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Osteopathic Manipulative Treatment for Postoperative Nausea and Vomiting

Journal: The Journal of the American Osteopathic Association University of North Texas Health Science Center, Date: 2008/08, 108(8):Pages: 413. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2008.108.8.413/html)

Keywords:

nausea [9]
OMT [3730]
osteopathic manipulative treatment [3750]
pilot study [190]
post-operative care [70]
randomized controlled trial [880]
vomiting [8]

Abstract:

Purpose: Postoperative nausea and vomiting (PONV) remains a concern despite medical advances; associated with potential mortality and morbidity, no therapy completely prevents its symptoms. This pilot study sought to evaluate the effect of osteopathic manipulative treatment (OMT) on the incidence and severity of PONV and to assess the feasibility of large-scale reproduction. Methods: Individuals undergoing orthopedic surgery under general anesthesia were recruited as subjects and given informed consent based on the IRB-approved protocol. Seventeen subjects completed the study-eight receiving treatment, nine as non-treatment controls. The OMT maneuvers were from an approved list of non-aggressive techniques, including cranial manipulation. Subjects, amnestic from anesthesia, and the study coordinator were blind to the treatment group. Nausea and pain visual analog scale (VAS) scores as well as vital signs were collected at baseline and again at times following treatment. The Ambulatory Surgery-Rhodes Index for Nausea, Vomiting, and Retching was completed 1 day following treatment. Vital signs and VAS scores were analyzed as deviation from baseline, though significance could not be assessed with the sample size. Results: Treatment and control groups were well matched with respect to demographics, risk factors for PONV, and baseline vital signs and VAS scores. There were no trends in reduction of incidence or severity of PONV; treatment group incidence of early emesis was reduced (0.37 v 0.89 episodes) as was 30-minute and peak nausea VAS scores and distress from nausea (0.5 v 1.9; 4 v 5.17; and 3.3 v 3.6, respectively). Additional analysis found pain VAS scores showing less elevation from baseline in treated subjects than controls (2 v 4.33 @ 30-minutes; 1.63 v 3.22 1-hour; and 1.1 v 3.8 post-discharge interview). This was accompanied by reduced mean utilization of pain medication in the post-anesthesia care unit (1.5 v 3.2 doses). Conclusions: Incidence of PONV was low in both groups, likely because of prophylaxis with antiemetics. Future study should increase enrollment, include higher-risk subjects, and restrict prophylactic treatment of PONV. Reduction of pain and use of analgesic medication in the treatment group is congruous with recent research linking the effect of OMT to modulation of endorphin and endocannabinoid systems. This pilot study demonstrated proof-of-concept and feasibility, with minor alteration, for reproduction on a larger scale.


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