Description point LI4 (hegu) to ST36 (zusanli), P6 (neiguan) to SJ5 (waiguan), and at KI6 (zhaohai); Acupuncture needles were also placed at HT7 (shenmen)
Experimental Description
Participants were block-randomized to receive acupuncture or sham acupuncture during anesthesia for tonsillectomy.
Fifty-nine children aged 3 to 12 years were randomized to receive acupuncture (n = 30) or sham acupuncture (n = 29).
Sample Count
59
Age
3月12日
Control
Sham
sham acupuncture(n=29)
Experiment
acupuncture(n=30)
Indicator
Vital signsPain scoresPostoperative Nausea and Vomiting(PONV)Time spent in the PACUOpioids administered in the perioperative periodTotal pain medication consumption
Auxiliary Medication
The perioperative protocol included a standard oral pre-medication of 0.5 mg/kg of midazolam. Anesthesia was induced by inhalation induction with sevofluorane and nitrous oxide. The patients were orotracheally intubated after intravenous administration of 2 to 4 mg/kg of propofol, 3 mcg/kg of hydro- morphone, and 0.5 mg/kg of dexamethasone. Additional hydro-morphone was administered as needed and titrated to a respiratory rate of >20 in the operating room. In the PACU, opioids were administered per protocol: fentanyl 0.5 mcg/kg for mild pain; hydromorphone 1 mcg/kg for moderate or severe pain. To convert fentanyl units to hydromorphone units, micrograms of fentanyl were multiplied by a conversion factor of 5 to yield micrograms of hydromorphone. Postoperatively, the patients were discharged home on a protocol of alternating acet- aminophen and ibuprofen. No postoperative opioids were pre- scribed for use at home.
Stimulation Method
EA
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
-
Pantheon stimulator
4/100 Hz
alternating wave
-
All needles were removed at the conclusion of surgery.
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
0.3×50 mm
Streitberger
0.5-1 cm
Description Acupuncture was performed by one of two American Academy of Medical Acupuncture board-certified acupuncturists (j.s. or b.g.). Streitberger needles, blunt control needles that collapse into the handle of the acupuncture needle and do not penetrate the skin (Fig. 1), were used for patients who were randomized to sham acupuncture. All of the needles were placed through specially designed needle holders to allow for blinding of the surgeons and other staff. Seirin junior acupuncture tacks (or control stickers without tacks) were placed in four ear acupuncture points after the body points were needled. All needles were removed at the conclusion of surgery.
Electroacupuncture at alternating frequencies of 4 and 100 Hertz using a Pantheon stimulator from point LI4 (hegu) to ST36 (zusanli), P6 (neiguan) to SJ5 (waiguan), and at KI6 (zhaohai) (Fig. 2). These points were chosen for their analgesic properties (ST36), relationship to analgesia at throat and head and neck (LI4, KI6), and antiemetic properties (P6). Alternating frequencies were chosen to optimize the release of endogenous endorphins, enkephalins, and dynorphins. Acupuncture needles were also placed at HT7 (shenmen) at the wrist crease on the ulnar side of the flexor carpi ulnaris tendon bilaterally without stimulation to decrease postoperative agitation. The needles were placed to a depth at which a fascial grab (deqi) was per- ceived by the practitioners, at approximately 0.5 to 1 cm. Seirin junior tacks were placed at auricular points HT7, master cerebral, cingulate gyrus, and tonsil for the duration of the surgery.
Fifty-nine children aged 3 to 12 years were randomized to receive acupuncture (n = 30) or sham acupuncture (n = 29). No significant demographic differences were noted between the two cohorts. Perioperative data were recorded for all patients; 73% of patients later returned home surveys. There were no significant differences in the amount of opioid med- ications administered or total postanesthesia care unit time between the two cohorts. Home surveys of patients but not of parents revealed significant improvements in pain control in the acupuncture treatment-group postoperatively (P=0.0065 and 0.051, respectively), and oral intake improved significantly earlier in the acupuncture treatment group (P=0.01). No adverse effects of acupuncture were reported. This study demonstrates that intraoperative acupuncture is feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively.
"Intraoperative acupuncture for posttonsillectomy pain: a randomized, double-blind, placebo-controlled trial."
Abstract
OBJECTIVES/HYPOTHESIS: To evaluate the effect of intraoperative acupuncture on posttonsillectomy pain in the pediatric population. STUDY DESIGN: Prospective, double-blind, randomized, placebo-controlled trial. METHODS: Patients aged 3 to 12 years undergoing tonsillectomy were recruited at a tertiary children's hospital between February 2011 and May 2012. Participants were block-randomized to receive acupuncture or sham acupuncture during anesthesia for tonsillectomy. Surgeons, staff, and parents were blinded from treatment. Tonsillectomy was performed by one of two surgeons using a standard technique (monopolar cautery), and a single anesthetic protocol was followed. Study endpoints included time spent in the postanesthesia care unit, the amount of opioids administered in the perioperative period, and pain measures and presence of nausea/vomiting from postoperative home surveys. RESULTS: Fifty-nine children aged 3 to 12 years were randomized to receive acupuncture (n = 30) or sham acupuncture (n = 29). No significant demographic differences were noted between the two cohorts. Perioperative data were recorded for all patients; 73% of patients later returned home surveys. There were no significant differences in the amount of opioid medications administered or total postanesthesia care unit time between the two cohorts. Home surveys of patients but not of parents revealed significant improvements in pain control in the acupuncture treatment-group postoperatively (P = 0.0065 and 0.051, respectively), and oral intake improved significantly earlier in the acupuncture treatment group (P = 0.01). No adverse effects of acupuncture were reported. CONCLUSIONS: This study demonstrates that intraoperative acupuncture is feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively. LEVEL OF EVIDENCE: 1b."
