Intraoperative acupuncture as complementary analgesic for post-tonsillectomy pain in children—a prospective randomised clinical trial of effects and safety

Abstract

Background: Tonsillectomy in children is usually accompanied by significant morbidity, including postoperative bleeding, pain, nausea, vomiting, poor oral intake and dehydration. Recent evidences in literature suggest that acupuncture could play a role in reducing postoperative pain in these children. This study aims to investigate the effect of intraoperative acupuncture on postoperative pain scores and oxycodone requirements in children following elective adenotonsillectomy in a prospective randomized controlled trial. Methods: A total of 251 healthy children undergoing tonsillectomy or adenotonsillectomy, aged between 2 and 10 years old, were randomly assigned to either control or acupuncture groups. Preoperative block randomisation and allocation concealment were performed. All patients received standardised anaesthesia and surgery including intraoperative Morphine, Dexamethasone, Granisetron, Clonidine and Paracetamol. In the acupuncture group, acupuncture was additionally applied at 10 specified points immediately after induction of anaesthesia. Postoperative pain relief consisted of Paracetamol regularly and Oxycodone as required. All patients, nursing staff and parents were blinded. All assessments of postoperative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale. Pain scores were recorded at regular intervals during the first 24 hours in hospital and on days 1, 2 and 5 at home following discharge. Results: There were 130 patients in control group and 121 patients in acupuncture group. Acupuncture treatment provided significant benefit for the initial postoperative pain. Pain scores were significantly lower in the acupuncture group compared to those in the control group in the first 12 hours but no difference was noted after discharge at home. There was no difference in the oxycodone requirements between the two groups in hospital but a significant reduction was noted in the acupuncture group on Day 2 at home. No significant adverse effects related to acupuncture treatment were observed. Conclusions: Our study lends support to other findings in the current literature that acupuncture is an effective supplemental tool for reducing early postoperative pain and Oxycodone requirement at home in children following adenotonsillectomy.