The effect of aquapuncture at Pericardium 6 (PC-6) on dexmedetomidine-induced nausea and vomiting in cats

Published:January 29, 2019DOI:



      To determine the effect of aquapuncture at acupuncture point Pericardium 6 (PC-6) on the incidence of dexmedetomidine-induced vomiting and nausea in cats.

      Study design

      Randomized, prospective, crossover study.


      A group of 22 cats, 14 females and eight males, aged 1–12 years and weighing 3.8–5.9 kg.


      Each cat was administered treatments in random order at ≥1 week intervals. For treatment (DEX–A), cats were administered PC-6 stimulation by aquapuncture (0.25 mL/250 μg vitamin B12 injection subcutaneously at PC-6). After 30 minutes, dexmedetomidine (10 μg kg–1) was administered intramuscularly (IM). For control treatment (DEX), cats were administered only dexmedetomidine (10 μg kg–1) IM. Incidence of vomiting, number of vomiting episodes and time to first vomiting were recorded by an observer unaware of treatment allocation. At 30 minutes after dexmedetomidine administration, atipamezole (0.1 mg kg–1) was injected IM. Behavior was video recorded and later scored by two observers for clinical signs of nausea. A regression model (analysis of covariance) was used to detect the influence of aquapuncture on vomiting and nausea. Significance was set at p < 0.05.


      Of 21 cats, 18 (85%) and 16 cats (76%) vomited in DEX–A and DEX, respectively. There was no significant difference in the incidence of vomiting (p = 0.55), number of vomiting episodes (p = 0.55), mean time to vomit (p = 0.88) or nausea score (p = 0.51) between DEX–A and DEX.

      Conclusions and clinical relevance

      PC-6 aquapuncture did not reduce the incidence of dexmedetomidine-induced vomiting or severity of nausea in cats.


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        • Altman S.
        Techniques and instrumentation.
        in: Schoen A.M. Veterinary Acupuncture. Mosby, USA2001: 95-111
        • Balaban C.D.
        • Ogburn S.W.
        • Warshafsky S.G.
        • et al.
        Identification of neural networks that contribute to motion sickness through principal components analysis of fos labeling induced by galvanic vestibular stimulation.
        PLoS One. 2014; 9: e86730
        • Blancquaert J.P.
        • Lefebvre R.A.
        • Willems J.L.
        Emetic and antiemetic effects of opioids in the dog.
        Eur J Pharmacol. 1986; 128: 143-150
        • Carmel R.
        How I treat cobalamin (vitamin B12) deficiency.
        Blood. 2008; 112: 2214-2221
        • Chen C.Y.
        • Lin C.N.
        • Chern R.S.
        • et al.
        Neuronal activity stimulated by liquid substrates injection at Zusanli (ST36) acupoint: the possible mechanism of aquapuncture.
        Evid Based Complement Alternat Med. 2014; 2014: 627342
        • Clement-Jones V.
        • McLoughlin L.
        • Tomlin S.
        • et al.
        Increased β-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain.
        Lancet. 1980; 2: 946-949
        • Clarke K.W.
        • England G.C.W.
        Medetomidine, a new sedative-analgesic for use in the dog and its reversal with atipamezole.
        J Small Anim Pract. 1989; 30: 343-348
        • Colby E.D.
        • McCarthy L.E.
        • Borison H.L.
        Emetic action of xylazine on the chemoreceptor trigger zone for vomiting in cats.
        J Vet Pharmacol Ther. 1981; 4: 93-96
        • Fan C.F.
        • Tanhui E.
        • Joshi S.
        • et al.
        Acupressure treatment for prevention of postoperative nausea and vomiting.
        Anesth Analg. 1997; 84: 821-825
        • Granholm M.
        • McKusick B.C.
        • Westerholm F.C.
        • Aspergrén J.C.
        Evaluation of the clinical efficacy and safety of dexmedetomidine or medetomidine in cats and their reversal with atipamezole.
        Vet Anaesth Analg. 2006; 33: 214-223
        • Hay Kraus B.L.
        Efficacy of maropitant in preventing vomiting in dogs premedicated with hydromorphone.
        Vet Anaesth Analg. 2013; 40: 28-34
        • Horn C.C.
        The physiology of vomiting.
        in: Koch K.L. Hasler W.L. Nausea and Vomiting. Springer, Switzerland2017: 15-25
        • Horn C.C.
        • Wallisch W.J.
        • Homanics G.E.
        • Williams J.P.
        Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting.
        Eur J Pharmacol. 2014; 722: 55-66
        • Jenkins L.
        • Lahay D.
        Central mechanisms of vomiting related to catecholamine response: anaesthetic implication.
        Canad Anaesth Soc J. 1971; 18: 434-441
        • Kerger H.
        • Turan A.
        • Kredel M.
        • et al.
        Patients’ willingness to pay for anti-emetic treatment.
        Acta Anaesthesiol Scand. 2007; 51: 38-43
        • Koch K.L.
        Physiology of nausea.
        in: Koch K.L. Hasler W.L. Nausea and Vomiting. Springer, Switzerland2017: 1-13
        • Koh R.B.
        • Isaza N.
        • Xie H.
        • et al.
        Effect of maropitant, acepromazine, and electroacupuncture on vomiting associated with administration of morphine in dogs.
        J Am Vet Med Assoc. 2014; 244: 820-829
        • Lee A.
        • Chan S.K.
        • Fan L.T.
        Stimulation of the wrist acupuncture point PC6 for prevention of postoperative nausea and vomiting.
        Cochrane Database Syst. 2015; 11: CD003281
        • Lee S.
        • Lee M.S.
        • Choi D.H.
        • Lee S.K.
        Electroacupuncture on PC6 prevents opioid-induced nausea and vomiting after laparoscopic surgery.
        Chin J Integr Med. 2013; 19: 277-281
        • Mendes G.M.
        • Selmi A.L.
        • Barbudo-Selmi G.R.
        • et al.
        Clinical use of dexmedetomidine as premedicant in cats undergoing propofol-sevoflurane anaesthesia.
        J Feline Med Surg. 2003; 5: 265-270
        • Monteiro E.R.
        • Campagnol D.
        • Parrilha L.R.
        • Furlan L.Z.
        Evaluation of cardiorespiratory effects of combinations of dexmedetomidine and atropine in cats.
        J Feline Med Surg. 2009; 11: 783-792
        • Napadow V.
        • Sheehan J.D.
        • Kim J.
        • et al.
        The brain circuitry underlying the temporal evolution of nausea and humans.
        Cereb Cortex. 2013; 23: 806-813
        • Pypendop B.H.
        • Barter L.S.
        • Stanley S.D.
        • Ilkiw J.E.
        Hemodynamic effects of dexmedetomidine in isoflurane-anesthetized cats.
        Vet Anaesth Analg. 2011; 38: 555-567
        • Ravi M.
        • Babu G.
        • Somasekharam N.
        • et al.
        Comparative efficacy of acupuncture at p6 point with 0.2ml 50% dextrose and inj ondansetron 50 μg kg-1 IV for preventing postoperative nausea and vomiting.
        J Anaesthesiol Clin Pharmacol. 2010; 26: 237-239
        • Santos L.C.
        • Ludders J.W.
        • Erb H.N.
        • et al.
        A randomized, blinded, controlled trial of the antiemetic effect of ondansetron on dexmedetomidine-induced emesis in cats.
        Vet Anaesth Analg. 2011; 38: 320-327
        • Scallan E.M.
        • Simon B.T.
        The effects of acupuncture point Pericardium 6 on hydromorphone-induced nausea and vomiting in healthy dogs.
        Vet Anaesth Analg. 2016; 43: 495-501
        • Tatewaki M.
        • Strickland C.
        • Fukuda H.
        • et al.
        Effects of acupuncture on vasopressin-induced emesis in conscious dogs.
        Am J Physiol Regul Integr Comp Physiol. 2005; 288: R401-R408
        • Thawley V.J.
        • Drobatz K.J.
        Assessment of dexmedetomidine and other agents for emesis induction in cats: 43 cases (2009-2014).
        J Am Vet Med Assoc. 2015; 247: 1415-1418
        • Vähä-Vahe T.
        Clinical evaluation of medetomidine, a novel sedative and analgesic drug for dogs and cats.
        Acta Vet Scand. 1989; 30: 267-273
        • Zhu D.
        • Gao Y.
        • Chang J.
        • Kong J.
        Placebo acupuncture devices: considerations for acupuncture research.
        Evid Based Complement Alternat Med. 2013; 2013: 628907