Role of Emotional Freedom Techniques in Reducing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy
Role of Emotional Freedom Techniques in Reducing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy
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.
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.
Inclusion Criteria:

 1. Patients undergoing elective laparoscopic cholecystectomy for gallstone disease.

 2. Patients with age range of 25 to 55 years

 Exclusion Criteria:

 1. H/O chronic illness like DM, IHD, CRF, CLD,

 2. H/O acute or chronic psychiatric or psychological illness.

 3. H/O APD (acid peptic disease) or regurgitation.

 4. H/O of any chemotherapy (cancer drugs, opioids), radiotherapy, any history of repeated
 infection.

 5. H/O use of hepatotoxic drugs like acetaminophen, ciprofloxacin, ATT, valproic acid
 etc. in last one month.

 6. H/O alcohol intake in last one month.

 7. Previous hepatobilliary surgery.

 8. Complicated cholecystectomy in which laparoscopic cholecystectomy is converted to open
 cholecystectomy.

 9. Patients who are given opioids in postoperative period.

 10. Patients who need epidural analgesia in postoperative period.