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Published on: November 6, 2019
Acupuncture versus usual care for postoperative nausea and vomiting in children after tonsillectomy/adenoidectomy: a
Ingrid Liodden1, Leiv Sandvik2, Berit Taraldsen Valeberg3
1NAFKAM, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Insights
Standardized acupuncture at PC6 did not reduce nausea and vomiting in children after tonsillectomy. This study controlled for placebo effects, finding no significant benefit of acupuncture over usual care for post-tonsillectomy symptoms.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Complementary and Alternative Medicine
Background:
- Post-tonsillectomy nausea and vomiting are common in children.
- Acupuncture is explored as a potential non-pharmacological intervention.
- Controlling for placebo effects is crucial in evaluating acupuncture efficacy.
Purpose of the Study:
- To assess the effectiveness of standardized acupuncture at the PC6 acupoint in reducing post-tonsillectomy nausea and vomiting in children.
- To preclude placebo effects by informing all participants about potential acupuncture treatment.
Main Methods:
- A pragmatic, multicenter, double-blinded, randomized controlled trial involving 282 children aged 1-11 years.
- Participants received either perioperative bilateral acupuncture at PC6 plus usual care or usual care alone.
- Nausea and vomiting incidence were assessed 24 hours postoperatively.
Main Results:
- No significant difference in the incidence of vomiting (44.2% vs 47.9%) or nausea (31.7% vs 32.6%) was observed between the acupuncture and usual care groups.
- The study had acceptable statistical power for comparing vomiting rates.
Conclusions:
- Standardized PC6 acupuncture, when placebo effects are controlled, does not effectively reduce nausea and vomiting in children post-tonsillectomy.
- Future research should focus on optimizing acupuncture dosage, technique, and child-friendly delivery methods.
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, double-blinded, 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.
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