A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Effectiveness of auricular acupressure in the treatment of nausea and vomiting in early pregnancy. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial. Acupressure and vitamin B6 to relieve nausea and vomiting in pregnancy: a randomized study. Menstruation increases the risk of nausea and vomiting after laparoscopy. A prospective randomized study. Efficacy of P6 acupressure in the treatment of nausea and vomiting during pregnancy. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial. The impact of the menstrual cycle and ondansetron on postoperative nausea and vomiting. A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. The effect of preoperative ondansetron on the incidence of postoperative nausea and vomiting in patients undergoing outpatient dentoalveolar surgery and general anesthesia. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. The prevention of emesis in plastic surgery: a randomized, prospective study. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Effect of acupuncture on nausea of pregnancy: a randomized, controlled trial. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia.
To evaluate the effectiveness of low-level nerve stimulation therapy over the volar aspect of the wrist at the P6 point to treat nausea and vomiting in early pregnancy.
                Pregnant volunteers (n = 230) with symptoms of mild to severe nausea and vomiting between 6 and 12 weeks' gestation participated in a 21-day clinical trial. Participants were randomly assigned to receive a device for nerve stimulation therapy or an otherwise identical but nonstimulating placebo device. The primary outcome measure was self-recorded symptoms according to the Rhodes Index of Nausea, Vomiting, and Retching (Rhodes Index). Secondary outcome measures were medication use, weight gain, and presence of urinary ketones.
                Baseline characteristics were similar in both groups. A total of 187 women (81%) completed the trial. Pretreatment Rhodes Index scores for the entire population demonstrated no significant differences between study and control groups. The time-averaged change in Rhodes Index total experience of 6.48 for the study group was significantly better than the control value of 4.65 (P =.02). Study patients gained more weight than controls (2.9 versus 1.2 lb, P =.003). There were no statistically significant differences in medication use or urinary ketone measurements.
                Nerve stimulation therapy is effective in reducing nausea and vomiting and promoting weight gain in symptomatic women in the first trimester of pregnancy. To evaluate the effectiveness of auricular acupressure in the treatment of nausea and vomiting in early pregnancy.
                Ninety-eight volunteer pregnant women with symptoms of nausea and vomiting in early pregnancy before 14 weeks gestation were enrolled. The participants were randomized into two groups: treatment group and control group. Each patient in the treatment group received magnet pellets, placed at both auricles. They were taught to start acupressure from the third to the sixth day. Outcome measurement was Rhodes index score, which describe the severity and frequency of nausea and vomiting in the form of a questionnaire. The patients from both groups were asked to complete and return the forms including the amount of anti-emetic drug taken. Mean Rhodes index score and total number of anti-emetic drug taken from day 4-6 were used to compare the treatment effect. Student's t test, Chi-square test and Mann-Whitney U test were used for statistical analysis.
                Ninety-one pregnant women who returned the questionnaires were evaluated. The Rhodes index scores of the treatment group were lower than that of the control group especially after day 4 to day 6 when the acupressure was started. However when comparing the mean score between the two groups, there were no statistically significant differences (p > 0.05). The total amount of anti-emetic tablets in day 4-6 after acupressure intervention was compared and there were no statistically significant differences (p > 0.05) between the groups.
                Auricular acupressure therapy in treatment of nausea and vomiting in early pregnancy may not relieve nausea and vomiting in early pregnancy and need further clinical research to confirm the effectiveness. To evaluate the effectiveness of acupressure in reducing nausea and vomiting of pregnancy.
                Symptomatic pregnant women were randomized to one of two acupressure groups: one treatment group using an acupressure point (PC-6) and one sham control group using a placebo point. Subjects were blind to the group assignment. Each evening for 10 consecutive days, the subjects completed an assessment scale describing the severity and frequency of symptoms that occurred. Data from the first 3 days were used as pre-treatment scores. Beginning on the morning of the fourth day, each subject used acupressure at her assigned point for 10 minutes four times a day. Data from day 4 were discarded to allow 24 hours for the treatment to take effect. Data from days 5-7 were used to measure treatment effect.
                Sixty women completed the study. There were no differences between groups in attrition, parity, fetal number, maternal age, gestational age at entry, or pre-treatment nausea and emesis scores. Analysis of variance indicated that both groups improved significantly over time, but that nausea improved significantly more in the treatment group than in the sham control group (F1,58 = 10.4, P = .0021). There were no differences in the severity or frequency of emesis between the groups. There was a significant positive correlation (r = 0.261, P = .044) between maternal age and severity of nausea.
                Our results indicate that acupressure at the PC-6 anatomical site is effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women. Nausea and vomiting in early pregnancy are troublesome symptoms for some women. We undertook a single blind randomized controlled trial to determine whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy.
                The trial was undertaken at a maternity teaching hospital in Adelaide, Australia, where 593 women less than 14 weeks' pregnant with symptoms of nausea or vomiting were randomized into 4 groups: traditional acupuncture, pericardium 6 (p6) acupuncture, sham acupuncture, or no acupuncture (control). Treatment was administered weekly for 4 weeks. The primary outcomes were nausea, dry retching, vomiting, and health status. Comparisons were made between groups over 4 consecutive weeks.
                Women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week compared with women in the no acupuncture control group. Women who received p6 acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared with women in the no acupuncture control group. Women in the sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the no acupuncture group. No differences in vomiting were found among the groups at any time.
                Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time-related placebo effect was found for some women. To compare the effectiveness of acupressure and vitamin B6 in the outpatient treatment of nausea and vomiting in early pregnancy.
                Pregnant volunteers with symptoms of mild to moderate nausea and vomiting between 6 and 12 weeks' gestation participated in a 7-day clinical trial. Participants were randomly assigned to receive a device for acupressure therapy and placebo drug or an otherwise identical but non-stimulating placebo device and vitamin B6. The primary outcome measure was self-recorded symptoms according to Rhodes index. Secondary outcome measures were weight gain and medication use.
                The mean change in Rhodes index was not significantly different between the two groups. There were no statistically significant differences in weight gain and medication use between the two groups.
                Acupressure therapy is not more effective than vitamin B6 in reducing nausea and vomiting in symptomatic women in the first trimester of pregnancy. Several factors may influence the incidences of postoperative nausea and vomiting. In women, one of these factors may be the timing of their surgery in relation to their menstrual cycle. The purpose of this study was to assess the effect of menstruation and efficacy of the antiemetic droperidol on postoperative nausea and vomiting.
                In a prospective randomized double-blind clinical trial, 100 female patients who were scheduled for laparoscopic tubal sterilization were stratified on the basis of the date of their last menses into menstrual (days 1-8) and nonmenstrual (days 9-28) groups. Patients in both groups were then randomized to receive placebo or 10, 20, or 30 micrograms/kg droperidol before induction of anesthesia, and data were obtained for 24 h after completion of their surgery.
                Nausea and vomiting were reported in 55 patients, and the risk was 2.92 times greater in the menstrual group (71.4%) than in the nonmenstrual group (46.2%; (P = .013). Droperidol (30 micrograms/kg) reduced the incidence of vomiting from 47.1% (placebo) to 13.3% in the nonmenstrual group (P = .045) but had no effect in the menstrual group. Five prognostic variables (menstrual stratum, droperidol, age 30 yr or younger, weight 65 kg or less, and history of nausea and vomiting) for postoperative nausea and vomiting were tested by stepwise logistic regression. Menstrual stratum was the only variable identified as a significant (P = .017) predictor, having a percent probability equal to 2.21.
                The risk of postoperative nausea and vomiting is increased in women undergoing laparoscopic tubal sterilization during the first 8 days of their menstrual cycle, and droperidol up to 30 micrograms/kg is not as effective in these patients. Our purpose was to investigate the efficacy of P6 acupressure in reducing or relieving symptoms of nausea with or without vomiting and retching during pregnancy.
                Symptomatic pregnant volunteers (n=161) participated in a 7-day community-based clinical trial. All participants were assigned to one of three groups (i.e., P6 acupressure, placebo [acupressure bands inappropriately placed], or control) on the basis of a process of blocked randomization. Data were analyzed by error bar charts and analysis of variance of difference scores.
                Of 161 women, 149 (92.5%) completed the protocol. Irrespective of group assignment, participants reported significant decreases in nausea (p<0.0009) and vomiting or retching (p<0.0009). However, there was no differential treatment effect as a result of acupressure.
                There was no apparent medical benefit from the use of P6 acupressure. Our findings differ from other recently published studies that did not include a control group. This study compares pyridoxine-metoclopramide combination therapy to prochlorperazine and promethazine monotherapies in the outpatient treatment of nausea and vomiting in pregnancy.
                In total, 174 first trimester, singleton pregnancies were evaluated for nausea and vomiting. Patients were prospectively randomized into three treatment groups: pyridoxine-metoclopramide, prochlorperazine, or promethazine. Prior to, and on the third day, patients recorded their subjective responses to the given treatment and their number of emesis episodes. The three treatment groups were compared for therapy response.
                There were no differences in the number of emesis episodes prior to treatment. Both subjective and objective responses to treatment differed among the three groups when comparing the combination therapy to the monotherapies (p<0.05).
                Combination therapy with pyridoxine and metoclopramide appears to be superior to either monotherapy in the treatment of nausea and vomiting in pregnancy. To compare the antiemetic effect of acupressure at the Neiguan point (P6) in a group of healthy women with normal pregnancy and nausea and vomiting during pregnancy (NVP) with a similar group receiving acupressure at a placebo point and another, similar group not receiving any treatment.
                A randomized, placebo-controlled, pilot study involving 60 women.
                It is possible to reduce NVP significantly with acupressure at P6 as compared to acupressure at a placebo point or no treatment at all in healthy women with normal pregnancies. Relief from nausea appeared one day after starting treatment in both the P6 and placebo groups but lasted for only six days in the placebo group. The P6 group, however, experienced significantly less nausea after 14 days as compared to the other two groups.
                This study involved 60 healthy women with normal pregnancy and suffering from NVP. According to the results, in healthy women with normal pregnancy it is possible to reduce NVP significantly at P6 as compared to acupressure at a placebo point and to no treatment. Our purpose was to determine the effectiveness of pyridoxine for nausea and vomiting of pregnancy.
                During an 11-month period 342 women who first attended Chiang Mai University Hospital antenatal clinic at < or = 17 weeks' gestation were randomized to received either oral pyridoxine hydrochloride, 30 mg per day, or placebo in a double-blind fashion. Patients graded the severity of their nausea by a visual analog scale and recorded the number of vomiting episodes over the previous 24 hours before treatment and again during 5 consecutive days on treatment.
                There was a significant decrease in the mean of posttherapy minus baseline nausea scores in the pyridoxine compared with that in the placebo group (t test, p = 0.0008). There was also a greater reduction in the mean number of vomiting episodes, but the differences did not reach statistical significance (p = 0.0552).
                Pyridoxine is effective in relieving the severity of nausea in early pregnancy. The incidence of postoperative nausea and vomiting was studied in a prospective group of 94 women of child-bearing age (18-42 years), undergoing unilateral elective thyroid surgery. In a subgroup of 47 examinees the postoperative nausea and vomiting episodes were analyzed according to the time of surgery within their menstrual cycle: the highest occurrence was observed in the periovulatory and premenstrual periods (65.5% vs. 27.8%, p < 0.02). In the formal part of this study, 25 patients randomly received ondansetron (8 mg intravenous [i.v.]): they had significantly less postoperative nausea and vomiting than their 22 placebo controls (4 ml saline i.v.): 16.0% vs. 45.5% (p < 0.04). It is concluded that elective surgery in young and middle-aged female patients is best avoided premenstrually and in the middle of their cycle. In these very periods, however, ondansetron effectively reduces the incidence and intensity of postoperative nausea and vomiting by about 70%. To study the efficacy of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy.
                Double blind randomized controlled trial.
                Department of Obstetrics and Gynecology, Thammasat Hospital, Faculty of Medicine, Thammasat University.
                Between January 2005 and December 2005, 170 pregnant women who attended at antenatal clinic Thammasat University Hospital with the symptoms of nausea and vomiting in pregnancy were randomly allocated into group A (n = 85) and group B (n = 85). The patients in group A received one capsule of ginger twice daily (one capsule contained 0.5 gm of ginger powder) while the patients in group B received the identical capsule of 50 mg dimenhydrinate twice daily. The visual analogue nausea scores (VANS) and vomiting times were evaluated at day 0-7 of the treatment.
                There was no significant difference in the visual analogue nausea scores (VANS) between group A and group B in day 1-7 of the treatment. The vomiting episodes of group A were greater than group B during the first and second day of the treatment with statistically significant difference. No difference in vomiting episodes during the day 3-7 of treatment was found in both groups. There was a statistically significant difference in the side effect of drowsiness after treatment in group B greater (77.64%) than group A (5.88%) (p < 0.01).
                From the presented data, ginger is as effective as dimenhydrinate in the treatment of nausea and vomiting during pregnancy and has fewer side effects. to compare the effectiveness of ginger and vitamin B6 for the treatment of nausea and vomiting in early pregnancy.
                double-blind randomised controlled trial. Pregnant women with nausea, who first attended the antenatal clinic at or before 17 weeks gestation, were invited to participate in the study. Over a 3-month period, 70 women were randomised to receive either ginger 1g/day or vitamin B6 40 mg/day for 4 days. Subjects graded the severity of their nausea using a visual analogue scale, and recorded the number of vomiting episodes in the 24 hours before treatment and during 4 consecutive days while taking treatment. At 7-day follow-up, women reported any changes in the severity of their symptoms.
                compared with baseline, the decrease in the visual analogue scores of post-therapy nausea in the ginger group was significantly greater than that for the vitamin B6 group (p = 0.024). The number of vomiting episodes decreased in both groups, and there was no significant difference between the groups. In the ginger group, 29/35 women reported an improvement in nausea symptoms, compared with 23/34 women in the vitamin B6 group (p = 0.52).
                ginger is more effective than vitamin B6 for relieving the severity of nausea, and is equally effective for decreasing the number of vomiting episodes in early pregnancy. To determine the effectiveness of ginger for the treatment of nausea and vomiting of pregnancy.
                Women with nausea and vomiting of pregnancy, who first attended an antenatal clinic at or before 17 weeks' gestation, were invited to participate in the study. During a 5-month period, 70 eligible women gave consent and were randomized in a double-masked design to receive either oral ginger 1 g per day or an identical placebo for 4 days. Subjects graded the severity of their nausea using visual analog scales and recorded the number of vomiting episodes in the previous 24 hours before treatment, and again during 4 consecutive days while taking treatment. At a follow-up visit 7 days later, five-item Likert scales were used to assess the severity of their symptoms.
                All participants except three in the placebo group remained in the study. The visual analog scores of posttherapy minus baseline nausea decreased significantly in the ginger group (2.1 +/- 1.9) compared with the placebo group (0.9 +/- 2.2, P =.014). The number of vomiting episodes also decreased significantly in the ginger group (1.4 +/- 1.3) compared with the placebo group (0.3 +/- 1.1, P <.001). Likert scales showed that 28 of 32 in the ginger group had improvement in nausea symptoms compared with 10 of 35 in the placebo group (P <.001). No adverse effect of ginger on pregnancy outcome was detected.
                Ginger is effective for relieving the severity of nausea and vomiting of pregnancy. To compare the efficacy of ginger to vitamin B6 in the treatment of nausea and vomiting of pregnancy.
                A randomized double-blind controlled trial.
                The Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital.
                Women with nausea and vomiting of pregnancy at or before 16 weeks of gestation, who attended the antenatal care clinic. The subjects requested anti-emetics, had no medical complications, non-hospitalized and were able to attend a one week follow-up visit. From November, 1999 to November 2000, 138 women participated and gave consent for the study.
                The subjects were randomly allocated into two groups to take either 500 mg of ginger orally or an identical 10 mg of vitamin B6 one capsule three times daily for three days. Subjects graded the severity of their nausea using visual analogue scales before treatment and recorded the number of vomiting episodes in the previous 24 hours and again during three consecutive days of treatment.
                The change of nausea scores and the number of vomiting episodes during three days of treatment.
                The 64 subjects in each group remained in the study. The demographic data were comparable in both groups. The ginger and vitamin B6 significantly reduced the nausea scores from 5.0 (SD, 1.99) to 3.6 (SD, 2.48) and 5.3 (SD, 2.08) to 3.3 (SD, 2.07) respectively, with p < 0.001. The mean score change after treatment with ginger was 1.4 (2.21), less than with vitamin B6, which was 2.0 (2.19) but with no statistically significant difference (95% CI -1.4 to 0.2, p = 0.136). The ginger and vitamin B6 also significantly reduced the number of vomiting episodes from 1.9 (2.06) to 1.2 (1.75) and 1.7 (1.81) to 1.2 (1.50) respectively, with p < 0.01. The mean number change after treatment with ginger was 0.7 (2.18), more than with vitamin B6, which was 0.5 (1.44) but with no statistically significant difference, (p = 0.498). There were some minor side effects in both groups such as sedation (26.6% vs 32.8%, p = 0.439), and heartburn (9.4% vs 6.3%, p = 0.510), a non-significant difference.
                The nausea score and the number of vomiting episodes were significantly reduced following ginger and vitamin B6 therapy. Comparing the efficacy, there was no significant difference between ginger and vitamin B6 for the treatment of nausea and vomiting during pregnancy. In this randomized double-blind trial we investigated the effect of acupressure on the incidence of nausea and vomiting after caesarean section under spinal anaesthesia with added intrathecal morphine. Parturients wore either acupressure or placebo wristbands during surgery and postoperatively for at least 10 h. There was no significant difference overall between the two groups in the incidence of intra- or postoperative nausea or vomiting/retching. Demand for antiemetic medication was also similar in the two groups. However, in the sub-group of parturients who gave a previous history of postoperative nausea or vomiting, there was a statistically significant reduction in both postoperative nausea and vomiting/retching in the acupressure group. Further investigations are needed to see whether acupressure may be an effective non-pharmacological, non-invasive treatment for a common problem in this sub-group of patients. The purpose of this investigation was to evaluate the efficacy of ondansetron in controlling postoperative nausea and vomiting (PONV) when used prophylactically in patients undergoing routine dentoalveolar surgery performed under general anesthesia.
                This was a prospective, double-blind, randomized, placebo-controlled evaluation. Fifty adult ASA I or II patients, requiring routine dentoalveolar surgery performed under general anesthesia, without a prior history of PONV, were randomly assigned to the experimental or control groups. Ondansetron (2.0 mL = 4.0 mg) or normal saline (2.0 mL) were administered intravenously before surgery. Age, gender, type of surgery, duration of surgery, anesthetic dosages, and PONV were evaluated. PONV was evaluated at time 0 (end of anesthesia) and at 30 and 60 minutes postoperatively. Nausea was evaluated using a visual analog scale (1, not nauseous; 5, about to vomit). Vomiting was assessed as a yes or no response. At 20 to 28 hours postoperatively, PONV was evaluated via a telephone call as a yes or no response, along with the number of episodes of nausea, vomiting, or both. Means and standard deviations were calculated for age, surgery, and anesthetics, and differences were assessed using an independent samples t-test. Differences for gender between the control and experimental groups were tested by a nonparametric chi-squared test. Differences between groups for nausea and vomiting were tested with a continuity correction chi-squared test. Differences were considered significant for a P < .05.
                No significant differences (P < .05) were found between the PONV groups for gender, duration of procedure, or anesthetic dosages. Statistically significant differences were noted in age and the type of surgical procedures performed. No statistically significant differences (P < .05) were noted between groups for nausea or vomiting.
                Based on the results of this study, PONV occurred in approximately 20% of patients (20% for nausea, 8% for vomiting). With the types of anesthetic agents and techniques used in this investigation, there were no significant differences between ondansetron and placebo for prophylaxis against PONV. Because no completely effective antiemetic exists for the prevention of postoperative nausea and vomiting (PONV), we hypothesize that a multimodal approach to management of PONV may reduce both vomiting and the need for rescue antiemetics in high-risk patients. After IRB approval, women undergoing outpatient laparoscopy were randomized to one of three groups. Group I (n = 60) was managed by using a predefined multimodal clinical care algorithm. Patients undergoing the same surgical procedure who received a standard balanced outpatient anesthetic with ondansetron 4 mg (Group II, n = 42) or placebo (Group III, n = 37) prophylaxis were chosen to establish baseline incidence of nausea and vomiting. None of the Group I patients vomited before discharge, compared with 7% in Group II (P = 0.07) and 22% in Group III (P = 0.0003). However, one patient (2%) in Group I required treatment for symptoms in the postanesthesia care unit, compared with 24% in Group II (P<0.0001) and 41% in Group III (P< 0.0001). Time to discharge-ready was significantly shorter in Group I (128, 118-139 min; mean, 95% confidence interval) versus Group II (162, 145-181 min; P = 0.0015) and Group III (192, 166-222 min; P = 0.0001). Patient satisfaction with control of PONV was not different between Group I and Group II. Return to normal daily activity and overall satisfaction were not different among groups. Multimodal management resulted in a 98% complete response rate and a 0% incidence of vomiting before discharge; however, this improvement did not result in an increased level of patient satisfaction when compared with routine monotherapy prophylaxis. We conclude that both multimodal management and routine monotherapy antiemetic prophylaxis resulted in an increased level of patient satisfaction than symptomatic treatment in this high-risk population. To find out whether acupressure wristband can alleviate nausea and vomiting in early pregnancy.
                Double-blind, placebo-controlled study.
                97 women with mean gestational length completed 8-12 weeks.
                Symptoms were recorded according to intensity, duration and nature of complaints.
                71% of women in the intervention group reported both less intensive morning sickness and reduced duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms. However, a significance level of 5% was reached only in the case of duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.018).
                Acupressure wristband might be an alternative therapy for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered. To investigate the effect of a ginger extract (EV.EXT35) on the symptoms of morning sickness.
                Double-blind randomised placebo-controlled trial.
                A tertiary metropolitan teaching hospital, March 1999-November 1999.
                The participants included 120 women less than 20 weeks pregnant, who had experienced morning sickness daily for at least a week and had had no relief of symptoms through dietary changes.
                Random allocation of 125 mg ginger extract (EV.EXT35; equivalent to 1.5 g of dried ginger) or placebo given four times per day for 4 days.
                Nausea, vomiting and retching as measured by the Rhodes Index of Nausea, Vomiting and Retching.
                The nausea experience score was significantly less for the ginger extract group relative to the placebo group after the first day of treatment and this difference was present for each treatment day. Retching was also reduced by the ginger extract although to a lesser extent. No significant effect was observed on vomiting. Follow-up of the pregnancies revealed normal ranges of birthweight, gestational age, Apgar scores and frequencies of congenital abnormalities when the study group infants were compared to the general population of infants born at the Royal Hospital for Women for the year 1999-2000.
                Ginger can be considered as a useful treatment option for women suffering from morning sickness. Perhaps the most unpleasant experience following outpatient plastic surgery procedures is postoperative nausea and vomiting. Postoperative nausea and vomiting often results in delayed recovery time and unintended admission, and it can be a contributing factor to the formation of hematoma following rhytidectomy. Ondansetron (Zofran) has proven benefit in preventing postoperative nausea and vomiting if given before general anesthesia in a variety of surgical procedures. Its utility in cases performed under conscious sedation has not been determined. The purpose of this study was (1) to test the ability of prophylactic ondansetron to prevent postoperative nausea and vomiting in plastic surgery cases performed under conscious sedation, and (2) to determine relative risk factors for postoperative nausea and vomiting and a selection policy for the administration of antiemetic prophylaxis. This was a prospective, randomized, double-blind study. One hundred twenty patients were enrolled after giving informed consent. Patients received a single dose of either placebo or ondansetron (4 mg intravenously) before administration of sedation. Sedation administration followed a standardized institutional protocol, using midazolam and fentanyl. Data were recorded from a series of three questionnaires: preoperatively, immediately postoperatively, and at the time of the first office return. Data were confirmed by means of telephone interview, chart analysis, and nursing documentation. Multivariate analysis was conducted. Nausea and emesis occurred with an overall frequency of 33 percent and 22 percent, respectively. Postoperative nausea and vomiting was associated with statistically longer recovery periods. The incidence of emesis was statistically higher among women, among those undergoing facial rejuvenation, and among those with a history of opioid-induced emesis or postoperative nausea and vomiting following a previous operation (p < 0.05). The incidence of postoperative nausea and vomiting paralleled increases in case duration; the incidence of emesis was zero in cases less than 90 minutes in duration. Ondansetron significantly reduced the incidence of emesis overall (placebo, 30 percent; ondansetron, 13 percent; p < 0.05). Postoperative perception of nausea was significantly lower among those who had received ondansetron (p < 0.05). These results confirm the efficacy of ondansetron for the prevention of postoperative nausea and vomiting in plastic surgery cases under conscious sedation. In those who are at increased risk, prophylaxis should be considered. Such risks include female gender, facial rejuvenation procedures, and a patient history of opioid-induced emesis or postoperative nausea and vomiting following a prior operation. The zero incidence of emesis in cases less than 90 minutes does not support the routine use of prophylaxis in such cases. Patient satisfaction in plastic surgery is derived from the overall subjective experience of the event as much as by the final result. By remaining attentive to patient concerns and optimizing perioperative care, we can improve the subjective experience for our patients. To estimate whether the use of ginger to treat nausea or vomiting in pregnancy is equivalent to pyridoxine hydrochloride (vitamin B6).
                A randomized, controlled equivalence trial involving 291 women less than 16 weeks pregnant was undertaken at a teaching hospital in Australia. Women took 1.05 g of ginger or 75 mg of vitamin B6 daily for 3 weeks. Differences from baseline in nausea and vomiting scores were estimated for both groups at days 7, 14, and 21.
                Ginger was equivalent to vitamin B6 in reducing nausea (mean difference 0.2, 90% confidence interval [CI] -0.3, 0.8), retching (mean difference 0.3; 90% CI -0.0, 0.6) and vomiting (mean difference 0.5; 90% CI 0.0, 0.9), averaged over time, with no evidence of different effects at the 3 time points.
                For women looking for relief from their nausea, dry retching, and vomiting, the use of ginger in early pregnancy will reduce their symptoms to an equivalent extent as vitamin B6.
                I To compare acupuncture with sham (placebo) acupuncture for treatment of nausea of pregnancy.
                In a subject- and observer-masked, randomized, controlled trial in the maternity unit at Exeter Hospital, we gave 55 women between 6 and 10 weeks' gestation genuine, traditional-style acupuncture or sham treatment with a cocktail stick on three or four occasions over 3 weeks. The main outcome measure was nausea score, as determined by subject report on a visual analogue scale in a daily diary. Anxiety and depression also were assessed.
                Nausea scores decreased from a median of 85.5 (interquartile range 71.25-89.75) to 47.5 (interquartile range 29.25-69.5) in the acupuncture group and from 87.0 (interquartile range 73.0-90.0) to 48.0 (interquartile range 14.0-80.0) in the sham treatment group. There was strong evidence of a time effect (P <.001) but no evidence of a group effect (P =.9) or a group-time interaction (P =.8). Similarly, there was evidence of time effects in scores for anxiety and depression but no group differences. The study had a power of 95% to detect significant differences in nausea scores.
                Acupuncture was as effective in treating nausea of pregnancy as a sham procedure. To compare the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in pregnancy.
                Randomized double-blind controlled trial.
                Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital.
                One hundred and twenty-six pregnant women, with a gestational age of < or = 16 weeks who had nausea and vomiting, required anti-emetics, had no medical complication, and were not hospitalized. Pregnant women were randomly allocated to receive either 650 mg of ginger or 25 mg of vitamin B6. They were given three times per day for 4 days. The degree of nausea and vomiting were assessed by three physical symptoms of Rhode's score (episodes of nausea, duration of nausea and number of vomits). These were recorded 24 hours before treatment for baseline and each subsequent day of treatment. Difference of baseline and post-treatment nausea vomiting scores were calculated for both groups during 4 days of treatment.
                One hundred and twenty-three women returned to follow-up. Ginger and vitamin B6 significantly reduced nausea and vomiting scores from 8.7 +/- 2.2 to 5.4 +/- 2.0 and 8.3 +/- 2.5 to 5.7 +/- 2.3 respectively, (p < 0.05). The mean score change after treatment with ginger was greater than with vitamin B6 (3.3 +/- 1.5 versus 2.6 +/- 1.3), (p < 0.05). There were some minor side effects in both groups 25.4% and 23.8% (p = 0.795) respectively, such as sedation, heartburn, arrhythmia.
                Both ginger and vitamin B6 were effective for treatment of nausea and vomiting in pregnancy. Moreover, ginger was more effective than vitamin B6. Side effects from ginger were reported to be minor and did not need any treatment. This prospective, randomised, placebo-controlled, double-blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy-four full-term parturients were studied. After umbilical-cord clamping, ondansetron 4 mg or 0.9% saline was injected intravenously and the study period continued for 2 h. The severity of nausea was graded from 0 = none to 10 = maximum, while that of vomiting was graded from single = once per min to continuous = multiple per min. The incidence of vomiting was lower following ondansetron (36%) compared with the control group (58%, p < 0.028). Neither the severity of vomiting nor the incidence of nausea was influenced by ondansetron. However, for those who experienced nausea, ondansetron reduced its severity (p = 0.05). We conclude that the intra-operative administration of 4 mg ondansetron intravenously during Caesarean section under spinal anaesthesia significantly reduces the incidence of vomiting and the severity of nausea.
Given the high prevalence of nausea and vomiting in early pregnancy, health professionals need to provide clear guidance to women, based on systematically reviewed evidence. There is a lack of high-quality evidence to support that advice. The difficulties in interpreting the results of the studies included in this review highlight the need for specific, consistent and clearly justified outcomes and approaches to measurement in research studies.