We read with great interest the article by Arnberger et al.  1in which the authors successfully demonstrated a significant reduction in the incidence of nausea and vomiting, compared with a control group. It was interesting that a conventional nerve stimulator, which is readily available, was used for this purpose. The overall incidence of postoperative nausea and vomiting (PONV) was 61% in the control group. However, even with intervention, the frequency of PONV in the intervention group remained unacceptably high (45%). Although the use of transcutaneous acupressure stimulation for prevention of PONV has been reported previously,2,3it has not been shown that P6 stimulation would provide a reduction in PONV when given in combination with other prophylactic therapies. It was reported previously that the combination of acupressure and ondansetron had a 73% response rate, versus  40% for acupressure alone, when used for treatment of PONV.4 

Given the low cost of ondansetron, it has become standard practice at our institution to administer ondansetron prophylactically, often in combination with other standard therapies such as dexamethasone, to patients at risk for PONV who are undergoing general anesthesia. It would be of interest to repeat the study to determine whether P6 stimulation, when combined with prophylactic therapy such as ondansetron, would in fact further decrease rates of PONV. This would have greater applicability to the current standard of practice, in which most patients undergoing general anesthesia receive prophylaxis for prevention of PONV.

*Mount Sinai Medical Center, New York, New York. steve.neustein@mssm.edu

1.
Arnberger M, Stadelmann K, Alischer P, Ponert R, Melber A, Greif R: Monitoring of neuromuscular blockade at the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting. Anesthesiology 2007; 107:903–8
2.
Fan CF, Tanhui E, Joshi S, Trivedi S, Hong Y, Shevde K: Acupressure treatment for prevention of postoperative nausea and vomiting. Anesth Analg 1997; 84:821–5
3.
Turgut S, Ozalp G, Dikmen S: Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia. Eur J Anaesthesiol 2007; 24:87–91
4.
Coloma M, White P, Ogunnaike B: Comparison of acustimulation and ondansetron for the treatment of established postoperative nausea and vomiting. Anesthesiology 2002; 97:1387–92