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P6 Acpupoint Injection A Prophylactic Treatment for PONV in Children


, : P6 Acpupoint Injection A Prophylactic Treatment for PONV in Children. Anesthesiology Abstracts of Scientific Papers Annual Meeting (2001): Abstract No A-1227

Introduction Current literature indicates that P6 acupuncture and related techniques are effective in preventing postoperative nausea and vomiting in adults (1). There are, however, paucity of data and inconsistent results regarding the use of P6 acupuncture as prophylactic treatment of PONV in children. We therefore sought to determine whether P6 acupoint injection decreases the incidence of PONV in children. Methods Following IRB approval, children 8-16 years old, ASA I-II, undergoing general anesthesia and surgery were randomly assigned to the following four groups: Group I- Acupuncture (IV saline+bilateral P6 acupoint), Group II- Droperidol (IV droperidol+sham P6 acupuncture), Group III- Control I (IV saline+sham P6 acupuncture), and Group IV- Control II (IV saline + IM injection at sham point). Anesthesia was induced using O2/N2O/sevoflurane and maintained using O2/Air/ isoflurane, 0.1 mg/kg of vecuronium and 2-4 mug/kg of fentanyl. No regional anesthesia was offered to participants of this study. At the onset of the surgery, subjects received either IV saline (Groups I+III+IV) or IV droperidol (Group II). At the conclusion of surgery, subjects received either P6 acupoint injections (Group I) or sham acupuncture (superficial needle prick) at P6 (Groups II+III), or IM injection at sham point (Group IV). In the PACU episodes PONV were recorded by a blinded observer and the anti-PONV medication (0.1 mg/kg of ondansetron) as rescue medication. Postoperative pain was assessed using the Bieri face scale, and if pain score was greater than 2, subjects were treated with 0.5 mug/kg of IV fentanyl. Twenty-four hours after the procedure (POD1) parents were contacted and asked about the frequency of their child's PONV and severity of pain. Results Sample size was calculated a priori to be 160 subjects. Data involving the first 95 subjects is presented below There are no group difference in demographic variables such as age, gender, weight and surgical procedures. PACU: As can be seen from Table 1, the incidence of vomiting was significantly lower in the acupuncture and droperidol groups (p=0.047). Similarly, the incidence of nausea was lower in the acupuncture group, however, it has not reached statistical significant (p=0.072). POD1: There are no differences in the incidence of nausea and vomiting between the four groups (p=ns). Conclusions These preliminary results indicate that P6 acupuncture is as effective as intravenous droperidol (10 mug/kg) prophylaxis in preventing PONV in children during the immediate postoperative period. Acupuncture may not, however, be effective in preventing the "delay" PONV at 24 hour postoperatively. We are still in the process of further patient recruitment to increase the power of the study.

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