P6 Acupressure Band for Prevention of Postoperative Nausea and Vomiting in Children
Condition: Postoperative Nausea and Vomiting; Postoperative Nausea and Vomiting \(PONV\)Acuppressure
MeSH terms: Nausea; Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      Nausea and vomiting after surgery are one of the most common side effects of general
      anaesthesia. Pressure at P6 acupuncture point around wrist area using acupressure band has
      been proven to reduce nausea and vomiting in adult. We would like to see if this acupressure
      band can reduce nausea and vomiting in children after surgery.

      Prior to operation, we will apply an elastic band at the P6 acupoint on your child's both
      hands. Your child will undergo anaesthesia as per usual and surgery as planned, with the
      elastic band onboard. Upon completion of surgery, your child will be required to wear the
      band and should not be removed. Your child will be monitored for up to 24 hours for episodes
      of nausea and vomiting. If so, rescue antivomit medication will be given. After 24 hours, we
      will record your level of satisfaction with the regimen provided
    

Detailed description: 
      Postoperative nausea and vomiting (PONV) are the second most prevalent complaint among
      paediatric patients and is one of the most complex and serious concerns in anaesthetic
      practice. In addition to causing the patient misery and discomfort, nausea and vomiting can
      decrease parental satisfaction, increase the risk of pain and bleeding, increase resource
      utilisation, and lengthen the stay in the postoperative ward and hospital. In all paediatric
      populations, the incidence ranges from 13 to 42%, making it twice as prevalent as in
      adults[1].

      The Eberhart categorization system for risk assessment of postoperative vomiting in
      paediatric patients encompasses several factors, namely age beyond 3 years, surgical length
      exceeding 30 minutes, undergoing strabismus surgery, and having a personal or family history
      of postoperative nausea and vomiting (PONV). The occurrence rates of postoperative nausea and
      vomiting (PONV) are reported as 10%, 20%, 50%, and 70% when one, two, three, or four risk
      factors are present, respectively [2]. A range of pharmacological and non-pharmacological
      approaches have been documented for the prevention and treatment of postoperative nausea and
      vomiting (PONV). Among the several non-pharmacological methods, acupoint stimulation appears
      to be the most promising approach[1].

      The stimulation of acupoints can be classified as invasive and non-invasive techniques.
      Acupressure, a form of non-invasive acupoint stimulation, has been performed by the Chinese
      for over 2500 years[3]. It uses magnets, pellets, electrical stimulation, or micro beads to
      trigger the central nervous system, either locally or from a distance3. It is based on the
      idea that life energy moves through "meridians" in the body. When physical pressure is put on
      these meridians, it is meant to clear any blockages. Instead of using needles, acupressure
      includes putting pressure (usually with fingertips) on certain points on the body[3]. A
      Cochrane review and meta-analysis of the different ways to stimulate acupoints at the
      traditional Chinese Pericardium 6 (P6) point to avoid PONV shows that it works better than a
      placebo in adults[4, 5].

      Research conducted on paediatric patients undergoing adenoidectomy or tonsillectomy has
      examined the efficacy of different acu-stimulation techniques, such as electroacupuncture and
      a combination of needle acupuncture and acupressure band, in comparison to standard care
      involving the use of dexamethasone. The findings of these studies indicate a statistically
      significant decrease in the occurrence of retching or vomiting among children who received
      acu-stimulation methods, as opposed to those who received standard care.[6, 7] In a
      systematic review conducted on a sample of 844 children, different approaches to
      administering acupoint stimulation at P6 were evaluated. The findings of this study revealed
      a statistically significant decrease in vomiting when compared to the control groups, which
      included Sham, placebo control, and conventional treatment.[8] This study postulates that the
      use of acupressure at the P6 acupoint in children, utilising an acupressure band, may provide
      an additional reduction in the occurrence of postoperative nausea and vomiting when combined
      with normal care. The objective of this study was to evaluate the efficacy of acupressure
      bands targeting the P6 acupoint in mitigating post-operative nausea and vomiting (PONV) among
      paediatric patients and to compare the postoperative need for metoclopramide between the
      group of patients using P6 acupressure bands and the group using a placebo.
    

Intervention name(s): Accupressure band
Intervention type(s): Device
Intervention description(s): The accupressure band and wirst band will be place 20 minutes prior to induction of anaesthesia. The induction and maintenance of anaesthesia performed at the discretion of the supervising anaesthesiologist. The maintenance of anaesthesia was achieved by administering sevoflurane at a minimum alveolar concentration (MAC) range of 1 to 1.2. A fresh gas flow rate of 2 L/min comprising a 50:50 concentration mixture of oxygen and air were employed. The patients will be ventilated and maintain end-tidal carbon dioxide (ETCO2) levels within the range of 35-40mmHg. All patients were administered intravenous dexamethasone at a dosage of 0.1mg/kg as a conventional prophylaxis for postoperative nausea and vomiting (PONV) following the induction of anaesthesia. Additionally, intravenous morphine was administered at a dosage of 0.05mg/kg and suppositories containing paracetamol were given at a dosage of 30mg/kg for analgesic purposes. Patients will be extubated at the end of surgery
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention