Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled Pilot Study

Abstract Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy—percutaneous peripheral nerve stimulation (PNS) – and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.

Download Full-text

Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13139 ◽

2020 ◽

Vol 23 (6) ◽

pp. 819-826 ◽

Cited By ~ 1

Author(s):

Ojas Mainkar ◽

Che Antonio Solla ◽

Grant Chen ◽

Aron Legler ◽

Amitabh Gulati

Keyword(s):

Pilot Study ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation

Download Full-text

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: A Pragmatic Effectiveness Trial of a Nonpharmacologic Alternative for the Treatment of Postoperative Pain

Pain Medicine ◽

10.1093/pm/pnaa332 ◽

2020 ◽

Vol 21 (Supplement_2) ◽

pp. S53-S61

Author(s):

Brian M Ilfeld ◽

Harold Gelfand ◽

Sandeep Dhanjal ◽

Robert Hackworth ◽

Anthony Plunkett ◽

...

Keyword(s):

Postoperative Pain ◽

Peripheral Nerve ◽

Postoperative Analgesia ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation ◽

Past Century ◽

Effectiveness Trial ◽

Small Series ◽

Surgical Pain ◽

Introducer Needle

Abstract Background Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducer needle followed by the delivery of electric current after needle withdrawal. This modality has been used extensively to treat chronic pain, but only small series have been published involving postoperative pain. The ultimate objective of this study is to determine the postoperative effects of percutaneous PNS following moderately to severely painful ambulatory surgery within a real-world clinical practice setting. The primary hypothesis is that surgical pain and opioid consumption during the initial 7 days after surgery will be reduced by percutaneous PNS compared with usual and customary analgesia (dual primary outcome measures). Design A multicenter pragmatic effectiveness trial. We are randomizing participants having painful orthopedic surgical procedures of the upper and lower extremity to receive 14 days of either 1) electrical stimulation or 2) sham in a double-masked fashion. End points are being assessed at various time points over 12 postoperative months. Summary The postoperative experience will be much improved if percutaneous PNS provides potent analgesia while concurrently decreasing opioid requirements following painful surgery. Because this modality can be administered for up to 60 days at home, it may provide postoperative analgesia that outlasts surgical pain yet has relatively few risks and, unlike opioids, has no systemic side effects or potential for abuse, addiction, and overdose. Percutaneous PNS has the potential to revolutionize postoperative analgesia as it has been practiced for the past century. This study will inform key stakeholders regarding an evidence-based nonpharmacologic approach to the management of postoperative pain.

Download Full-text

Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled Pilot Study

Anesthesiology ◽

10.1097/aln.0000000000003776 ◽

2021 ◽

Author(s):

Brian M. Ilfeld ◽

Anthony Plunkett ◽

Alice M. Vijjeswarapu ◽

Robert Hackworth ◽

Sandeep Dhanjal ◽

...

Keyword(s):

Postoperative Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Treatment Effect ◽

Rating Scale ◽

Pulse Generator ◽

Femoral Nerve ◽

Opioid Consumption ◽

Peripheral Nerve Stimulation ◽

Pain Scores

Background Percutaneous peripheral nerve stimulation is an analgesic technique involving the percutaneous implantation of a lead followed by the delivery of electric current using an external pulse generator. Percutaneous peripheral nerve stimulation has been used extensively for chronic pain, but only uncontrolled series have been published for acute postoperative pain. The current multicenter study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent clinical trial and (2) estimate the treatment effect of percutaneous peripheral nerve stimulation on postoperative pain and opioid consumption. Methods Preoperatively, an electrical lead was percutaneously implanted to target the sciatic nerve for major foot/ankle surgery (e.g., hallux valgus correction), the femoral nerve for anterior cruciate ligament reconstruction, or the brachial plexus for rotator cuff repair, followed by a single injection of long-acting local anesthetic along the same nerve/plexus. Postoperatively, participants were randomized to 14 days of either electrical stimulation (n = 32) or sham stimulation (n = 34) using an external pulse generator in a double-masked fashion. The dual primary treatment effect outcome measures were (1) cumulative opioid consumption (in oral morphine equivalents) and (2) mean values of the “average” daily pain scores measured on the 0 to 10 Numeric Rating Scale within the first 7 postoperative days. Results During the first 7 postoperative days, opioid consumption in participants given active stimulation was a median (interquartile range) of 5 mg (0 to 30) versus 48 mg (25 to 90) in patients given sham treatment (ratio of geometric means, 0.20 [97.5% CI, 0.07 to 0.57]; P < 0.001). During this same period, the average pain intensity in patients given active stimulation was a mean ± SD of 1.1 ± 1.1 versus 3.1 ± 1.7 in those given sham (difference, −1.8 [97.5% CI, −2.6 to −0.9]; P < 0.001). Conclusions Percutaneous peripheral nerve stimulation reduced pain scores and opioid requirements free of systemic side effects during at least the initial week after ambulatory orthopedic surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

Acute postoperative pain management with percutaneous peripheral nerve stimulation: the SPRINT neuromodulation system

Expert Review of Medical Devices ◽

10.1080/17434440.2021.1877134 ◽

2021 ◽

pp. 1-6

Author(s):

Rodney A. Gabriel ◽

Brian M. Ilfeld

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Postoperative Pain Management ◽

Peripheral Nerve Stimulation ◽

Acute Postoperative Pain

Download Full-text

Percutaneous Peripheral Nerve Stimulation for the Management of Postoperative Pain

Neuromodulation ◽

10.1016/b978-0-12-805353-9.00060-7 ◽

2018 ◽

pp. 753-762

Author(s):

Amorn Wongsarnpigoon ◽

Brian M. Ilfeld

Keyword(s):

Postoperative Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation

Download Full-text

Peripheral nerve stimulation for the management of acute and subacute post-amputation pain: a randomized, controlled feasibility trial

Pain Management ◽

10.2217/pmt-2021-0087 ◽

2021 ◽

Author(s):

Brooke Albright-Trainer ◽

Thomas Phan ◽

Robert J Trainer ◽

Nathan D Crosby ◽

Douglas P Murphy ◽

...

Keyword(s):

Pilot Study ◽

Peripheral Nerve ◽

Medical Therapy ◽

Nerve Stimulation ◽

Opioid Consumption ◽

Peripheral Nerve Stimulation ◽

Phantom Limb ◽

Feasibility Trial ◽

Limb Pain ◽

Standard Medical Therapy

Introduction & aim: Temporary (60-day) percutaneous peripheral nerve stimulation (PNS) has demonstrated effectiveness for the treatment of chronic post-amputation pain, and this pilot study aims to evaluate the feasibility of temporary percutaneous PNS for the treatment of acute post-amputation pain. Patients & methods: Sixteen veterans undergoing lower extremity amputation received PNS and standard medical therapy or standard medical therapy alone. Results: The PNS group reported greater reductions in average phantom limb pain, residual limb pain and daily opioid consumption, and there were fewer participants taking opioids through 3 months post-amputation. Conclusion: This pilot study suggests that PNS is feasible in the acute postoperative period following lower limb amputation and may provide a non-pharmacologic analgesic therapy that lowers pain scores and reduces opioid consumption, and thus warrants further investigation.

Download Full-text