International Journal of Research in Medical Sciences

Nani D et al. Int J Res Med Sci. 2015 Dec;3(Suppl 1):S119-S122

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151531
Research Article
Effect of acupressure therapy point HT 6 and LI 4
on post cesarean sectio’s pain
Desiyani Nani1*, Susio Maryati2, Rizka Rahmaharyanti3

1
Nursing Program, Faculty of Health Sciences, University of Jenderal Soedirman. Purwokerto, Central Java, Indonesia
2
Department of Nursing, Margono Soekardjo Hospital, Purwokerto, Central Java, Indonesia
3
Puspita Ardelia Institute of Complementary and Alternative Healthcare, Indonesia

Received: 26 September 2015

Accepted: 13 November 2015

*Correspondence:
Desiyani Nani,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Stimulation at acupressure point can activate three centre of body control, there are spinal cord,
midbrain, and pituitary to release neurochemical such as endorphin, serotonin, and norepinephrine effect to blockage
pain. Cesarean sectio’s pain begins since decreasing of the effect from anesthetical medication. Acupressure therapy
at point HT6 and LI4 can activate these three centre of body control. So it is possible to reduce pain sensation when
stimulated both. This study was carried out to identify the effects of HT 6 and LI 4 acupressure on sectio cesarea’s
pain in post-partum periods.
Methods: A single blind randomized clinical trial is performed on seven eligible women who are at the beginning of
post-partum periods. The participants are matched duration after sectio cesarean before 24 hours, nulliparas and
multiparas. There is no additional administration of analgesics during the study period. The women receive
acupressure at HT 6 and LI 4 for 20 minutes. The severity of pain is measured by using the Visual Analogue Scale for
pain. Intensity of pain are measured before and immediately after the intervention. Statistical analyses are perform
using SPSS 20.
Results: the rate of pain intensity’s scale before and after treatment are ( 84,29 ± 15,65) and (64,57 ± 15,80). There
are significant differences between both of groups. The pain intensity after the intervention was significantly decrease
than pain intensity before (p = 0.04). There are significant differences between the groups in subjective pain scale
before intervention and immediately after intervention. The pain intensities after the intervention are significantly
decrease than pain intensities before the intervention (p = 0.04).
Conclusions: Acupressure at HT6 and LI4 point reduced the severity of pain at the beginning of post partum periods
after cesarean sectio. These findings show that combination HT6 and LI4 acupressure are effective for reducing
esarean sectio’s pain. HT6 and LI4 acupressure can be an effective nursing management for women in post partum
periods.

Keywords: Pain, Delivery, Abdominal surgery, Maternal, Childbirth

INTRODUCTION to bladder and bowel, lactation failure, and less maternal

newborn bonding.1
The woman who has undergone cesarean section has
more problems, minor or major, than a woman with Pain remains a significant problem following surgical
vaginal delivery. Some problem are like longer duration operations. Pain is the most unpleasant state at patient after
of hospital stay, post-operative pain, delayed CS treatment. Pain is above all an individual
ambulation, increased period required to return to phenomenon. Only the person experiencing it is able to
normal meals, breast engorgement, problems in relation really know what that pain is like. Other people may

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think that they know what the pain is like. They may of pain, and the resultant parameter value has been
have experienced pain in the same part of the body, or shown to correlate highly with the level of pain as
7
possibly due to a similar cause, in the past. measures with verbal and numerical rating scales.
Alternatively, they have witnessed or even provided
care for a number of people and think they know what a RESULTS
person who is experiencing this form of pain looks like.
All of these people, whether they are experienced or Maternal characteristics in Table 1 showed that most of
whether they are witnesses, are mistaken. They are cesarean delivery women (57.2%) are in age group of
making assumptions which are either weakly founded between 26-325 years. Multiparas (57.2%) are the most of
or totally unfounded. Obviously, such unfounded maternal parital state. Middle socioeconomic group
assumptions carry serious implications for the person (42.8%) as well as low socioeconomic group of
actually experiencing the pain.2 Assessing pain using participants. None of participants had history of abortion
visual analogue scale (VAS) in the postoperative period and previous fetal deaths. 57.2% are in before 6 hours
is essential to improve pain management. after CS delivery.

Acupressure is a therapy that is conducted by applying Table 1: Socio-demographic factors of participants.

physical pressure on various points on body surface by
means of energy circulation and balance in cases of pain Maternal factors Frequencies (n) (%)
symptoms. This therapy is similar to the acupuncture Maternal age (years)
and it is conducted by applying pressure on selected < 25 2 28.6
points of the body by fingers, hands, palms, wrists and 26-35 4 57.2
knees in order to provide internal flow of energy. >35 1 14.2
Acupressure technique is a noninvasive, safe and
Parity
effective application.3-5
Primipara 3 42.9
This study is important to encourage the effectiveness of Multipara 4 57.2
pain management using acupressur technique in order to Socioeconomic status
relieve pain at postoperative Cesarean Sectio’s patient. Low 3 42.8
Sample has taken place at Post partum room at rural Middle 3 42.8
hospital in Banyumas. High 1 14.3
H/o Abortion
METHODS No 7 100
Yes 0 0
This study is quasy experimental with seven women
H/o Fetal death in
who attended post partum room after their cesarean
previous pregnancy
sectio for delivering their babies.
No 7 100
Data have been collected were following aspects: Yes 0 0
Length of time after CS
1. Sociodemographic data < 6 hours 4 57.1
2. Maternal characteristics 7-12 hours 2 28.6
3. Indication of delivery >12 hours 1 14.3
4. Pain scale measured with Visual Analogue Scale for
pain (VASP) before and after acupressure treatment
Table 2: Intensity of pain with Visual Analogue Scale
(VAS) for Pain (1-100 mm).
Acupressure therapy point HT6 and LI 4 have done for
6 second and 2 second released for 5 minutes each limb
Percentage
until 20 minutes overall.6 Evaluation done before and Score of Pain Frequency (n)
(%)
after each treatment, followed with pain measurements
Before
with VASP. The VASP consist of 10 cm horizontal
treatment
scale with the descriptors ‘no pain’ written on the left
adn ‘worst possible pain” written on the right of the <50 0 0
scale. Participants were asked to place a mark on the 10 50-75 1 14.3
cm line, at a point that corresponded to the level of pain >75 6 85.7
intensity that they felt at time of enquiry. The distance in After treatment
centimeters from the no pain (left hand) end of the <50 1 14.3
VASP to the participant’s mark was used as a numerical 50-75 4 57.2
index of the severity of pain experienced. The VASP >75 2 28.6
has been reported to be sensitive to pharmacologic and
nonpharmacologic procedures that alter the experience

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Pain intensity outcome is tabulated in Table 2 which results of study conducted by Kotani et al., which
showed that before acupressure treatment 85.7% featured abdominal surgery patients, indicated that
participants report above 75 point scale. After acupressure acupuncture could effetively alleviate patients’
treatment only 28.6% participants report the similar scale. postoperative pain.10

Table 3 shows the rate of pain intensity’s scale before and Goddard et al. reported on 18 patients who were
after treatment are (84.29 ± 15.65) and (64.57 ± 15.80). randomly assigned to one of two experimental groups,
There are significant differences between both of groups. 10 patients receiving acupuncture and eight receiving
The pain intensity after the intervention was significantly sham acupuncture.11 These investigators found that
decrease than pain intensity before (p = 0.04). both acupuncture and sham acupuncture reduce the
intensity of pain evoked by stimulation at masseter
DISCUSSION muscles among myofascial patients.

High-quality pain relief is important after cesarean This study shows the effectiveness of acupressure to
section to promote early recovery and optimize mothers’ relieve pain. Seven respondents that given acupressure
ability to care for their newborns. Surveys have shown therapy demonstrated the decrease at pain scale. The
that parturient consider pain during and after cesarean decrease of pain intensity through physiologically
section as their most important concern.8 Despite processes during acupressure treatment. Stimulation at
advances in postoperative pain management, acupressure point activated three centre, spinal cord,
postoperative pain relief and satisfaction are still midbrain, and pituitary. Neurochemical is released, such
inadequate in some patients because of individual as endorphine, serotonin and norepinephrine for the use
variability and limitation from side effects of analgesic to blocked pain messages. Acupessure stimulation also
drugs or techniques.9 could release adrenocorticotropin hormone (ACTH)
from pituitary. Three mechanism to explain acupressure
This present study finds that acupressure is able to work to decrease pain sensation that is: Neurotransmitter
effectively reduce the intensity of pain at periods of theory, autonomic nervous systems and gate control
post-operative cesarean section deliveries. Similarly, the theory.12

Table 3: Intensity of pain’s rate scale before and after acupressure treatment.

Treatment Frequency (n) Mean±SD Min-max 95% CI

Before treatment 7 84.29 ± 15.65 55-98
13.75-25.68
After treatment 7 64.57 ± 15.80 36-84

