Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia

Grant, Stuart A.

doi:10.1097/aap.0000000000000481

Cited by 39 publications

(45 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 15% (5 of 34) of leads whose removal was documented, the lead was fractured at the distal tip on removal 19 23. Lead fragments (100 μm diameter wire), which were labeled as magnetic resonance (MR) Conditional following recent testing,24 were observed in situ and no fragment-related sequelae were subsequently reported during follow-up, similar to previous reports 15…”

Section: Resultssupporting

confidence: 83%

Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial

Gilmore

Ilfeld

Rosenow

et al. 2019

Reg Anesth Pain Med

116

120

View full text Add to dashboard Cite

Background and objectivesChronic neuropathic pain is a common challenging condition following amputation. Recent research demonstrated the feasibility of percutaneously implanting fine-wire coiled peripheral nerve stimulation (PNS) leads in proximity to the sciatic and femoral nerves for postamputation pain. A multicenter, double-blinded, randomized, placebo-controlled study collected data on the safety and effectiveness of percutaneous PNS for chronic neuropathic pain following amputation.MethodsTwenty-eight lower extremity amputees with postamputation pain were enrolled. Subjects underwent ultrasound-guided implantation of percutaneous PNS leads and were randomized to receive PNS or placebo for 4 weeks. The placebo group then crossed over and all subjects received PNS for four additional weeks. The primary efficacy endpoint evaluated the proportion of subjects reporting ≥50% pain reduction during weeks 1–4.ResultsA significantly greater proportion of subjects receiving PNS (n=7/12, 58%, p=0.037) demonstrated ≥50% reductions in average postamputation pain during weeks 1–4 compared with subjects receiving placebo (n=2/14, 14%). Two subjects were excluded from efficacy analysis due to eligibility changes. Significantly greater proportions of PNS subjects also reported ≥50% reductions in pain (n=8/12, 67%, p=0.014) and pain interference (n=8/10, 80%, p=0.003) after 8 weeks of therapy compared with subjects receiving placebo (pain: n=2/14, 14%; pain interference: n=2/13, 15%). Prospective follow-up is ongoing; four of five PNS subjects who have completed 12-month follow-up to date reported ≥50% pain relief.ConclusionsThis work demonstrates that percutaneous PNS therapy may provide enduring clinically significant pain relief and improve disability in patients with chronic neuropathic postamputation pain.Trial registration number NCT01996254.

show abstract

Section: Resultssupporting

confidence: 83%

Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial

Gilmore

Ilfeld

Rosenow

et al. 2019

Reg Anesth Pain Med

116

120

View full text Add to dashboard Cite

show abstract

“…One potential analgesic technique used historically to relieve chronic pain is neuromodulation involving the delivery of electric current to a target nerve,2 3 suggesting that this modality may also provide analgesia in the acute pain setting. Since conventional systems for peripheral nerve stimulation (PNS) usually require invasive surgery to both implant and remove multiple electrodes in close proximity to the peripheral nerve,4 5 the intrusiveness and cost of applying neuromodulation have been a major barrier to use of this modality to treat acute pain syndromes 6…”

Section: Introductionmentioning

confidence: 99%

“…However, a percutaneous lead (figure 1A) and wearable stimulator (figure 1B) were recently cleared by the US Food and Drug Administration to treat both chronic and acute postoperative pain with a lead implantation period of up to 60 days,7 8 affording the possibility of providing a non-opioid analgesic that outlasts surgical procedure-related pain 6. This system has been reported in small series of patients used to target the femoral and sciatic nerves following surgical procedures of the knee and foot 9–12.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the suprascapular nerve and brachial plexus for postoperative analgesia following ambulatory rotator cuff repair. A proof-of-concept study

Ilfeld

Finneran

Gabriel

et al. 2019

Reg Anesth Pain Med

View full text Add to dashboard Cite

Background and objectivesPercutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain following knee and foot surgery. However, it remains unknown if this analgesic technique may be used in ambulatory patients following upper extremity surgery. The purpose of this proof-of-concept study was to investigate various lead implantation locations and evaluate the feasibility of using percutaneous brachial plexus PNS to treat surgical pain following ambulatory rotator cuff repair in the immediate postoperative period.MethodsPreoperatively, an electrical lead (SPR Therapeutics, Cleveland, Ohio) was percutaneously implanted to target the suprascapular nerve or brachial plexus roots or trunks using ultrasound guidance. Postoperatively, subjects received 5 min of either stimulation or sham in a randomized, double-masked fashion followed by a 5 min crossover period, and then continuous stimulation until lead removal postoperative days 14–28.ResultsLeads (n=2) implanted at the suprascapular notch did not appear to provide analgesia, and subsequent leads (n=14) were inserted through the middle scalene muscle and placed to target the brachial plexus. Three subjects withdrew prior to data collection. Within the recovery room, stimulation did not decrease pain scores during the first 40 min of the remaining subjects with brachial plexus leads, regardless of which treatment subjects were randomized to initially. Seven of these 11 subjects required a single-injection interscalene nerve block for rescue analgesia prior to discharge. However, subsequent average resting and dynamic pain scores postoperative days 1–14 had a median of 1 or less on the Numeric Rating Scale, and opioid requirements averaged less than 1 tablet daily with active stimulation. Two leads dislodged during use and four fractured on withdrawal, but no infections, nerve injuries, or adverse sequelae were reported.ConclusionsThis proof-of-concept study demonstrates that ultrasound-guided percutaneous PNS of the brachial plexus is feasible for ambulatory shoulder surgery, and although analgesia immediately following surgery does not appear to be as potent as local anesthetic-based peripheral nerve blocks, the study suggests that this modality may provide analgesia and decrease opioid requirements in the days following rotator cuff repair. Therefore, it suggests that a subsequent, large, randomized clinical trial with an adequate control group is warranted to further investigate this therapy in the management of surgical pain in the immediate postoperative period. However, multiple technical issues remain to be resolved, such as the optimal lead location, insertion technique, and stimulating protocol, as well as preventing lead dislodgment and fracture.Trial registration number NCT02898103.

show abstract

“…For example, ultrasound-guided percutaneous peripheral nerve stimulation offers the promise of blocking pain signals at the level of the spinal cord, without inducing a motor, sensory, or proprioception block. 174,175 Similarly, there is evidence that cryoneurolysis of the superficial, sensory-only anterior femoral cutaneous and infrapatellar saphenous nerves provides post-TKA analgesia without any weakening of the quadriceps femoris muscle. 176,177 In addition, several nonpharmacologic approaches have been investigated for post-TKA analgesia.…”

Section: Ketaminementioning

confidence: 99%

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty

Kopp

Børglum

Buvanendran

et al. 2017

Regional Anesthesia and Pain Medicine

Self Cite

165

View full text Add to dashboard Cite

In 2014, the American Society of Regional Anesthesia and Pain Medicine in collaboration with the European Society of Regional Anaesthesia and Pain Therapy convened a group of experts to compare pathways for anesthetic and analgesic management for patients undergoing total knee arthroplasty in North America and Europe and to develop a practice pathway. This review is intended to be an analysis of the current literature to assist individuals and institutions in designing a pathway for total knee arthroplasty that is based on existing evidence and expert recommendation and may be customized according to individual settings.

show abstract

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia

Cited by 39 publications

References 40 publications

Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial

Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial

Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the suprascapular nerve and brachial plexus for postoperative analgesia following ambulatory rotator cuff repair. A proof-of-concept study

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty

Contact Info

Product

Resources

About