Intraoperative pediatric acupuncture is widely accepted by parents.

OBJECTIVE: Medical acupuncture is increasingly recognized for reducing postoperative pain, nausea and emergence agitation. Anesthetic induction is an ideal time to perform acupuncture in an effort to reduce the adverse side effects of surgery. Acupuncture is safe, inexpensive and does not lengthen the duration of anesthesia. There are however no published reports of how often patients will choose intraoperative acupuncture when given the opportunity to do so. METHODS: A retrospective review of all surgical procedures performed by one surgeon over 12 months was done. This yielded 401 unique patients ranging in age from 3 months to 21 years with a mean of 6 years. Five of these patients had emergent surgery and 396 patients had scheduled surgery; there were a total of 822 surgical procedures performed on these individuals. Intraoperative acupuncture was offered only to the scheduled surgical patients. RESULTS: 388 of 396 (98%) parents chose to have intraoperative acupuncture done for their child. No complications of acupuncture were encountered. CONCLUSION: These results demonstrate strong acceptance of intraoperative acupuncture by parents. We hope this report encourages surgeons to become trained in medical acupuncture.

Korean hand therapy for tonsillectomy pain in children.

OBJECTIVES: Severe throat pain can result from tonsillectomy and last up to 10 days in children. Codeine has recently been banned by the FDA in light of a recently recognized risk of death in these patients. Acupuncture has previously been associated with decreased pain in children after tonsillectomy. However, about 1 in 5 patients will refuse traditional acupuncture because of fear of needles. We explored Korean Hand Therapy (KHT), an acupuncture technique which does not involve needles, to see if this would also be associated with pain relief and be more widely accepted by children. METHODS: This was a retrospective review of children who underwent tonsillectomy over a 4-month window. No narcotics were prescribed after surgery. Patients who wanted help with pain relief were offered KHT. Perceived pain level was assessed before and after the KHT treatment. Following the 10-day recovery for tonsillectomy, patients or their parents were queried as to how long the pain relief from the KHT intervention was perceived to last. RESULTS: Fifty-six children underwent tonsillectomy; 29 of these patients (1-14 years) presented for pain relief after tonsillectomy and received KHT. 100% of patients (29 of 29) who were offered KHT accepted the intervention. The mean reported pain level before KHT was 5.03 (SD=2.69) out of 10. This fell to 3.06 (SD=3.15) after KHT. Statistical analyses supported the general conclusion that pain reports decline after KHT in the sampled population. 15 patients who received KHT - or their parents - provided a post-recovery report for how long they believed the KHT intervention lasted. The mean duration of perceived KHT benefit was 78.20h, though the standard deviation was large (64.38h). With the exception of one child reporting a slight increase in pain, no adverse effects were associated with KHT. CONCLUSIONS: The data tentatively suggest KHT is associated with decreases in perceived pain after tonsillectomy and is widely accepted by children. These data - combined with the cost effectiveness, safety and ease of administering KHT - suggest that further studies exploring the effectiveness of KHT for pain relief after tonsillectomy are merited.

Acupuncture instead of codeine for tonsillectomy pain in children.

OBJECTIVES: Severe throat pain can result from tonsillectomy and last up to 10 days in children. Codeine elixir has long been used for pain relief, but has recently been banned by the Food and Drug Administration due to a recently recognized risk of death. We explored acupuncture as an alternative means of pain relief for children and adolescents after tonsillectomy. METHODS: This was a retrospective review of children and adolescents who underwent tonsillectomy over a three-month period. No narcotics were prescribed after surgery. Patients who wanted help with pain relief were offered acupuncture. Perceived pain level was assessed before and after the acupuncture treatment. Following the 10-day recovery for tonsillectomy, patients or their parents were queried as to how long the pain relief from acupuncture intervention was perceived to last. RESULTS: 56 children and adolescents underwent tonsillectomy in the three-month window selected for the retrospective review. 31 of these patients (ranging from 2 to 17 years in age) received an acupuncture intervention for postoperative pain. The mean reported pain level before acupuncture was 5.52 (SD = 2.28) out of 10. This fell to 1.92 (SD = 2.43) after acupuncture. Statistical analysis supported the general conclusion that pain reports decline after acupuncture in the sampled population. However, the limitations of the methodology and the sample suggest that this generalization should be treated as preliminary. 17 patients or their parents provided a post-recovery report for how long they believed the acupuncture intervention lasted. The mean duration of perceived acupuncture benefit was 61.24 h, though the standard deviation was large (64.58 h) with about 30% of patients reporting less than three hours of benefit and about 30% reporting more than 60 h. No adverse effects were observed as a result of acupuncture treatments. CONCLUSIONS: The data tentatively suggest that acupuncture decreases perceived pain in children and adolescents after tonsillectomy. These data - combined with the cost effectiveness, safety and ease of administering acupuncture - suggest that further studies exploring the effectiveness of acupuncture in juveniles after tonsillectomy are merited.

Intrathoracic nontuberculous mycobacterial infections in otherwise healthy children.

BACKGROUND: Nontuberculous mycobacterial (NTM) infection is typically associated with lymphadenitis in immune competent children, and disseminated disease in children with immune deficiencies. Isolated pulmonary NTM disease is seen in cystic fibrosis, and is increasingly recognized in immunocompetent elderly women, where it is associated with an increased incidence of cystic fibrosis transmembrane regulator (CFTR) mutations. Thoracic NTM infection has been reported rarely in otherwise healthy children. We aimed to determine whether otherwise healthy children with pulmonary NTM disease had immunologic abnormalities or CFTR mutations. Clinical presentations of five otherwise healthy children with pulmonary NTM were reviewed. Immunologic studies were performed including a complete blood cell count (CBC), flow cytometric lymphocyte phenotyping and IFN-gamma receptor expression, in vitro cytokine stimulation, and serum immunoglobulin levels. Mutational analysis was performed for CFTR. The children ranged in age from 12 months to 2.5 years at diagnosis. Four presented with new onset wheezing or stridor failing bronchodilator therapy. One child was asymptomatic. Endobronchial lesions and/or hilar lymph nodes causing bronchial obstruction were identified in all patients. Mycobacterium avium complex was cultured from four patients, and Mycobacterium abscessus from one patient. All patients were successfully treated with anti-mycobacterial therapy with or without surgery. No definitive immunologic abnormalities were identified. No clinically significant mutations were found in CFTR. Pulmonary NTM infection should be considered in otherwise healthy young children presenting with refractory stridor or wheezing with endobronchial lesions or hilar lymphadenopathy. It does not appear to be associated with recognized underlying immune deficiency or CFTR mutations.