Nothing leaves a bad taste in a patient's mouth like feeling queasy while recovering after surgery. The good news: Simple, non-pharmaceutical treatments can help prevent post-operative nausea and vomiting (PONV). And we're not talking about flat ginger ale, but alternative holistic and non-pharmacological preventive approaches: aromatherapy, acupuncture and acupressure. Plus, we update you on 3 promising antiemetics that could soon hit the market (see "3 PONV Drugs in the Pipeline").

1. Aromatherapy

Aromatherapy has proven to be an effective way to reduce PONV, either as a monotherapy or in conjunction with pharmacologic antiemetics. We asked Lenora Brown, DNP, RN, FNP-BC, a nurse practitioner on short surgical stay at Weill Cornell Medical Center at New York (N.Y.) Presbyterian Hospital, to share the results of her recently completed study on the stomach-settling effects ascribed to the aromatic compounds in essential oils and other plant extracts.

The inspiration for Dr. Brown's study came from something she observed right on her own unit. Why is it, she wondered, did some patients arrive in her 20-bed short-stay unit with nausea, while others did not. Despite coming from different areas of the hospital, the patients with the calm stomachs wore a lavender and saddlewood aromatherapy clip-on patch on their gowns.

The patients without the patches? "They would always seem to come up nauseous," says Dr. Brown. Because aromatherapy patches were already being used in her facility, Dr. Brown decided to test them in her recovery unit to determine if aromatherapy could prevent the cost and hassle of using antiemetics to treat PONV.

"Let's try to initiate something that doesn't require a doctor's order. When the nausea is mild, let's try a holistic approach," says Dr. Brown. "If we initiate aromatherapy early enough, we may not have to use the traditional medications like Zofran (ondansetron) and Reglan (metoclopramide) to treat nausea."

For her study, published in last month's AORN Journal (osmag.net/XZ4ojQ), Dr. Brown offered post-op patients who received general anesthesia the option of an aromatherapy patch as an adjunct treatment for PONV or a standard Zofran antiemetic treatment. The patients who opted for the aromatherapy patch, a blend of orange and peppermint essential oils, wore it on the upper chest of their gowns. Nurses assessed the patients' PONV levels before getting the patch and upon their arrival in the short-stay unit using a 5-point Likert scale: 1 for no nausea to 5 for severe nausea. Patients who wore the patch had nausea ratings ranging from 2 to 5 before getting it. When nurses assessed patients after 30 minutes of aromatherapy treatment, nearly half (48%) reported their nausea had subsided.

Stephanie R. Landmesser, MSN, RN, CNOR, CCNS, a clinical nurse specialist at Thomas Jefferson University Hospital in Philadelphia, Pa., also decided to test the effectiveness of aromatherapy for PONV prevention. But Ms. Landmesser decided to focus on patients receiving ear, nose and throat (ENT) procedures. Why the focus on ENT? For one thing, ENT procedures, along with abdominal surgeries, are considered the highest risk surgeries for PONV. So, if you want to prove aromatherapy can prevent PONV, you may as well test that theory on the procedures most likely to cause nausea and vomiting post-op.

Another reason for using ENT patients was the otolaryngologist's support. "I needed a solid physician champion, and he was totally onboard with the study, as were his patients," says Ms. Landmesser.

The ongoing study will compare aromatherapy to traditional antiemetic during early PONV, defined as 2 to 6 hours after surgery (Phase I recovery). Ms. Landmesser will evaluate 100 patients before tabulating the results.

If you're worried about convincing a skeptical surgical board about the viability of something like aromatherapy, you shouldn't be. As Ms. Landmesser points out, even the American Society for Anesthesiologists (ASA) has built a non-traditional antiemetic (aromatherapy) into its algorithm for PONV treatment.

"If key organizations and key leaders are looking into aromatherapy as an alternative then we, too, need to study this as healthcare providers," says Ms. Landmesser. "You need to impress upon those who may not have experience in the surgical arena that we need to have alternatives in the OR."

2. Acupuncture

Acupuncture, specifically acupuncture of the Pericardium 6 (PC6) acupoint in the wrist during surgery, is another evidence-backed alternative therapy to prevent PONV. A Cochrane review of 59 randomized control trials (updated in 2015) involving more than 7,500 patients found that the use of acupuncture on the PC6 acupoint — found between the tendons about 3 finger widths below the wrist — was comparable to traditional antiemetics in preventing PONV. Before or after surgery, either a licensed acupuncturist or an anesthesiologist with an acupuncture certification places the needles after the patient is under anesthesia.

When PC6 acupoint stimulation was compared to 6 traditional antiemetic drugs (metoclopramide, cyclizine, prochlorperazine, droperidol, ondansetron and dexamethasone) in preventing PONV, there was no difference between the methods. In other words, "acupuncture was just as effective as medication with the medication side effects," says Francoise Adan, MD, the medical director for University Hospitals Connor Integrative Health Network in Ohio. And without the added expense.

3. Acupressure

Acupressure, which is similar to acupuncture, is another potential prevention tactic for PONV. While both acupuncture and acupressure involve acupoints such as the PC6, acupressure uses a firm pressure to "massage" those points, whereas acupuncture involves using hair-thin needles to "stimulate" them.

Although there is less research on acupressure preventing PONV, studies are underway. What's more, there are several advantages to at least putting this technique out there as an option for patients. One big one: You can teach patients or their family members to use this technique directly. The patient, the family or staff can perform acupressure.

Alternative medicine

Regardless of whether it's aromatherapy, acupuncture or acupressure, there's a growing movement to add alternative therapies to the standard protocol for treating PONV. But these therapies should be used to buoy, not replace, traditional treatments.

"Integrated medicine is bringing the best of what we know. Of course, we need surgery, of course we need pharmacology, but what else? It's not either-or, it's altogether how can we make it what's best for the patient?" says Dr. Adan. "And what's best for the patient is really what's best for the clinician and for the business."

Alternative therapies also make sense from a business perspective. As Dr. Adan points out, health care is becoming a consumer-driven business, and the consumers want integrative health options from their providers. This can be especially true in the case of outpatient centers where competition is fierce and savvy patients are looking for something that sets a facility apart from the pack.

"Let's face it, there are many, many outstanding surgeons out there today. A good surgeon is what's expected from an outpatient center. What patients want to know is, "?Why else should I go to your facility?'" says Dr. Adan. OSM