Information de reference pour ce titreAccession Number: | 00000542-200202000-00013.
|
Author: | Rusy, Lynn M. M.D. *; Hoffman, George M. M.D. +; Weisman, Steven J. M.D. ++
|
Institution: | * Associate Professor of Anesthesiology, + Associate Professor of Anesthesiology and Pediatrics, ++ Professor of Anesthesiology and Pediatrics, Department of Anesthesiology. Received from the Department of Pediatric Anesthesiology, Medical College of Wisconsin-Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
|
Title: | |
Source: | Anesthesiology. 96(2):300-305, February 2002.
|
Abstract: | Background: Electrical stimulation of acupuncture point P6 reduces the incidence of postoperative nausea or vomiting (PONV) in adult patients. However, acupressure, laser stimulation of P6, and acupuncture during anesthesia have not been effective for reducing PONV in the pediatric population. The authors studied the effect of electrical P6 acupuncture in awake pediatric patients who had undergone surgery associated with a high incidence of PONV.
Methods: Patients aged 4-18 yr undergoing tonsillectomy with or without adenoidectomy were randomly assigned to acupuncture, sham acupuncture, or control groups. Acupuncture needles at P6 and a neutral point were placed while patients were anesthetized, and low-frequency electrical stimulation was applied to these points for 20 min in the recovery room while the patients were awake (P6 Acu group). This treatment was compared with sham needles along the arm at acupuncture points not associated with antiemesis (sham group) and a no-needle control group. The arms were wrapped to prevent identification of treatment group, and anesthetic, analgesic, and surgical technique were standardized. Assessed outcomes were occurrence of nausea, occurrence and number of episodes of vomiting, time to vomiting, and use of antiemetic rescue medication.
Results: One hundred twenty patients were enrolled in the study, 40 per group. There were no differences in age, weight, sex, or opioid administration between groups. The PONV incidence was significantly lower with P6 acupuncture (25 of 40 or 63%; odds ratio, 0.135; number needed to treat, 3.3;P < 0.001) compared with controls (37 of 40 or 93%). Sham puncture had no effect on PONV (35 of 40 or 88%;P = not significant). Occurrence of nausea was significantly less in P6 Acu (24 of 40 or 60%; odds ratio, 0.121;P < 0.01), but not in the sham group (34 of 40 or 85%) compared with the control group (37 of 40 or 93%). Vomiting occurred in 25 of 40 or 63% in P6 Acu; 35 of 40 or 88% in the sham group, and 31 in 40 or 78% in the control group (P = not significant). Patients receiving sham puncture vomited significantly earlier (P < 0.02) and needed more rescue treatment (33 of 40 or 83%; odds ratio, 3.48;P < 0.02) compared with P6 Acu (23 of 40 or 58%) and the control group (24 of 40 or 60%).
Conclusions: Perioperative P6 electroacupuncture in awake patients significantly reduced the occurrence of nausea compared with the sham and control groups, but it did not significantly reduce the incidence or number of episodes of emesis or the use of rescue antiemetics. Sham acupuncture may exacerbate the severity but not the incidence of emesis. The efficacy of P6 acupuncture for PONV prevention is similar to commonly used pharmacotherapies. Its appropriate role in prevention and treatment of PONV requires further study.
(C) 2002 American Society of Anesthesiologists, Inc.
