Newswise – CHICAGO – A technique called percutaneous peripheral nerve stimulation achieves “impressive” reductions in pain scores and opioid use in the first week after common orthopedic surgery procedures, concludes a randomized clinical trial published in line first in Anesthesiology, the official peer-reviewed journal of the American Society of Anesthesiologists (ASA), today.
According to the randomized trial report by Brian M. Ilfeld, MD, MS and colleagues. With further study, they believe peripheral nerve stimulation may be a safe, effective, opioid-reducing non-drug supplement for pain management after surgery.
In percutaneous peripheral nerve stimulation, a small electrical wire (insulated wire) is placed next to a nerve and connected to a battery-powered pulse generator. The generator delivers mild electrical stimulation to the nerve, interrupting the transmission of pain. Although this “neuromodulation” technique has been widely used for patients with chronic pain, the new study is the first randomized controlled trial to evaluate its use for acute pain after surgery.
The study included 65 patients undergoing common outpatient joint surgery, such as bunion surgery on the foot or rotator cuff repair in the shoulder. All patients underwent catheter placement near the nerve (s) serving the surgical joint. Half of the patients were randomly assigned to active electrical stimulation, adjusted to achieve the desired sensory change – sometimes described as a “pleasant massage” sensation. The remainder of the patients received an inactive “dummy” treatment, with a pulse generator that appeared to be functioning normally, but delivered no electrical current. After one week, pain scores and opioid use were compared between groups. The evaluations were carried out in “double masked” mode: neither the researchers nor the patients knew what treatment the patient was receiving.
The results showed significantly lower pain ratings in the active nerve stimulation group. The mean pain score (on a scale of 0 to 10) was 1.1 in the patients receiving active treatment, compared to 3.1 in the sham group.
Active nerve stimulation was also associated with much lower use of opioids to control postoperative pain. The median dose of opioids (oral morphine equivalents) throughout the first week after surgery was 5 milligrams in the active treatment group, compared to 48 milligrams in the sham group. This is a significant benefit because of the possible side effects of postoperative opioids, such as nausea, constipation, sedation, and respiratory depression.
Although the trial was designed as a pilot study, the results “on their own and indicate that percutaneous peripheral nerve stimulation is very effective for acute pain,” wrote Dr. Ilfeld and his co-authors. They described plans for a subsequent study that is currently recruiting a much larger number of patients and will include a more comprehensive evaluation of the effect of treatment on patient subgroups.
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTSFounded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research, and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. The ASA is committed to ensuring that anesthetists assess and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care that every patient deserves.
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