Acupuncture for postoperative morbidities in children, and placebo by proxy

Abstract

Acupuncture may be beneficial for the prevention of postoperative nausea and vomiting in children and is associated with minor adverse events. The two RCTs in this dissertation investigated the effects of acupuncture by means of a pragmatic randomised controlled trial design. Placebo effects are affected by patient expectancy towards the treatment. The present survey explored the placebo effects by proxy which is a rather unexplored field. A narrative review summarised research on acupuncture and acupressure in ambulatory anaesthesia. Conclusions • When investigating the system effect, acupuncture during anaesthesia followed by postoperative acupressure seems to reduce vomiting in children after tonsillectomy and/or adenoidectomy. • When investigating the specific effect with the intention to exclude placebo effects, acupuncture during anaesthesia does not seem to reduce nausea and vomiting in children after tonsillectomy and/or adenoidectomy. • The survey on preoperative parental expectancy to treatment efficacy was not able to detect any such placebo effect by proxy. • There may have been a placebo effect that was not captured by our measure of parental preoperative expectancy, and the explanations for the manifest discrepancy between the RCTs should be sought understood by the following factors: o Placebo effects not accounted for by preoperative parental expectancy: Placebo effects emerging into and throughout the postoperative period on/by parents and children. o Placebo effects conveyed by care-givers and assessor in the postoperative period. o Nocebo effects in the Paper I study conveyed by all involved persons (children, parents, care-giver, and assessor), knowing that the children were allocated to control group. o A specific effect of acupressure in the postoperative period, as opposed to only acupuncture during anaesthesia. • The review showed that it is reasonable to consider acupuncture as part of ambulatory anaesthesia. However, since conclusive evidence regarding acupuncture effect is lacking, there have to be a trade-off between these treatments and other strategies in the future. • Studies investigating acupuncture treatment for children should manage a balance between an adequate acupuncture dose and technique, and a child-friendly approach. • Interesting issues for the future may be research on different acupuncture techniques and characteristics – in addition to the essential question about specific effects versus placebo effects.