Electroacupuncture Assessed as Possible Preventative of Postoperative Nausea and Vomiting in Pediatric Patients.

Abstract

Electroacupuncture Assessed as Possible Preventative of Postoperative Nausea and Vomiting in Pediatric Patients. Rusy et al. (page 300)Electrical stimulation of acupuncture site P6, located two Chinese inches proximal to the distal skin crease of the wrist, has been effective in adult chemotherapy patients to help curb nausea and vomiting. Rusy et al. designed a trial to compare electroacupuncture to sham acupuncture and no acupuncture in pediatric patients who had undergone tonsillectomy with or without adenoidectomy.Of the 122 patients approached for the study, 120 were enrolled. All patients were between the ages of 4 and 18. The patients were randomly assigned to one of three groups. Acupuncture needles were placed at P6 and at a neutral point (for the acupuncture group) or at two positions further up the arm (sham acupuncture group) while patients were still anesthetized. Their arms were then wrapped to disguise needle placement, thus diminishing the patients’ fear of needles while accomplishing observer blinding to technique. Stimulation of the needles at a low frequency of 4 Hz was begun as the patient awakened and continued for 20 min. In the control group patients, insulated wires were attached to the insides of the arm covers, and a box with sham indicator lights was also used to maintain blinded study conditions. Experienced recovery room nurses blinded to group assignment recorded episodes of nausea and vomiting in the postoperative patients. If nausea persisted for 15 min, or if two or more episodes of vomiting occurred, rescue treatment with ondansetron was instituted. Parents of the patients were given questionnaires for reporting of nausea and vomiting episodes within the first 24h of returning home.In patients receiving electroacupuncture, the incidence of nausea was 60%, compared with 85% and 93% in the sham acupuncture and control groups respectively. However, the incidence of vomiting was not significantly different between the three study groups. P6 acupuncture did not reduce the incidence of rescue treatment for postoperative nausea and vomiting, which was nevertheless the highest in the sham acupuncture group (58% in P6; 83% in the sham group). Patients in the sham acupuncture group also vomited much earlier than those in the other two groups. So while P6 electroacupuncture reduced the feeling of nausea in the study participants, this effect may not be powerful enough to reduce the incidence of vomiting after tonsillectomy, commonly an emetogenic procedure. With significantly higher and earlier incidence of vomiting in the sham acupuncture group, the study does point to the potentially harmful effect of improper acupuncture technique.