Acupuncture versus Usual Care for Postoperative Nausea and Vomiting in Children after Tonsillectomy/Adenoidectomy: A Pragmatic, Multicentre, Double-Blinded, Randomised Trial

Abstract

Objectives To investigate the effect of a standardised acupuncture on nausea and vomiting in children after tonsillectomy with or without adenoidectomy when possible placebo effects were precluded. Methods A pragmatic, multicentre, doubleblinded, randomised controlled trial. The study was conducted over 10 months in 2012-2013 at three ambulatory clinics. Two hundred and eighty-two children, age 1-11 years, American Society of Anesthesiologists grade ≤II, were included. To equalise expectancy effects, all parents were told that their child would receive acupuncture. However, children were randomly allocated to perioperative bilateral needling acupuncture at PC6, depth 7 mm, mean time 17 min (SD 5-45) during anaesthesia plus usual care, or to usual care only. The regional ethics committee approved this approach. Primary endpoints were nausea and vomiting 24 h postoperatively. Results This study did not demonstrate any effect of acupuncture (95% CI) compared with standard care. The overall vomiting in the acupuncture and usual-care groups was 44.2% and 47.9%, respectively. Nausea was experienced by 31.7% in the acupuncture group and by 32.6% in the usual-care group. The test power was acceptable for comparisons of vomiting. Conclusions The findings suggest that when controlling for possible placebo effects standardised PC6 acupuncture needling during anaesthesia without further stimulation of PC6 is not effective in reducing nausea and vomiting in children after tonsillectomy with or without adenoidectomy. Future studies should investigate acupuncture treatment which balances adequate dose and technique and a feasible, child-friendly acupuncture treatment. Trial registration number ClinicalTrials.gov NCT01729052.

Acupuncture in ambulatory anesthesia: a review

“…Four studies reported the need for rescue medication 52,61,62 64,66 and five reported adverse events. 37,53,57,59,63 Discomfort and treatment satisfaction were reported twice. 37,59,60,62 Resumption to normal activity, complete response, emergence agitation, parent satisfaction, and recovery time were reported once each.…”

“…59 For maintenance anesthesia, ten studies used volatile anesthetics, 52,[54][55][56]58,60,[62][63][64][65] four studies used intravenous anesthetics, 57,59,61,66 a multicenter study included both volatile and intravenous anesthetics, 37 and in one study anesthesia was not specified. 53 The studies encompassed a range of types of surgery, including strabismus surgery, tonsillectomy, and laparoscopic cholecystectomy.…”

“…52,54,55,60 Two out of eight studies on acupuncture and three out of eight studies on acupressure did not find any effect on the selected primary endpoints. 37,[63][64][65][66] Eleven studies reported on PONV as a primary endpoint using acupuncture/acupressure at point PC6, and among these eleven studies one study 60 combined PC6 with CV13. 37,[52][53][54][55]60,[62][63][64][65][66] Three studies 57,58,61 reported on POP as primary endpoint.…”

“…63 Blinding of patients and assessor occurred in eleven studies out of 16. 37,54,55,57,58,60,[62][63][64][65][66] In four studies, 52,53,56,61 patient was blinded but blinding of assessors was unclear.…”

“…58 One study reported on acupuncture applied to the PC6 acupoint to treat sore throat due to intubation. 56 Acupuncture or acupressure was initiated before the induction of anesthesia in seven studies, 52,53,55,62,[64][65][66] during anesthesia in five studies, 37,56,[58][59][60] and postoperatively in three studies. 54,57,61 One study tested both preoperative and perioperative acupuncture.…”