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Weber B, Knoth S, Kranke P, Eberhart L. Study protocol for a randomised, patient- and observer-blinded evaluation of P6 acustimulation for the prevention of nausea and vomiting in the postoperative period in patients receiving routine pharmacological prophylaxis (P6NV-Trial). Trials 2022; 23:497. [PMID: 35710447 PMCID: PMC9205120 DOI: 10.1186/s13063-022-06369-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of pericardium 6 (P6) acupoint stimulation to reduce the incidence of postoperative nausea and vomiting (PONV) has been proven in several randomised controlled clinical trials. However, little is known about the effectiveness in daily practice and its use in combination with traditional pharmacologic approaches. METHODS The primary objective of the P6NV study is to determine whether intraoperative acustimulation (acupuncture or acupressure) at the point P6 provides additional benefit when applied along with customary prophylactic intravenous antiemetics administered according to the local standard operating procedures (SOP). The primary endpoint is the incidence and severity of PONV within the first 24 h postoperatively reported with a validated postoperative nausea and vomiting intensity scale. The patient-reported outcome of perioperative quality of life (using the PPP33-questionnaire) and the detection of antiemetic-related side effects as well as the severity of PONV (via a standardised questionnaire) are secondary study objectives. P6NV is a national, multicentre, randomised, prospective, patient- and examiner-blinded interventional study and will be performed on 3500 adult patients with ASA classification I-III undergoing elective surgery under general anaesthesia and hospitalised for at least 24 h. Participating anaesthesiologists commit themselves to administer customised conventional antiemetic prophylaxis according to the local SOP by signing a statement before randomisation. The intervention group receives bilateral acupuncture or acupressure at P6. The control group receives no intervention. Before extubation, acustimulation is removed. DISCUSSION Since P6 acustimulation is performed by a wide range of anaesthesiologists receiving written and verbal information on acustimulation beforehand, this trial will provide information on the effectiveness of an ad hoc implementation of P6 stimulation techniques in anaesthesia departments using traditional pharmacologic PONV prophylaxis. TRIAL REGISTRATION DRKS DRKS00015272 . Registered on August 15, 2018.
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Affiliation(s)
- Benedict Weber
- Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg, Marburg, Germany
| | - Selena Knoth
- Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg, Marburg, Germany.,Department of Anaesthesiology and Intensive Medicine, Asklepios Stadtklinik, Bad Wildungen, Germany
| | - Peter Kranke
- Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Würzburg, Germany
| | - Leopold Eberhart
- Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg, Marburg, Germany.
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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Zhang Y, Zhang C, Yan M, Wang N, Liu J, Wu A. The effectiveness of PC6 acupuncture in the prevention of postoperative nausea and vomiting in children: A systematic review and meta-analysis. Paediatr Anaesth 2020; 30:552-563. [PMID: 32198961 DOI: 10.1111/pan.13860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A growing number of studies have demonstrated the effectiveness of acupuncture in preventing and treating postoperative nausea and vomiting. Here, we used meta-analysis to confirm these benefits in children and to determine the optimal time to perform this treatment. METHODS Four databases (MEDLINE, EMBASE, CENTRAL, and Chinese Database of Biology and Medicine) were searched from inception until January 16, 2019. We included randomized controlled trials for evaluating the effectiveness of acupuncture in the prevention and treatment of postoperative nausea and vomiting during the early stage (0-4 hours) and within 24 hours postoperatively in pediatrics. Control groups received standardized care control or standardized care combined with sham control. RESULTS Sixteen literatures and 1773 patients undergoing general anesthesia were included in the study. The results indicated that acupuncture was effective in reducing postoperative vomiting, both during the first 4 hours (RR = 0.47, 95% CI 0.26, 0.84; low quality) and within 24 hours postoperatively (RR = 0.74, 95% CI 0.60, 0.91; low quality). Stratifying by the timing of acupuncture, acupuncture was effective in reducing the first 4 hours (RR = 0.34, 95% CI 0.18, 0.64; moderate quality), and 0-24 hours postoperative vomiting (RR = 0.81, 95% CI 0.70, 0.93; moderate quality) when performed before and during anesthesia, respectively. Further, the RR value was more robust when acupuncture was performed before anesthesia. Acupuncture was also effective in treating 0-24 hours postoperative nausea (RR = 0.73, 95% CI 0.60, 0.88; moderate quality) and in reducing the utilization of remedies during the first 4 hours (RR = 0.64, 95% CI 0.45, 0.89; moderate quality). CONCLUSION Acupuncture reduces the incidence of postoperative nausea and vomiting as well as the utilization of antiemetic remedies, particularly during the first 4 hours following the operation. Acupuncture performed before anesthesia was demonstrated to be the most ideal intervention time for children.
