Does Acupressure Affect Gastrointestinal Function, Pain and Anxiety?
Condition: Gastrointestinal Dysfunction; Anxiety; Pain, Postoperative
MeSH terms: Pain, Postoperative; Anxiety Disorders
Study type: Interventional

Summary: 
      The aim of this randomised, placebo-controlled, 3-way blinded study was to determine the
      effect on GIS symptoms, pain and anxiety of acupressure applied for a total of 12 mins, as 3
      mins at each of the ST25, CV12, TH6 and HT7 acupuncture points, at 0, 4 and 8 hours after
      laparoscopic cholecystectomy operation. The research data were collected using a patient data
      collection form, the Numeric Pain Intensity Scale and the State-Trait Anxiety Inventory. The
      patients were evaluated in respect of the time to first flatus and defecation, pain and the
      State-Trait Anxiety points at 0, 4, and 8 hours postoperatively.
    

Detailed description: 
      Together with technological advances in the field of healthcare, there is currently a greater
      preference for the laparoscopic cholecystectomy procedure, as length of hospital stay is
      shorter, workforce loss is lower, good cosmetic results are obtained and postoperative
      patient satisfaction is higher, when compared to open cholecystectomy.

      One of the basic factors affecting the patient is the anesthesia applied in the laparoscopic
      surgical approach. Following general anaesthesia, metabolic activity slows and
      gastrointestinal system (GIS) movements are reduced. In addition, by increasing
      intra-abdominal pressure, the gas insufflation applied to the peritoneal cavity in
      laparoscopic surgery, reduces blood flow in the stomach and small and large intestines. As a
      result of this reduced blood flow, ischemia and dysfunction in the intestines may cause ileus
      symptoms to emerge. Pain occuring as a response to surgical stress causes a decrease in
      intestinal motility. If pain is not brought under control postoperatively, nausea, vomiting,
      constipation and ileus may occur.

      Preoperative anxiety has been reported to be associated with postoperative pain, cognitive
      disorders and delayed healing. Stress reaction, surgical intervention to the abdominal
      region, trauma, postoperative pain, and the use of anaesthetic and narcotic agents are among
      the factors causing the development of GIS problems. An increase in sympathetic activity
      which occurs in the stress reaction and the use of general/narcotic anaesthesia reduce
      gastrointestinal motility. Pharmacological treatments are applied to improve GIS functions.
      It has been reported that intravenous infusion of lidocaine in the perioperative period
      provides a faster recovery of bowel functions. Postoperative gastrointestinal dysfunction is
      usually treated using alvimopan, but the drug used has side effects such as nausea and
      vomiting. Postoperative pain and nausea-vomiting are common complaints after laparoscopic
      cholecystectomy, despite the use of multimodal analgesia consisting of dexamethasone,
      opioids, nonsteroidal anti-inflammatory drugs and local anesthetics used in the perioperative
      period. In addition, of the nursing applications used, the application of acupressure is of
      benefit. Acupressure is accepted as a non-invasive application that can easily be applied by
      trained nurses, which increases the quality of the medical care administered and contributes
      to physical and psychological recovery. In studies of acupressure applied for the recovery of
      GIS functions, it has been reported that acupressure can be applied as non-invasive nursing
      care which improves postoperative ileus symptoms.

      In a study by Chao et al, acupressure applied after abdominal surgery was reported to improve
      gas output, shorten the time to oral nutritional intake, and improve ileus symptoms.
      Acupressure applied to the P6 point following appendectomy decreased the frequency of
      vomiting. In another study, acupressure was determined to be effective in improving GIS
      movement. Acupressure improved intestinal functions but stated that more experimental studies
      were needed.

      It is recommended to teach the use of acupuncture warning devices to patients with
      post-operative nausea, vomiting and anxiety problems. However, there is no definitive
      evidence as to when, how and for how long acupressure should be administered. Moreover,
      studies conducted by nurses on this subject are limited and studies with high evidence value
      are needed. As a result of our literature review, the effect of acupressure applied to ST25,
      CV12, TH6 and HT7 on bowel movements, first flatus and defecation time, pain and anxiety
      after laparoscopic cholecystectomy was not investigated. Therefore, our study was carried out
      to evaluate the effect of acupressure applied to patients after laparoscopic cholecystectomy
      on GIS functions, pain and anxiety.
    

Intervention name(s): Acupressure
Intervention type(s): Other
Intervention description(s): Acupressure is accepted as a non-invasive application that can easily be applied by trained nurses, which increases the quality of the medical care administered and contributes to physical and psychological recovery.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Acupressure; Gastrointestinal Dysfunction; Anxiety; Pain