Acupressure enhance post-operative physiologis inces disease, revealed that acupuncture at Neiguan point
(respiration, pulse, systolic blood pressure, and siastolic reduces subjects’ heart rates, and increased
blood pressure.6 The results of this study suggest that parasympathetic nerve activity.14
significant differences in the levels of postoperative
anxiety and pain existed between subjects who did and The results of our study suggest, however, a contrary
did not receive acupressure, indicating that postoperative result compared to Hinze trial, who assigned 48 healthy
acupressure may effectively reduce postoperative anxiety women to one of four different study groups, namely a
and pain. Over the recent years, researchers have control group, a transcutaneous electrical nerve
investigated the use of the endogenous opioid system to stimulation (TENS) group, a placebo group and an
explain the pain-alleviating mechanism. When people are acupressure group.15 Hinze’s study showed no significant
under pressure, endorphin is produced, which elicits difference in anxiety and pain awareness between any of
interferential obstruction at the nerve fibers. This the four groups. The reason for this may associate to the
endorphin property provides a pain- alleviating effect. different medical situations for different study
When an individual’s skin is stimulated, e.g. by massage participants, sinceit would appear that for women
or acupressure, endorphin levels are increased, which undergone surgery and for those women who are still in
elicit a pain-alleviating effect. The therapeutic effect on labor, both groups of women face high levels of anxiety
postoperative anxiety elicited by acupressure was also and pain, level that given appropriate therapeutic
reported by Ip who used a descriptive cross-sectional techniques, could effectively be reduced.
study to investigate the conditions under which patients
consult an acupuncturist.13 From Ip’s results, there was a Acupressure therapy could decrease pain at 71.4%
mean effectiveness rating of 74.4%. Similarly, Chen and respondents. Information given to family about
Huang, in their study of patients with coronary artery acupressure procedure could be accepted. 100 % family

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 Nani D et al. Int J Res Med Sci. 2015 Dec;3(Suppl 1):S119-S122

member that accompany respondent could 7. Chang MY, Wang SY, Chen CH. Effects of
redemonstrated acupressure point HT 6 and LI 4 and used massage on pain and anxiety during labour: a
it when pain onset begins. randomized controlled trial in Taiwan. Kaohsiung J
Med Sci. 2002;18:68-73.
CONCLUSION 8. Carvalho B, Cohen SE, Lipman SS, Fuller A,
Mathusamy AD, Macario A. Patient preferences for
It is concluded that Acupressure at HT6 and LI4 point anesthesia outcomes associated with cesarean
reduced the severity of pain at the beginning of post delivery. Anesth Analg. 2005;101:1182-7.
partum periods after sectio cesarean. These finding shows 9. Dolin SJ, Cashman JN, Bland JM. Effectiveness of
that combination HT6 and LI4 acupressure therapy was acute postoperative pain management: I. Evidence
effective for reducing cesarean section’s pain. from published data. Br J Anaesth. 2002;89:409-23.
Acupressure therapy at point HT6 and LI4 can be an 10. Kotani N, Hashimoto H, Sato Y, Sessler DI,
effective nursing management for women in periods of Yoshioka H, Kitayama M, et al. Preoperative
post-operative cesarean section. intradermal acupuncture reduces postoperative pain,
nausea and vomiting, analgesic requirement, and
Funding: No funding sources sympathoadrenal responses. Anesthesiology.
Conflict of interest: None declared 2001;95:349-56.
Ethical approval: The study was approved by the 11. Goddard G, Karibe H, McNeill C, Villafuerte E.
Institutional Ethics Committee Acupuncture and sham acupuncture reduce muscle
pain in myofascial pain patients. J Orofac Pain.
REFERENCES 2001;16:71-6.
12. Kalyani P. The massage connection. In: Anatomy
1. Zalon M. Recovery after Abdominal Surgery. and physiology. Philadelpia: Lippicont Williams &
Nursing Research. 2004;153(2):106-10. Wilkins. 3rd ed; 2004.
2. Mander R. Pain in childbearing and its control. 2 nd 13. Ip VHY. The use of acupuncture for pain relief in a
Ed. Blackwell Publishing, Ltd, 2011. Chinese hospital clinic. Acupunct Med.
3. Hakverdioğlu G, Türk G. Acupressure. Journal of 1999;17:101-9.
Hacettepe University School of Nursing. 2006;43-7. 14. Chen GY, Huang ST. Effect of acupuncture at
4. Tsay SL, Rong JR, Lin PF. Acupoints massage in Neiguan P6 on heart rate variability in healthy
improving the quality of sleep and quality of life in subjects and patients with coronary artery disease.
patients with end-stage renal disease. Journal of Chin J Med. 2001;19:128-44.
Advanced Nursing. 2003;42(2):134-42. 15. Hinze MLM. The Effect of therapeutic Touch and
5. Tsay SL, Chen ML. Acupressure and quality of Acupressure on Experimentally-induces Pain. PhD
sleep in patients with end- stage renal disease-a thesis, The University of Texas at Austin. 1988:1-
randomized controlled trial. International Journal of 246.
Nursing Studies. 2003;40(1):1-7.
6. Chen HM, Chung FY, Hsu CT. Effect of Cite this article as: Nani D, Maryati S,
acupressure on nausea, vomiting, anxiety and pain Rahmaharyanti R. Effect of acupressure therapy
among post-cesarean section in women in Taiwan. point HT 6 and LI 4 on post cesarean sectio’s pain.
Koohsiung J Med Sci. 2005;21. Int J Res Med Sci. 2015;3(Suppl 1):S119-22.

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