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Affiliation(s)
- Yi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chang Zhang
- Department of Traditional Chinese Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Meihua Yan
- Institute of Medical Science, China-Japan Friendship Hospital, Beijing, China
| | - Ningyu Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Martin CS, Deverman SE, Norvell DC, Cusick JC, Kendrick A, Koh J. Randomized trial of acupuncture with antiemetics for reducing postoperative nausea in children. Acta Anaesthesiol Scand 2019; 63:292-297. [PMID: 30397904 DOI: 10.1111/aas.13288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/07/2018] [Accepted: 10/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is common after tonsillectomy in children. There is evidence that perioperative acupuncture at the pericardium 6 (P6) point is effective for preventing PONV in adults. Our goal was to determine if intraoperative acupuncture at the P6 point, in addition to usual antiemetics, is more effective than antiemetics alone in preventing PONV in children. METHODS In a randomized double-blind trial, 161 children age 3 through 9 years undergoing tonsillectomy with or without adenoidectomy were randomized to either bilateral acupuncture at P6 plus antiemetics (n = 86) or antiemetics only (n = 75). All participants received ondansetron 0.15 mg/kg and dexamethasone 0.25 mg/kg, up to 10 mg. The presence of nausea, retching, emesis and administration of additional antiemetics were recorded during phases I and II of PACU recovery. Follow-up calls occurred on postoperative day 1 (POD 1). RESULT During phase I and II recovery, the incidence of PONV was significantly less with acupuncture than without (7.0% vs 34.7%, RR: 0.2, 95% CI: 0.09-0.46; P < 0.001). The difference in PONV was driven by less nausea in the acupuncture group (5.0% vs 24.0%), with no difference in vomiting between the two groups. In the first 24 hours, PONV occurred in 36.1% with acupuncture and 49.3% without; these values did not differ significantly (P = 0.09). CONCLUSIONS Children receiving acupuncture plus antiemetic therapy had less risk of developing nausea during phase I and II recovery, but there was no difference in PONV on POD 1. Acupuncture may reduce nausea in the PACU, even when combined with antiemetics.
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Affiliation(s)
- Christine S. Martin
- Department of Anesthesia and Perioperative Medicine, Division of Pediatric Anesthesia; Oregon Health & Science University; Portland Oregon
| | - Sarah E. Deverman
- Department of Anesthesia and Perioperative Medicine, Division of Pediatric Anesthesia; Oregon Health & Science University; Portland Oregon
| | | | - Jordan C. Cusick
- Department of Anesthesia and Perioperative Medicine, Division of Pediatric Anesthesia; Oregon Health & Science University; Portland Oregon
| | - Angela Kendrick
- Department of Anesthesia and Perioperative Medicine, Division of Pediatric Anesthesia; Oregon Health & Science University; Portland Oregon
| | - Jeffrey Koh
- Department of Anesthesia and Perioperative Medicine, Division of Pediatric Anesthesia; Oregon Health & Science University; Portland Oregon
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Role of Complementary and Alternative Medicine in Otolaryngologic Perioperative Care. Ochsner J 2018; 18:253-259. [PMID: 30275790 DOI: 10.31486/toj.18.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background During the perioperative period for otolaryngologic surgical cases, complications and delays can occur as the result of anxiety, pain, nausea, and vomiting. Conventional methods used to treat these symptoms include medications that can be expensive and invasive or that can cause adverse effects. Because of the concerns about opioid use in the United States, providers might want to consider using complementary and alternative medicine (CAM) as adjunctive or primary treatment plans. Methods To assess the current knowledge about the clinical effectiveness of CAM for patients undergoing otolaryngologic procedures, we searched the literature using MEDLINE, PubMed, and Google Scholar. We excluded studies published prior to 1990 and articles about surgeries that were unrelated to otolaryngology. Results An analysis of the selected studies revealed that CAM therapies-acupuncture, aromatherapy, hypnosis, and music therapy-have been shown to be effective at reducing preoperative anxiety, postoperative pain, and postoperative nausea and vomiting. No adverse side effects were associated with CAM use in these studies. Conclusion The use of CAM in patients undergoing otolaryngologic surgeries may relieve common perioperative symptoms. While further study is warranted, otolaryngology providers might consider implementing CAM with patients electing surgery.
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Moeen SM. Could acupuncture be an adequate alternative to dexamethasone in pediatric tonsillectomy? Paediatr Anaesth 2017; 27:219. [PMID: 28101979 DOI: 10.1111/pan.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moeen SM. Reply to Xin, Juan; Zhang, Yabing; Zhou, Xiaoshuang; Liu, Bin, regarding their comment 'Acupuncture may be an effective supplement treatment for dexamethasone in pediatric tonsillectomy'. Paediatr Anaesth 2017; 27:212. [PMID: 28101980 DOI: 10.1111/pan.13043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Seham M Moeen
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Asyut, Egypt
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Moeen SM. Response to comment "Cox: alternative therapies and postoperative vomiting". Paediatr Anaesth 2016; 26:1213. [PMID: 27870273 DOI: 10.1111/pan.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Seham M Moeen
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Asyut, Egypt
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Ideno S, Seki H, Wakamiya R, Minoshima R, Morisaki H. Comment on: S. M. Moeen 'Could acupuncture be an adequate alternative to dexamethasone in pediatric tonsillectomy?'. Paediatr Anaesth 2016; 26:1212. [PMID: 27870275 DOI: 10.1111/pan.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Satoshi Ideno
- Department of Anesthesiology, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Seki
- Department of Anesthesiology, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Rie Wakamiya
- Department of Anesthesiology, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Rie Minoshima
- Department of Anesthesiology, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
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Xin J, Zhang Y, Zhou X, Liu B. Acupuncture may be an effective supplement treatment for dexamethasone in pediatric tonsillectomy. Paediatr Anaesth 2016; 26:1213-1214. [PMID: 27870278 DOI: 10.1111/pan.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Juan Xin
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoshuang Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Affiliation(s)
- Robin G Cox
- Department of Anesthesia, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
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