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Metaanalysis of acustimulation effects on postoperative nausea and vomiting in children
Linda S Dune1, Shyang-Yun Pamela K Shiao
1University of Texas School of Nursing at Houston, Houston, TX, USA. Linda.S.Dune@uth.tmc.edu
Insights
Acustimulation, including acupressure and acupuncture, effectively reduces postoperative nausea and vomiting (PONV) in children. These methods are as effective as medications for reducing vomiting and offer a viable alternative treatment.
Area of Science:
- Pediatric Anesthesiology
- Integrative Medicine
- Evidence-Based Practice
Background:
- Postoperative nausea and vomiting (PONV) is a common complication in children undergoing surgery.
- Current pharmacological interventions for PONV have potential side effects.
- Non-pharmacological approaches like acustimulation (AS) warrant investigation for efficacy and safety.
Purpose of the Study:
- To systematically evaluate the effectiveness of various acustimulation (AS) modalities in managing postoperative nausea and vomiting (PONV) in pediatric patients.
- To compare the efficacy of different AS techniques (acupressure, acupuncture, laser acupuncture, electrical stimulation) against control groups and pharmacological treatments.
Main Methods:
- A comprehensive meta-analysis was conducted on randomized controlled trials (RCTs) identified through extensive database searches.
- RCTs published from 1966 to May 2005 were included, with reference lists of relevant papers also scanned.
- Methodological quality was assessed using QUOROM guidelines, and results were pooled using a fixed-effects model.
Main Results:
- The meta-analysis of 12 RCTs indicated that all AS modalities significantly reduced both vomiting and nausea within 24 hours post-surgery.
- Acupressure and acupuncture demonstrated significant effectiveness in reducing vomiting, while electrical stimulation of the transelectroacupuncture point (ETS) did not show statistically significant results.
- AS treatments were found to be comparable in efficacy to standard antiemetic medications for reducing postoperative vomiting.
Conclusions:
- Acupressure and acupuncture are effective interventions for reducing postoperative vomiting in children.
- Acupuncture provides a level of antiemetic efficacy similar to that of conventional medications in pediatric patients.
- Acupuncture appears to be the most impactful AS modality for reducing postoperative vomiting compared to acupressure and ETS.
Objective:
Using metaanalysis, we sought to determine acustimulation (AS) effects on postoperative nausea and vomiting (PONV) in children.
Methods:
Metaanalyses were performed on various acupoint AS effects including acupressure, acupuncture, laser acupuncture, and electrical stimulation (ETS) on PONV in children. On-line databases were searched for randomized controlled trials (RCTs) from 1966 through May 2005. In addition, the reference lists of reviewed papers were scanned for additional trials. The identified RCTs were evaluated for methodological quality using the Quality Reporting of Meta-analyses (QUOROM) guidelines, and results were pooled using the fixed-effects model.
Results:
Twelve RCTs were pooled for the outcomes of 24-hour PONV including 12 trials for vomiting and two trials for nausea. Compared with the control groups, all AS modalities reduced vomiting (RR = 0.69, 95% CI: 0.59-0.80, P < .0001) and nausea (RR = 0.59, 95% CI: 0.46-0.76, P < .0001). Acupressure (two trials) and acupuncture (six trials) modalities were effective in reducing vomiting (P < .005); however, ETS (two trials) did not show significant effects in reducing the vomiting (P = .118) in children. Compared with the controls, medications (three trials) reduced vomiting (RR = 0.42, 95% CI: 0.22-0.7, P = .0056). There were no differences between the medication and AS treatments (three trials) in reducing vomiting (RR = 1.25, 95% CI: 0.54-2.93, P = .6025).
Conclusions:
This metaanalysis demonstrated that acupressure and acupuncture are effective treatment modalities to reduce postoperative vomiting in children. Acupuncture treatment is as effective as medications to reduce vomiting in children. Acupuncture had the greatest impact on reducing vomiting when compared with acupressure and ETS in children.