In Reply:—
Dr. Cohn raises several very interesting points in his letter concerning our manuscript “Electroacupuncture prophylaxis of postoperative nausea and vomiting following pediatric tonsillectomy with or without adenoidectomy.”1Although he seems knowledgeable about acupuncture, his title casts a certain unnecessary pejorative air on this subject. He may very well be correct; that other more “potent” acupuncture sites may be better used to prevent postoperative nausea and vomiting. In fact, since our only real significant outcome improvement was in nausea reduction, other stimulation points might prove useful as well. P6 was chosen because it is the most commonly reported acupuncture point for nausea and vomiting related to chemotherapy and postoperative nausea and vomiting. ST-36 and ST-43 certainly should be studied in this setting.
The P6 needles were placed anatomically, using cun units that correlated with the size of the patient's finger and De Qi was not possible as the patients were anesthetized. In general, this is required, in our current culture, where most children are needle-phobic and not accustomed to medical acupuncture. Once awake, electrical stimulation was activated that the patients could report feeling along with “needle grab.” In no case was excitation of the median nerve noted. There were no noted muscle contractions or patients who complained of paresthesias during the study.
We do not believe that our report condemns the use of acupuncture for postoperative nausea and vomiting in children after emetogenic procedures. Rather, it does substantiate the notion that there was a treatment effect and that further investigations are needed to attempt to establish a useful role for these techniques. We are optimistic that carefully completed placebo-controlled trials such as ours will eventually lead to more mainstream adoption of acupuncture in children. Once we can establish strong treatment effects, we will be in a better position to begin to advocate for the use of acupuncture even in nonsedated children.
