Acupuncture: an evidence-based review of the clinical literature

Combination therapy for postoperative nausea and vomiting - a more effective prophylaxis?

The problem of postoperative nausea and vomiting (PONV) remains far from being resolved. Despite the introduction of new classes of antiemetics and a vast amount of published research, there is a general impression that there has been little progress in this area. The multifactorial etiology of PONV might be better addressed using a combination of drugs acting at different receptor sites. This approach of balanced antiemesis may be the answer towards achieving a significant improvement in the management of PONV. This article will cover the different strategies used to prevent PONV with particular emphasis on combination antiemetics. A review of the currently available methods to manage PONV as well as the physiological and pharmacological basis of combination therapy is presented.

Acupuncture effects on reflex responses to mental stress in humans

In animal studies, acupuncture has been shown to be sympathoinhibitory, but it is unknown if acupuncture is sympathoinhibitory in humans. Nineteen healthy volunteers underwent mental stress testing pre- and postacupuncture. Muscle sympathetic nerve activity (MSNA), blood pressure, and heart rate during mental stress were compared pre- and postacupuncture. Control acupuncture consisted of acupuncture at nonacupoints and "no-needle" acupuncture. Acupuncture had no effect on resting MSNA, blood pressure, or heart rate. After real acupuncture, the increase in mean arterial pressure (pre- vs. postacupuncture 4.5 vs. 1.7 mmHg, P < 0.001), but not MSNA or heart rate, was blunted during mental stress. Similarly, following nonacupoint acupuncture, the increase in mean arterial pressure was blunted during mental stress (5.4 vs. 2.9 mmHg, P < 0.0003). No-needle acupuncture had no effect on these variables. In conclusion, acupuncture at traditional acupoints, nonacupoints, and no-needle acupuncture does not modulate baseline MSNA or MSNA responses to mental stress in normal humans. Acupuncture significantly attenuates the increase in blood pressure during mental stress. Needling nonacupoints, but not "no-needle" acupuncture, have a similar effect on blood pressure.