|
References: | 1. Furst SR, Rodarte A: Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy. A nesthesiology 1994; 81: 799-803
2. Watcha MF, White PF: Postoperative nausea and vomiting. A nesthesiology 1992; 77: 162-84
3. Facco E, Manani G, Angel MD: Comparison study between acupuncture and pentazocine analgesic and respiratory post-operative effects. Am J Chinese Med 1981; 9: 225-35
4. Schlager A, Offer T, Baldissera I: Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anaesth 1998; 81: 529-32
5. Shenkman Z, Holzman RS, Kim C, Ferrari LR, DiCanzio J, Highfield ES, VanKeuren K, Kaptchuk T, Kenna MA, Berde CB, Rockoff MA: Acupressure-acupuncture antiemetic prophylaxis in children undergoing tonsillectomy. A nesthesiology 1999; 90: 1311-6
6. Acupuncture-NIH Consensus Conference: JAMA 1998; 280: 1518-24
7. Helms JM: Acupuncture Energetics. Berkeley, Medical Acupuncture Publishers, 1995, pp 400-4
8. Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KTJ, Lynas AGA: Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Br J Anaesth 1989; 63: 612-8
9. Tsen LC, Segal S, Pothier M, Bader AM: Alternative medicine use in presurgical patients. A nesthesiology 2000; 93: 148-51
10. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Rompay MV, Kessler RC: Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998; 280: 1569-75
11. Paramore LC: Use of alternative therapies: Estimates from the Robert Wood Johnson Foundation national access to care survey, US Cancer Pain Relief Committee. J Pain Symptom Manage 1997; 13: 83-9
12. Christensen PA, Noreng M, Andersen PE, Nielsen, JW: Electroacupuncture and postoperative pain. Br J Anaesth 1989; 62: 258-62
13. Lewis LH, Pryn SJ, Reynolds PI, Pandit UA, Wilton NCT: Effect of P6 acupressure on postoperative vomiting in children undergoing outpatient strabismus correction. Br J Anaesth 1991; 67: 73-8
14. Yentis SM, Bissonnette B: P6 acupuncture and postoperative vomiting after tonsillectomy in children. Br J Anaesth 1991; 67: 119-80
15. Yentis SM, Bissonnette B: Ineffectiveness of acupuncture and droperidol in preventing vomiting following strabismus repair in children. Can J Anaesth 1992; 38: 151-4
16. Dundee JW, Ghaly RG, Fitzpatrick KTJ, Abram WP, Lynch GA: Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 1989; 82: 268-71
17. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekelle PG: Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA 2000; 284: 2755-61
18. Araujo MS: Does the choice of placebo determine the results of clinical studies on acupuncture? Forsch Komplementarmed 1998; 5: 8-11
19. Barsoum G, Perry EP, Fraser IA: Postoperative nausea is relieved by acupressure. J Royal Soc Med 1990; 83: 86-9
20. Zarate E, Mingus M, White P, Chiu JW, Scuderi P, Loskota W, Daneshgari V: The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 2001; 92: 629-35
21. Rose JB, Brenn BR, Corddry DH, Thomas PC: Preoperative oral ondansetron for pediatric tonsillectomy. Anesth Analg 1996; 82: 558-62
22. Roila F: Dexamethasone alone or in combination with ondansetron for the prevention of delayed nausea and vomiting induced by chemotherapy. N Engl J Med 2000; 342: 1554-9
23. Henzi I, Walder B, Tramer MR: Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000; 90: 186-94
24. Aouad MT, Sahar SS, Siddik SS, Rizk LB, Zaytoun GM, Baraka AS: The effect of dexamethasone on postoperative vomiting after tonsillectomy. Anesth Analg 2001; 92: 636-40
25. White PF, Watcha MF: Postoperative nausea and vomiting: prophylaxis versus treatment. Anesth Analg 1999; 89: 1337-9
26. Sadhasivam S, Shende D, Madan R: Prophyalctic ondansetron in prevention of postoperative nausea and vomiting following pediatric strabismus surgery. A nesthesiology 2000; 92: 1035-42
27. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N: A simplified risk score for predicting postoperative nausea and vomiting. A nesthesiology 1999; 91: 693-700
28. Welters ID, Meneges T, Graf M, Beikirch C, Menzenbach A, Hempelmann G: Reduction of PONV by dimenhydrinate suppositories after strabismus surgery in children. Anesth Analg 2000; 90: 311-4
29. Rose JB, Martin TM, Corddry DH, Zagnoev M, Kettrick RG: Ondansetron reduces the incidence and severity of postrabismus repair vomiting in children. Anesth Analg 1994; 79: 486-9
30. Bowhay AR, May HA, Rudnicka AR, Booker PD: A randomized controlled trial of the antiemetic effect of three doses of ondansetron after strabismus surgery in children. Paediatr Anaesth 2001; 11: 215-21
31. Henzi I, Sonderegger J, Tramer MR: Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anaesth 2000; 47: 537-51
|
Language: | English.
|
Document Type: | CLINICAL INVESTIGATIONS.
|
Journal Subset: | Clinical Medicine.
|
ISSN: | 0003-3022
|
NLM Journal Code: | 4sg, 1300217
|
Annotation(s) | |
|
|