0.30 to 0.54, 10 studies, 1340 women, moderate-certainty evidence), and these drugs may show a reduction in postoperative vomiting (aRR 0.47, 95% CI 0.31 to 0.69, 10 studies, 1450 women, low-certainty evidence). Dopamine antagonists: We found dopamine antagonists may reduce intraoperative nausea but the evidence is very uncertain (aRR 0.38, 95% CI 0.27 to 0.52, 15 studies, 1180 women, very low-certainty evidence). Dopamine antagonists may reduce intraoperative vomiting (aRR 0.41, 95% CI 0.28 to 0.60, 12 studies, 942 women, low-certainty evidence) and postoperative nausea (aRR 0.61, 95% CI 0.48 to 0.79, 7 studies, 601 women, low-certainty evidence). We are uncertain if dopamine antagonists reduce postoperative vomiting (aRR 0.63, 95% CI 0.44 to 0.92, 9 studies, 860 women, very low-certainty evidence). Corticosteroids (steroids): We are uncertain if intraoperative nausea is reduced by corticosteroids (aRR 0.56, 95% CI 0.37 to 0.83, 6 studies, 609 women, very low-certainty evidence) similarly for intraoperative vomiting (aRR 0.52, 95% CI 0.31 to 0.87, 6 studies, 609 women, very low-certainty evidence). Corticosteroids probably reduce postoperative nausea (aRR 0.59, 95% CI 0.49 to 0.73, 6 studies, 733 women, moderate-certainty evidence), and may reduce postoperative vomiting (aRR 0.68, 95% CI 0.49 to 0.95, 7 studies, 793 women, low-certainty evidence). Antihistamines: Antihistamines may have little to no effect on intraoperative nausea (RR 0.99, 95% CI 0.47 to 2.11, 1 study, 149 women, very low-certainty evidence) or intraoperative vomiting (no events in the one study of 149 women). Antihistamines may reduce postoperative nausea (aRR 0.44, 95% CI 0.30 to 0.64, 4 studies, 514 women, low-certainty evidence), however, we are uncertain whether antihistamines reduce postoperative vomiting (average RR 0.48, 95% CI 0.29 to 0.81, 3 studies, 333 women, very low-certainty evidence). Anticholinergics: Anticholinergics may reduce intraoperative nausea (aRR 0.67, 95% CI 0.51 to 0.87, 4 studies, 453 women, low-certainty evidence) but may have little to no effect on intraoperative vomiting (aRR 0.79, 95% CI 0.40 to 1.54, 4 studies; 453 women, very low-certainty evidence). No studies looked at anticholinergics in postoperative nausea, but they may reduce postoperative vomiting (aRR 0.55, 95% CI 0.41 to 0.74, 1 study, 161 women, low-certainty evidence). Sedatives: We found that sedatives probably reduce intraoperative nausea (aRR 0.65, 95% CI 0.51 to 0.82, 8 studies, 593 women, moderate-certainty evidence) and intraoperative vomiting (aRR 0.35, 95% CI 0.24 to 0.52, 8 studies, 593 women, moderate-certainty evidence). However, we are uncertain whether sedatives reduce postoperative nausea (aRR 0.25, 95% CI 0.09 to 0.71, 2 studies, 145 women, very low-certainty evidence) and they may reduce postoperative vomiting (aRR 0.09, 95% CI 0.03 to 0.28, 2 studies, 145 women, low-certainty evidence). Opioid antagonists: There were no studies assessing intraoperative nausea or vomiting. Opioid antagonists may result in little or no difference to the number of women having postoperative nausea (aRR 0.75, 95% CI 0.39 to 1.45, 1 study, 120 women, low-certainty evidence) or postoperative vomiting (aRR 1.25, 95% CI 0.35 to 4.43, 1 study, 120 women, low-certainty evidence). **Acupressure**: It is uncertain whether acupressure/acupuncture reduces intraoperative nausea (aRR 0.55, 95% CI 0.41 to 0.74, 9 studies, 1221 women, very low-certainty evidence). Acupressure may reduce intraoperative vomiting (aRR 0.52, 95% CI 0.33 to 0.80, 9 studies, 1221 women, low-certainty evidence) but it is uncertain whether it reduces postoperative nausea (aRR 0.46, 95% CI 0.27 to 0.75, 7 studies, 1069 women, very low-certainty evidence) or postoperative vomiting (aRR 0.52, 95% CI 0.34 to 0.79, 7 studies, 1069 women, very low-certainty evidence). Ginger: It is uncertain whether ginger makes any difference to the number of women having intraoperative nausea (aRR 0.66, 95% CI 0.36 to 1.21, 2 studies, 331 women, very low-certainty evidence), intraoperative vomiting (aRR 0.62, 95% CI 0.38 to 1.00, 2 studies, 331 women, very low-certainty evidence), postoperative nausea (aRR 0.63, 95% CI 0.22 to 1.77, 1 study, 92 women, very low-certainty evidence) and postoperative vomiting (aRR 0.20, 95% CI 0.02 to 1.65, 1 study, 92 women, very low-certainty evidence). Few studies assessed our secondary outcomes including adverse effects or women's views. |
+^Authors' conclusions| This review indicates that 5-HT3 antagonists, dopamine antagonists, corticosteroids, sedatives and **acupressure** probably or possibly have efficacy in reducing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. However the certainty of evidence varied widely and was generally low. Future research is needed to assess side effects of treatment, women's views and to compare the efficacy of combinations of different medications. |

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