Acupuncture for the prevention and treatment of pediatric perioperative conditions

Background: Many pediatric anesthesiologists are interested in multimodal approaches, such as acupuncture, to help manage clinical conditions commonly encountered in the perioperative setting. Methods: A review of the web-based search engine PubMed was conducted to identify research articles that covered the use of acupuncture to prevent or treat perioperative conditions in pediatric patients. Once an article was identified, the reference list of that article was also reviewed to identify additional studies. Results: Sixteen articles were included that investigated the use of acupuncture to prevent or treat four commonly encountered perioperative conditions in children: postoperative nausea and vomiting (PONV), emergence delirium or agitation, acute postoperative pain, and laryngospasm. Articles were excluded if they were not available in English or the specific acupuncture points used were not identified in the article. Acupuncture and acupressure at the Pericardium 6 point were the techniques most often used in studies on the prevention of PONV. However, there was variability in the duration and type of acupuncture or acupressure utilized. Two studies on emergence agitation were included and both reported a decrease in the incidence of agitation, compared to control groups. There is limited data on acute postoperative pain, and includes studies on pain after tonsillectomy and spinal fusion. There are mixed results from two studies on postoperative stridor and laryngospasm. Although many of the studies reviewed demonstrate the benefit of acupuncture in the perioperative setting, they were often conducted using techniques that could not easily be used in a busy anesthetic practice because of limited time and availability of specialized skills. Thus, the challenge for most clinicians is how to incorporate acupuncture into the daily practice of pediatric anesthesia. Conclusions: There is some evidence to support the use of acupuncture to prevent common perioperative conditions in children. More research is needed to determine the best acupuncture techniques to use for these conditions.