This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia.
Sample Count
90
Age
4月12日
Control
Std
Blank
No treatment(n=30)
Experiment
single dose of Ondansetron(n=30); electrical stimulation(n=30)
Indicator
Postoperative Nausea and Vomiting(PONV)Side effectsSatisfaction scale
Auxiliary Medication
Thirty minutes prior to anesthesia, 0.5 mg kg-1 midazolam was administered in 0.3 mL kg-1 of coke with a view to mild sedation and amnesia. For the induction of anesthesia, 2-5% sevoflurane was given in 100% O2 via mask and intravenous vecuronium 0.1 mg kg-1 was given to facilitate nasotracheal intubation. Anesthesia was maintained with sevoflurane in 66% N20-33% O2 and fentanyl in fractional doses of 1 ug kg-1. Postoperative pain was treated in the postanesthesia care unit (PACU) with intravenous fentanyl 1 ug kg-1 in fractionated doses. 25 mg kg -1 rectal acetaminophen was administered in the DSCU. Ondansetron group: Following intubation, 0.15 mg.kg -1 ondansetron was diluted in 50 mL of physiologic saline and intravenous infusion was completed in 15 minutes.
Stimulation Method
TEAS
Induction Method
Electroacupuncture Instrument Model
Manufacturer
Frequency
Waveform
Strength
Induction Time
Acmodermil Stimulator
SBJ Interna-tional, France
20 Hz
-
10 mA
5 min
Acupuncture_Needle
Needle_Manufacturer
Needle_Depth
-
-
-
Description 20 Hz, 5 minutes
Anesthesia Method
AAA
Clinical Trial Type
random
Adverse Effects
One patient from the TEAS group developed bleeding from the tonsillary lodge in the 30th postoperative minute; he was followed-up and excluded from the study. Two patients from the same group could not be reached by telephone postoperatively and were excluded as well. One patient from the control group developed respiratory distress due to edema, was adminis_x005ftered steroids and steam, and excluded from the study. Four other children were randomly selected to replace these four patients.Two patients in the control group experienced frequent retching and nausea attacks upon discharge from the hospital following the surgery. Due to the frequency of the emetic attacks, these children were rehospitalized overnight. They were treated with intravenous fluids and 0.15 mg kg 1 ondansetron. As they did not develop any further complications, they were discharged the next day.In two children from the TEAS group, erythemas of 0.3 diameters developed on the P6 and CV13 points. These two children were positive for dermographism find_x0002_ings. Erythemas of both children disappeared before leaving the PACU. Two children in the ondansetron group developed flushing of the head and neck following the infusion of ondansetron. Flushing of one child spontaneously regressed within 3 minutes. The other child had to be administered antihistamine. This child was not excluded from the study; however, the postoperative side-effects were evaluated in line with the side-effects of the antihistamine. Also in this group, 4 children had drowsiness and dizziness that continued on the first postoperative day, and 2 children had
stomach ache.
Contraindications
Exclusion criteria were allergy to ondansetron, antiemetic therapy within 10 days of surgery, auricular operation, any symptomatic medical disease or infectious disease within the previous 2 weeks, or local infection near an acupuncture site. Additionally, children who had respiratory distress, edema, or hemorrhage in the postoperative period were excluded
Effector
There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy.
Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy.
Abstract
OBJECTIVES: Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort, distress, and complications. Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV. The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists, such as ondansetron. We aimed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation (TEAS) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting. SUBJECT AND DESIGN: This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia. In the first group, electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed (20 Hz, 5 minutes). The second group received a single dose of Ondansetron (0.15 mg . kg(-1)). No treatment was given to the control group. OUTCOME MEASURES: The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit, on the day of surgery after discharge, and on the first day after surgery. A satisfaction scale was completed by each family. RESULTS: There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). CONCLUSION: Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy."
