Objective To investigate the effectiveness of acupuncture and acupressure as supplements to standard treatment for postoperative vomiting in children undergoing tonsillectomy and/or adenoidectomy. Methods A pragmatic, open, block-randomised controlled trial. The results were analysed according to the intention-to-treat principle. The study was conducted without extra resources in a normal setting at the day-surgery department of Lovisenberg Diakonale Hospital in Oslo. 154 children with an American Society of Anesthesiologists grade 1-2, weighing at least 10 kg, were included. Children with concomitant gastrointestinal diseases, emesis or antiemetic treatment <24 h preoperatively, rash or local infection over the actual acupuncture points were excluded together with patients whose parents' informed consent could not be obtained. The intervention group received acupuncture at pericardium 6 bilaterally, at a depth of approximately 0.7 cm with a median of 21 min during anaesthesia, followed by acupressure wristbands for 24 h and standard treatment. The control group received standard treatment. The primary end point was the occurrence of vomiting or retching during 24 h postoperatively. Results Children in the acustimulation group experienced less retching and vomiting than the control group-46.8% versus 66.2% (p=0.015). The effect of acustimulation was specifi cally pronounced in girls and children aged 1-3 years. Conclusion This trial indicates the effectiveness of acustimulation as an adjunct to standard treatment. The results should encourage and promote the implementation of acustimulation for postoperative vomiting in children undergoing adenoidectomy or tonsillectomy.

Objectives To investigate the effect of a standardised acupuncture on nausea and vomiting in children after tonsillectomy with or without adenoidectomy when possible placebo effects were precluded. Methods A pragmatic, multicentre, doubleblinded, randomised controlled trial. The study was conducted over 10 months in 2012-2013 at three ambulatory clinics. Two hundred and eighty-two children, age 1-11 years, American Society of Anesthesiologists grade ≤II, were included. To equalise expectancy effects, all parents were told that their child would receive acupuncture. However, children were randomly allocated to perioperative bilateral needling acupuncture at PC6, depth 7 mm, mean time 17 min (SD 5-45) during anaesthesia plus usual care, or to usual care only. The regional ethics committee approved this approach. Primary endpoints were nausea and vomiting 24 h postoperatively. Results This study did not demonstrate any effect of acupuncture (95% CI) compared with standard care. The overall vomiting in the acupuncture and usual-care groups was 44.2% and 47.9%, respectively. Nausea was experienced by 31.7% in the acupuncture group and by 32.6% in the usual-care group. The test power was acceptable for comparisons of vomiting. Conclusions The findings suggest that when controlling for possible placebo effects standardised PC6 acupuncture needling during anaesthesia without further stimulation of PC6 is not effective in reducing nausea and vomiting in children after tonsillectomy with or without adenoidectomy. Future studies should investigate acupuncture treatment which balances adequate dose and technique and a feasible, child-friendly acupuncture treatment. Trial registration number ClinicalTrials.gov NCT01729052.

BackgroundComplementary therapists spend considerable time with their patients, especially in the first consultation. The communication between patients and their therapists is important for raising consciousness and activation of the patient’s self-healing power. Thus, the aims in this study were to delineate what complementary therapists regard as essential in patient consultations, their view of the healing process, and how the therapists understand the placebo effect and its position in the healing process.MethodsSemi-structured individual interviews (n = 4), focus group interview (n = 1) and participant observation were conducted among four different complementary therapists in a Norwegian community. The text data was transcribed verbatim and the analysis of the material was conducted according to conventional and direct content analysis. Some codes were predefined and others were defined during the analysis.ResultsThe pilot study showed that the implemented methods seems feasible and fit well with the aims of this study. Complementary therapists (chiropractor, naprapath (musculoskeletal therapist), acupuncturist and acupuncturist/homeopath) representing four different complementary modalities participated. A combination of the conversation and examination during the first consultation formed the basis for the therapist’s choice of treatment. A successful consultation was characterized by a fruitful relationship between the therapist and the patient. Moreover, the therapist needs to be humble and show the patient respect. Patients’ positive beliefs and expectations about the treatment play a significant role in the healing process. The more hope the therapist can bring about, the more easily the patient can start believing that it is possible to get well.ConclusionThis was a pilot study. Therefore the findings should be appreciated as limited and preliminary. Therapists’ and patients’ mutual understanding and treatment goals were essential for a successful consultation. The therapists emphasized their professional skills and therapeutic competence as important when building fruitful relationships with their patients. Exerting authority and making the patient feel confident were essential factors for a successful healing process. The complementary therapists understood the placebo effect as the patient’s self-healing power, resulting from establishing trust and belief in the treatment process.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-017-1770-8) contains supplementary material, which is available to authorized users.

Objective To test the feasibility of research on acupuncture and acupressure for children undergoing tonsillectomy and/or adenoidectomy. Methods During January and February 2008, 20 patients from the ordinary waiting list at Lovisenberg Diakonale Hospital in Oslo were randomised to either acupuncture while under anaesthesia or standard care as control. The authors gave acupuncture at Pericardium 6 (P6) at a depth of approximately 0.7 cm on both forearms. The needles were removed when the patient was transferred to the recovery unit and replaced with acupressure wristbands. The outcome measure in the pilot study was to explore if acupuncture and acupressure could be implemented without extending the anaesthesia time and surgical time. This pilot study also tested the feasibility of the research protocol for future investigation in the fi eld, with postoperative nausea, vomiting and retching as the primary end points for effect. Results The study showed no delay in the surgical procedure and no additional anaesthesia time attributable to the introduction of acupuncture. The protocol was found to be feasible with regard to performance of the main study. Vomiting occurred in fi ve patients in the treatment group and 10 patients in the control group. The total numbers of vomiting events were 13 in the treatment group and 19 in the control group. ConclusionThe results encouraged performance of the main study according to the research protocol. INTRODUCTIONPostoperative nausea and vomiting (PONV) can cause distress and discomfort 1 and patients report PONV as the least desirable side effect of surgical treatment.2 Risk factors for PONV have been identifi ed, and drug treatment is only partially effective in prevention.3 PONV is of especial concern for children undergoing tonsilloadenoidectomy. 4 The effi cacy of acupuncture as an antiemetic might be regarded as evidence based.5 However, contradictory studies have been published.6 Acupressure following acupuncture seems to prolong the antiemetic effect.7 While some authors have suggested that acupuncture/acupressure administered after the induction of anaesthesia has little or no effect, 6 others have demonstrated to the contrary. 8 Finally, acupuncture and acupressure are inexpensive and the adverse effects are considered minimal. 9Acupuncture has been integrated into standard hospital procedures, has been used in Norwegian pain clinics for decades, 10 and is implemented as standard care in some hospitals for nausea in chemotherapy. 11Bearing in mind that we consider the risk of adverse effects in acupuncture to be minimal, 12 and the fact that standard conventional care is insufficient, there is a need for research into the role of acupuncture in optimised surgical care.In the planning process of a full-scale pragmatic effectiveness study of acupuncture for postoperative nausea, we considered piloting the research procedure to be of great importance.The aim of this pilot study was therefore to focus on the feasibility of the protocol of acupuncture and acupres...

Pharmacological drug treatment may be only partially effective and produce an adverse event. Research suggests that acustimulation may alleviate postoperative morbidities, although the body of evidence of the effect is equivocal. The treatments are easy to perform, and adverse events and costs are minimal. It may be profitable to implement this beneficial treatment to asmbulatory patients.