Patients aged 4-18 yr undergoing tonsillectomy with or without adenoidectomy were randomly assigned to acupuncture, sham acupuncture, or control groups.
Sample Count
120
Age
4月18日
Control
Sham
Std
control group(n=40)
Experiment
acupuncture(n=40);sham acupuncture(n=40)
Indicator
Postoperative Nausea and Vomiting(PONV)Use of antiemetic rescue medication
Auxiliary Medication
All patients received oral midazolam (0.5 mg/kg to a maximum of 10 mg) 20 min before induction of anesthesia with halothane or sevoflurane in oxygen (30%) and nitrous oxide (70%) via mask. After intrave- nous cannulation, 0.2 mg/kg mivacurium, 0.1 mg/kg morphine sulfate, and at least 20 ml/kg lactated Ringer’s solution were administered. Anesthesia was maintained with oxygen, 70% nitrous oxide, and isoflurane via an endotracheal tube. Awake tracheal extubation was performed after orogastric suction. Postoperative pain was treated with 0.05 mg/kg morphine, repeated as needed. Lactated Ringer’s solution was infused at a maintenance rate until oral clear liquids were accepted without vomiting. Thereafter, oral analgesics were administered as needed every 3 h (acet-aminophen with codeine, 1 mg/kg).
Stimulation Method
EA
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
LTD IC-1107
ITO-Co., Braintree, MA
4 Hz
-
-
20 min
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
0.25×30 mm
Shizuoka, Japan
10 mm
Description Stimulation of the needles at low frequency, 4 Hz, was continued for 20 min as soon as the patient was awake.
Anesthesia Method
GA
Clinical Trial Type
random
Contraindications
Exclusion criteria in_x005fcluded presence of skin lesions near acupuncture sites,previous and severe PONV, or a chronic history of nausea and vomiting
Effector
Perioperative P6 electroacupuncture in awake patients significantly reduced the occurrence of nausea compared with the sham and control groups, but it did not significantly reduce the incidence or number of episodes of emesis or the use of rescue antiemetics. Sham acupuncture may exacerbate the severity but not the incidence of emesis. The efficacy of P6 acupuncture for PONV prevention is similar to commonly used pharmacotherapies.
Electroacupuncture prophylaxis of postoperative nausea and vomiting following pediatric tonsillectomy with or without adenoidectomy.
Abstract
BACKGROUND: Electrical stimulation of acupuncture point P6 reduces the incidence of postoperative nausea or vomiting (PONV) in adult patients. However, acupressure, laser stimulation of P6, and acupuncture during anesthesia have not been effective for reducing PONV in the pediatric population. The authors studied the effect of electrical P6 acupuncture in awake pediatric patients who had undergone surgery associated with a high incidence of PONV. METHODS: Patients aged 4-18 yr undergoing tonsillectomy with or without adenoidectomy were randomly assigned to acupuncture, sham acupuncture, or control groups. Acupuncture needles at P6 and a neutral point were placed while patients were anesthetized, and low-frequency electrical stimulation was applied to these points for 20 min in the recovery room while the patients were awake (P6 Acu group). This treatment was compared with sham needles along the arm at acupuncture points not associated with antiemesis (sham group) and a no-needle control group. The arms were wrapped to prevent identification of treatment group, and anesthetic, analgesic, and surgical technique were standardized. Assessed outcomes were occurrence of nausea, occurrence and number of episodes of vomiting, time to vomiting, and use of antiemetic rescue medication. RESULTS: One hundred twenty patients were enrolled in the study, 40 per group. There were no differences in age, weight, sex, or opioid administration between groups. The PONV incidence was significantly lower with P6 acupuncture (25 of 40 or 63%; odds ratio, 0.135; number needed to treat, 3.3; P < 0.001) compared with controls (37 of 40 or 93%). Sham puncture had no effect on PONV (35 of 40 or 88%; P = not significant). Occurrence of nausea was significantly less in P6 Acu (24 of 40 or 60%; odds ratio, 0.121; P < 0.01), but not in the sham group (34 of 40 or 85%) compared with the control group (37 of 40 or 93%). Vomiting occurred in 25 of 40 or 63% in P6 Acu; 35 of 40 or 88% in the sham group, and 31 in 40 or 78% in the control group (P = not significant). Patients receiving sham puncture vomited significantly earlier (P < 0.02) and needed more rescue treatment (33 of 40 or 83%; odds ratio, 3.48; P < 0.02) compared with P6 Acu (23 of 40 or 58%) and the control group (24 of 40 or 60%). CONCLUSIONS: Perioperative P6 electroacupuncture in awake patients significantly reduced the occurrence of nausea compared with the sham and control groups, but it did not significantly reduce the incidence or number of episodes of emesis or the use of rescue antiemetics. Sham acupuncture may exacerbate the severity but not the incidence of emesis. The efficacy of P6 acupuncture for PONV prevention is similar to commonly used pharmacotherapies. Its appropriate role in prevention and treatment of PONV requires further study."
