scholarly journals Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

2020 ◽  
Vol 133 (5) ◽  
pp. 1127-1149 ◽  
Author(s):  
Brian M. Ilfeld ◽  
John J. Finneran
Keyword(s):  
Peripheral Nerve ◽  
Acute Pain ◽  
Nerve Stimulation ◽  
Pulse Generator ◽  
Electrical Current ◽  
Peripheral Nerve Stimulation ◽  
Single Application ◽  
Duration Of Action ◽  
Randomized Controlled ◽  
Extended Duration

Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.

scholarly journals Peripheral Nerve Stimulation for the 21st Century: Sural, Superficial Peroneal, and Tibial Nerves

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S64-S67
Author(s):  
Aaron Hanyu-Deutmeyer ◽  
Scott G Pritzlaff
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Pulse Generator ◽  
Peripheral Nerve Stimulation ◽  
Patient Comfort ◽  
Tarsal Tunnel ◽  
Ultrasound Images ◽  
Entrapment Neuropathies ◽  
Randomized Controlled Studies

Abstract Objective Peripheral nerve stimulation (PNS) of the lower extremity has progressed significantly over the last decade. From the proof of concept that ultrasound-guided, percutaneous implantation was possible to advances in waveforms, the field has been rapidly evolving. While most nerves in the lower extremity can be PNS targets, consideration must be given to the ergonomics of pulse generator placement, patient comfort, and avoidance of lead migration. For this paper, we examine some of the conditions amenable to lower extremity PNS, review the evidence and history behind PNS for these conditions, and describe approaches for the tibial, sural, and superficial peroneal nerves. Methods A literature search was conducted using PubMed. Search terms used were “peripheral nerve stimulation,” “lower extremity entrapment neuropathies,” “sural nerve,” “superficial peroneal nerve,” “tibial nerve,” and “tarsal tunnel syndrome.” Emphasis was placed on randomized controlled studies, anatomical dissections, and comprehensive review articles. Approaches to nerves and ultrasound images were based on anecdotal PNS cases from an experienced implanter (SP). Conclusions The development of ultrasound as a viable method of image guidance for percutaneous peripheral nerve stimulation has led to an exponential growth in the field. Lower extremity percutaneous lead placement is both feasible and an appropriate treatment modality for certain pain conditions.

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

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

scholarly journals Peripheral Nerve Stimulation of the Occipital Nerve to Treat Postherpetic Neuralgia

2020 ◽  
pp. 193-197
Author(s):  
Roshina Khan
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Postherpetic Neuralgia ◽  
Pulse Generator ◽  
Peripheral Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Nerve Blocks ◽  
Implantable Pulse Generator ◽  
Occipital Nerve ◽  
Posterior Neck

Background: Herpes zoster infection and subsequent postherpetic neuralgia can cause chronic neuropathic pain. Patients who do not respond well to pharmacotherapy require therapeutic options that are typically more invasive; our goal was to minimize invasiveness. Case Presentation: We present a case of intractable postherpetic neuralgia refractory to conservative pharmacological treatment and multiple occipital nerve blocks, which was successfully treated using peripheral occipital nerve stimulation (ONS) with an external implantable pulse generator (IPG). Conclusion: For interventionalists, one of the technical difficulties during ONS placement involves tunneling leads through the high-risk and difficult anatomy of the posterior neck. Further complicating placement and increasing patient discomfort are the long leads required for internal IPG implantation. The most commonly cited complication is lead migration or lead breakage. This difficulty can be attenuated by using an external IPG, such as was used in this case. An external IPG makes the ONS procedure significantly less invasive and reduces trauma and discomfort for the patient. Key words: Peripheral nerve stimulation (PNS), occipital nerve, postherpetic neuralgia (PHN), occipital nerve stimulation (ONS), implantable pulse generator (IPG), external IPG

scholarly journals Techniques for Peripheral Nerve Stimulator Implantation of the Upper Extremity

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S27-S31
Author(s):  
Vinita Singh ◽  
Diya Sandhu ◽  
Nan Xiang
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Nerve Stimulation ◽  
Pulse Generator ◽  
Technical Note ◽  
Peripheral Nerve Stimulation ◽  
Nerve Stimulator ◽  
Peripheral Nerve Stimulator ◽  
Academic Center ◽  
Technical Details

Abstract Objective To present a technical note on how to perform upper extremity peripheral nerve stimulators for three major nerves: median, ulnar, and radial. Design Literature review and expert opinion. Setting Single academic center. Results Peripheral nerve stimulation has recently become popular with the development and availability of peripheral nerve stimulators with an external pulse generator. Here, we describe ultrasound anatomy and technical details for peripheral nerve stimulation in the upper extremity for three major nerves: median, ulnar, and radial. Conclusions Upper extremity peripheral nerve stimulation can be considered as an option for refractory neuropathic upper extremity pain.

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