The New York Times ran a piece last week on the treatment of postoperative nausea and vomiting. As my Letter to the Editor (published in October 10th’s Science Times) points out, they completely ignored perhaps the most effective therapy for this condition.
Easing Symptoms of Nausea
To the Editor:
Re “Answers Fall Short for Nausea After Surgery”
(Second Opinion, Oct. 3): As an academic integrative pediatrician often
consulted to work with children suffering from postoperative nausea and
vomiting, I read Denise Grady’s piece this morning with great interest.
I was surprised, however, to see no mention of one of the more effective,
evidence-based approaches to this troublesome and common complication.
Acupuncture and acupressure, specifically applied to the P6 (Neiguan)
point, has been demonstrated in both children and adults to be both a
safe and effective treatment for postoperative nausea and vomiting,
often with fewer side effects than conventional medication therapies.
Lawrence D. Rosen
Dr. Sunita Vohra and I presented data supporting this claim, as part of our recent AAP NCE talk on CAM research in children. Published research supports not only the safety of acupuncture and tolerability in children, but also demonstrates its efficacy for postoperative nausea and vomiting. I’ve listed a few relevant references below – it’s a rich and expanding literature. The most recent meta-analysis abstract is posted in its entirety.
Kemper KJ, et al: On pins and needles? Pediatric pain patients’ experience with acupuncture. Pediatrics 105 supplement: 941-947, 2000.
NIH Consensus Development Panel on Acupuncture: Acupuncture consensus conference report. JAMA 280: 1518-1524, 1998.
White A, et al: Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 323:485-486, 2001.
OBJECTIVE: Using metaanalysis, we sought to
determine acustimulation (AS) effects on postoperative nausea and
vomiting (PONV) in children. METHODS: Metaanalyses were performed on
various acupoint AS effects including acupressure, acupuncture, laser
acupuncture, and electrical stimulation (ETS) on PONV in children.
On-line databases were searched for randomized controlled trials (RCTs)
from 1966 through May 2005. In addition, the reference lists of
reviewed papers were scanned for additional trials. The identified RCTs
were evaluated for methodological quality using the Quality Reporting
of Meta-analyses (QUOROM) guidelines, and results were pooled using the
fixed-effects model. RESULTS: Twelve RCTs were pooled for the outcomes
of 24-hour PONV including 12 trials for vomiting and two trials for
nausea. Compared with the control groups, all AS modalities reduced
vomiting (RR = 0.69, 95% CI: 0.59-0.80, P < .0001) and nausea (RR =
0.59, 95% CI: 0.46-0.76, P < .0001). Acupressure (two trials) and
acupuncture (six trials) modalities were effective in reducing vomiting
(P < .005); however, ETS (two trials) did not show significant
effects in reducing the vomiting (P = .118) in children. Compared with
the controls, medications (three trials) reduced vomiting (RR = 0.42,
95% CI: 0.22-0.7, P = .0056). There were no differences between the
medication and AS treatments (three trials) in reducing vomiting (RR =
1.25, 95% CI: 0.54-2.93, P = .6025). CONCLUSIONS: This metaanalysis
demonstrated that acupressure and acupuncture are effective treatment
modalities to reduce postoperative vomiting in children. Acupuncture
treatment is as effective as medications to reduce vomiting in
children. Acupuncture had the greatest impact on reducing vomiting when
compared with acupressure and ETS in children.
PMID: 16846819 [PubMed – in process]