title: Acupuncture management of pain and emergence agitation in children after bilateral myringotomy and tympanostomy tube insertion.
abstract: OBJECTIVE
  To further investigate the effect of acupuncture in postoperative pain and emergence agitation in children undergoing bilateral myringotomy and tympanostomy tube (BMT) placement.
  
  
  BACKGROUND
  BMT insertion surgery in children is routinely performed under general anesthesia and is associated with a high incidence of postoperative pain and agitation upon emergence from anesthesia. Various medications have been investigated to alleviate the pain and agitation, which have been accompanied by high incidence of adverse effects. In children, anecdotal reports suggest that acupuncture may offer postoperative analgesia.
  
  
  METHODS
  This prospective randomized controlled trial is to evaluate the effectiveness of acupuncture to control pain and agitation after initial bilateral myringotomy tube placement in 60 nonpremedicated children. Acupuncture was applied at points LI-4 (he gu) and HT-7 (shen men) immediately after induction of anesthesia. A single-blinded assessor evaluated postoperative pain and agitation using CHEOPS and emergence agitation scale. Pain and agitation scores were significantly lower in the acupuncture group compared to those in the control group at the time of arrival in the post anesthesia care unit and during the subsequent 30 min.
  
  
  RESULTS
  Acupuncture treatment provided significant benefit in pain and agitation reduction. The median time to first postoperative analgesic (acetaminophen) administration was significantly shorter in the control group. The number of patients who required analgesia was considerably fewer in the acupuncture group than that in the control. No adverse effects related to acupuncture treatment were observed.
  
  
  CONCLUSIONS
  Our study suggests that acupuncture therapy may be effective in diminishing both pain and emergence agitation in children after BMT insertion without adverse effects.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. Yuan-chi.lin@childrens.harvard.edu
authors.forename: Yuan-Chi
authors.initials: YC
authors.lastname: Lin
authors.forename: Rosalie F
authors.initials: RF
authors.lastname: Tassone
authors.forename: Stefan
authors.initials: S
authors.lastname: Jahng
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
authors.forename: Robert S
authors.initials: RS
authors.lastname: Holzman
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Navil F
authors.initials: NF
authors.lastname: Sethna
mesh_terms: D015667:Acupuncture Analgesia; D015670:Acupuncture Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects* / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000517:prevention & control*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome