Skip to main content

20.04.2024 | Acute Pain Medicine (R Urman, Section Editor)

Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review

verfasst von: Alan D. Kaye, Taylor R. Plaisance, Summer A. Smith, Amanda R. Ragland, Michael J. Alfred, Catherine G. Nguyen, Azem A. Chami, Saurabh Kataria, Kylie Dufrene, Sahar Shekoohi, Christopher L. Robinson

Erschienen in: Current Pain and Headache Reports

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Recent research has shown the effectiveness of peripheral nerve stimulators (PNS) in managing chronic pain conditions. Ongoing studies aim to explore its potential application in treating acute postoperative pain states. The purpose of this systematic review is to assess the role of PNS in providing relief for postoperative pain.

Recent Findings

Clinical studies investigating the use of peripheral nerve stimulators (PNS) for analgesia following various surgeries, such as total knee arthroplasty, anterior cruciate ligament repair, ankle arthroplasty, rotator cuff repair, hallux valgus correction, and extremity amputation, have shown promising results. Lead placement locations include the brachial plexus, sciatic, femoral, tibial, genicular, perineal, sural, radial, median, and ulnar nerves. These studies consistently report clinically significant reductions in pain scores, and some even indicate a decrease in opioid consumption following PNS for postoperative pain.

Summary

PNS involves the subcutaneous placement of electrode leads to target peripheral nerve(s) followed by delivery of an electric current via an external pulse generator. While the precise mechanism is not fully understood, the theory posits that PNS modulates electrical stimulation, hindering the signaling of nociceptive pain. PNS presents itself as an alternative to opioid therapy, holding promise to address the opioid epidemic by offering a nonpharmacologic approach for both acute and chronic pain states.
Literatur
3.
Zurück zum Zitat • Ilfeld BM, Gelfand H, Dhanjal S, Hackworth R, Plunkett A, Turan A, et al. Ultrasound-guided percutaneous peripheral nerve stimulation: a pragmatic effectiveness trial of a nonpharmacologic alternative for the treatment of postoperative pain. Pain Med. 2020;21(2):S53–61. This study determined the effects of utilizing peripheral nerve stimulation (PNS) postoperatively following ambulatory surgery, with the hypothesis that pain and opioid consumption will be reduced in comparison to standard analgesic techniques. • Ilfeld BM, Gelfand H, Dhanjal S, Hackworth R, Plunkett A, Turan A, et al. Ultrasound-guided percutaneous peripheral nerve stimulation: a pragmatic effectiveness trial of a nonpharmacologic alternative for the treatment of postoperative pain. Pain Med. 2020;21(2):S53–61. This study determined the effects of utilizing peripheral nerve stimulation (PNS) postoperatively following ambulatory surgery, with the hypothesis that pain and opioid consumption will be reduced in comparison to standard analgesic techniques.
4.
Zurück zum Zitat Berardino K, Carroll AH, Kaneb A, Civilette MD, Sherman WF, Kaye AD. An update on postoperative opioid use and alternative pain control following spine surgery. Orthop Rev (Pavia). 13(2):24978. Berardino K, Carroll AH, Kaneb A, Civilette MD, Sherman WF, Kaye AD. An update on postoperative opioid use and alternative pain control following spine surgery. Orthop Rev (Pavia). 13(2):24978.
5.
Zurück zum Zitat Joshi G, Gandhi K, Shah N, Gadsden J, Corman SL. Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities. J Clin Anesth. 2016;35:524–9.CrossRefPubMed Joshi G, Gandhi K, Shah N, Gadsden J, Corman SL. Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities. J Clin Anesth. 2016;35:524–9.CrossRefPubMed
6.
Zurück zum Zitat Capdevila X, Bringuier S, Borgeat A. Infectious risk of continuous peripheral nerve blocks. Anesthesiology. 2009;110(1):182–8.CrossRefPubMed Capdevila X, Bringuier S, Borgeat A. Infectious risk of continuous peripheral nerve blocks. Anesthesiology. 2009;110(1):182–8.CrossRefPubMed
9.
Zurück zum Zitat Kaye AD, Ridgell S, Alpaugh ES, Mouhaffel A, Kaye AJ, Cornett EM, et al. Peripheral nerve stimulation: a review of techniques and clinical efficacy. Pain Ther. 2021;10(2):961–72.CrossRefPubMedPubMedCentral Kaye AD, Ridgell S, Alpaugh ES, Mouhaffel A, Kaye AJ, Cornett EM, et al. Peripheral nerve stimulation: a review of techniques and clinical efficacy. Pain Ther. 2021;10(2):961–72.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Nayak R, Banik RK. Current innovations in peripheral nerve stimulation. Pain Res Treat. 2018;13(2018):9091216. Nayak R, Banik RK. Current innovations in peripheral nerve stimulation. Pain Res Treat. 2018;13(2018):9091216.
12.
Zurück zum Zitat Xu J, Sun Z, Wu J, Rana M, Garza J, Zhu AC, et al. Peripheral nerve stimulation in pain management: a systematic review. Pain Physician. 2021;24(2):E131–52.PubMedPubMedCentral Xu J, Sun Z, Wu J, Rana M, Garza J, Zhu AC, et al. Peripheral nerve stimulation in pain management: a systematic review. Pain Physician. 2021;24(2):E131–52.PubMedPubMedCentral
13.
14.
Zurück zum Zitat Helm S, Shirsat N, Calodney A, Abd-Elsayed A, Kloth D, Soin A, et al. Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety. Pain Ther. 2021;10(2):985–1002.CrossRefPubMedPubMedCentral Helm S, Shirsat N, Calodney A, Abd-Elsayed A, Kloth D, Soin A, et al. Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety. