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NEW ORLEANS -- Acupuncture is just as effective as the
leading medication used to reduce nausea and vomiting after
major breast surgery, according to a new study conducted by
Duke University Medical Center researchers. The 5,000-year-old
Chinese practice also decreased postoperative pain in these
women, they report.

Based on strong trends emerging during the course of their
ongoing clinical trial, the Duke researchers believe
acupuncture is an effective antiemetic (a drug that reduces
nausea and vomiting) that is less expensive and has fewer side
effects than medications currently used.

"Up to 70 percent of women who undergo major breast surgery
experience significant postoperative nausea and vomiting, so it
is an important medical issue," said lead investigator and Duke
anesthesiologist Dr. Tong Joo (T.J.) Gan.

"We've known from previous studies that acupuncture can be
an effective antiemetic when compared to placebo, but it has
never been tested against one of the most commonly used
medications ondansetron (Zofran)," Gan continued. "Acupuncture
turns out to be just as effective as the drug or better, and
our patients also reported much less pain after surgery, a
finding that surprised us."

Gan presented the results of his team's study today (Oct.
15) during the annual scientific sessions of the American
Society of Anesthesiologists.

The study enrolled 40 women who were undergoing major breast
surgery (breast augmentation, breast reduction or mastectomy)
requiring general anesthesia. The procedures lasted between two
and four hours, and most women were discharged after spending
the night in the hospital.

Women were equally divided into three groups ? one received
acupuncture before the surgery, one received ondansetron prior
to surgery and one received neither. They found that two hours
following surgery, 23 percent of acupuncture patients reported
nausea, compared to 36 percent for the drug and 69 percent for
placebo. After 24 hours, 38 percent of acupuncture patients
reported nausea, compared to 57 percent for the drug and 61
percent for placebo.

In regards to vomiting, 7 percent of acupuncture patients
reported vomiting two hours following surgery, compared to 7
percent who received ondansetron and 23 percent who received
the placebo. After 24 hours, 23 percent of acupuncture patients
reported vomiting, compared to 28 percent for the drug and 46
percent for placebo.

"We were most surprised by the level of pain reported by
women, with 31 percent of acupuncture patients reporting
moderate to severe pain two hours after surgery, compared to 64
percent for ondansetron and 77 percent for placebo," Gan
said.

Specifically, the researchers applied acupuncture at the
sixth point along the pericardial meridian, which is located
two inches below the bottom of the palm of the hand and between
the two tendons connecting the lower arm with the wrist.
According to Chinese healing practices, there are about 360
specific points along 14 different lines, or meridians, that
course throughout the body just under the skin.

"The Chinese believe that our vital energy, known as chi,
courses throughout the body along these meridians," Gan
explained. "While healthiness is a state where the chi is in
balance, unhealthiness arises from either too much or too
little chi, or a blockage in the flow of the chi. By applying
acupuncture to certain well-known points, the Chinese believe
they can bring the chi back into balance."

For their study, the researchers used electroacupuncture,
which uses an electrode ? like that used in standard EKG tests
? at the appropriate point. Instead of actually breaking the
skin with the traditional long slender needles, the
electroacupuncture device delivers a small electrical pulse
through the skin.

"Electroacupuncture enhances or heightens the effects of
traditional acupuncture," Gan explained. "In China, when
acupuncture is used during surgery for pain relief, they
commonly use electroacupuncture devices."

While it is not completely known why or how acupuncture ?
whether electroacupuncture or traditional ? works, recent
research seems to point to its ability to stimulate the release
of hormones or the body's own painkillers, known as endorphins,
Gan said.

"Ten years ago, a study involving acupuncture would not have
been accepted at a scientific meeting like this," Gan said. "In
many ways, the practices of the East are being accepted by the
West, especially as we continue to learn why practices like
acupuncture work."

The Duke trial will continue with a total of 75 patients, at
which point the results will be used as the basis of an
application to the National Institutes of Health for a larger
clinical trial. The researchers also will look to combine
acupuncture with antiemetics to see if this combination of
Eastern and Western approaches has greater effectiveness.

The research was supported by Duke's department of
anesthesiology. Duke colleagues Dr. Steve Parillo, Dr. Jennifer
Fortney and Dr. Gregory Georgiade were part of Gan's research
team.

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