Role of Emotional Freedom Techniques in Reducing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy
Condition: Postoperative Nausea and Vomiting
MeSH terms: Nausea; Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      In our study the investigators want to evaluate the effects of EFTs (emotional freedom
      techniques) for reducing incidence of PONV (Postoperative nausea and vomiting). The effects
      of EFTs have been quiet evident on many aspects if the incidence of PONV is reduced then it
      will be much valuable adjunct to postoperative management of the patients.

      Our hypothesis was Emotional freedom techniques are very useful to reduce the incidence of
      postoperative nausea and vomiting after laparoscopic cholecystectomy.
    

Detailed description: 
      The laparoscopic cholecystectomy is now considered as the gold standard for gall stone
      disease worldwide and over 90% of cholecystectomies are now performed laparoscopically. Due
      to variety of factors, postoperative nausea and vomiting (PONV) which occurs in 40-70 % of
      patients undergoing laparoscopic cholecystectomy (LC) is sometimes much troublesome to
      manage. To reduce the incidence of PONV many drugs and modifications were introduced, such as
      use of dexamethasone, serotonin receptor antagonists, changing drugs and dosages during
      anesthesia and acupressure. All these measures except acupressure have some degree of side
      effects on patients.

      The Emotional Freedom Techniques (EFTs) which has been pioneered by Gary Craig is a form of
      alternate medicine which works by tapping on body energy meridian points. Unlike drugs the
      EFTs has no side effects too. The role of EFTs for various kinds of physical and mental
      problems has been established and has shown quite significant results. Initially EFTs were
      used for psychological benefits but later on research proved that it works on the physical
      and biochemical levels too which is comparable to the various drugs which act by biochemical
      changes on human body.

      In our study we want to evaluate the effects of EFTs for reducing incidence of PONV. The
      effects of EFTs have been quiet evident on many aspects if the incidence of PONV is reduced
      then it will be much valuable adjunct to postoperative management of the patients. We have
      taken into the consideration of PONV only and after promising results we can evaluate EFTs on
      more and more other aspects of patient management After meeting inclusion and exclusion
      criteria, All patients were given Tab. Midazolam 7.5 mg PO at night before surgery and
      received same standard general anesthesia with endotracheal intubation. Inj. Midazolam IV 0.7
      mg/kg was given 45 min before surgery as premedication. Anesthesia was induced by propofol
      (2.5 mg/kg) after 3 minutes of preoxygenation. Muscle relaxation was achieved by atracuium
      (0.5 mg/kg). Anesthesia was maintained with sevoflurane (2.5 vol %) and oxygen in air mixture
      (0.50 ratio). Ventilation was controlled mechanically and end tidal normocapnia was
      maintained by keeping pCO2 at 35-38 mmHg.

      Following medications were given to patients during the process.

        -  Inj. Cefuroxime 1.5 gm. IV (2 doses, 1st dose 30-60 min before surgery and 2nd dose 6
           hours after surgery)

        -  Inj. Ketorolac 30mg IV (3 doses total, 1st dose immediate postop, 2nd and 3rd at 8 and
           16 hours after surgery respectively)

        -  Inj. Zantac 50 mg IV (2 doses total, 1st immediate postop and 2nd at 12 hours after
           surgery) All patients were operated by the consultant surgeons. After surgery ward all
           patients received same standard postoperative care. At 6 hour postoperative period all
           patients were assessed for PONV by VDS. Then patients were divided randomly into two
           groups equally by consecutive non probability sampling. Group A was control group while
           Group B received one session of EFTs tapping for 5 to 10 min. All patients were assessed
           by PONV at 7, 10 and 15 hours postoperatively. Rescue antiemetic (inj. Metoclopramide
           10mg IV) was used when the score of PONV was 2 or more on VDS. To see the effectiveness
           of EFTs in study group the no. of injections of metoclopramide were not counted at 6
           hour postoperatively i.e. before intervention of EFTs.

      All the data was recorded on specially designed Performa. Statistical analysis: Data was
      analyzed using SPSS version 12. Mean and standard deviation were calculated for quantitative
      data like age, frequency of antiemetic injections. Frequency and percentages were calculated
      for qualitative data like gender, PONV on the basis of VDS scale. The results were finally
      analyzed and compared for the two groups using Chi-square test and Mann Whitney U tests where
      applicable. A p value <0.05 was considered significant.
    

Intervention name(s): EFTs (emotional freedom techniques); Tab. Midazolam 7.5 mg; Inj. Midazolam 0.7mg/kg; Inj. Propofol 2.5mg/kg; Inj. Atracurium 0.5 mg/kg; Sevoflurane 2.5 vol %; Inj. Cefuroxime 1.5 g IV; Drug: Inj. Ketorolac 30 mg IV; Inj. Zantac 50mg IV
Intervention type(s): Behavioral; Drug; Drug; Drug; Drug; Drug; Drug; Drug; Drug
Intervention description(s): The Emotional Freedom Techniques (EFTs) which has been pioneered by Gary Craig is a form of alternate medicine which works by tapping on body energy meridian points. Unlike drugs the EFTs has no side effects too; Tab. Midazolam 7.5 mg will be given to all patients at night before surgery.; Inj . Midazolam 0.7 mg/kg given as premedication 45 min before surgery.; It was given to induce anesthesia after 3 min of pre oxygenation.; It was given to induce muscle relaxation during anesthesia; It was given to maintain anesthesia during surgery alongwith oxygen in air mixture; It was given as prophylactic antibiotic. 2 doses given. 1st 30-60 min before surgery. 2nd 6 hours after surgery; 3 doses for analgesia. 1st immediate postoperative, 2nd at 8 hours postoperative and 3 rd at 16 hours postoperative period; 2 doses. 1st at immediate postoperative and 2nd 12 hours after surgery
Other intervention name(s): EFTs by garry craig; Tab. Doramicum; inj. Doramicum; inj. zinacef
Intervention MeSH terms: Cefuroxime; Cefuroxime axetil; Ketorolac; Midazolam; Propofol; Sevoflurane; Atracurium
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cholecystectomy; Laparoscopic; Postoperative Nausea and Vomiting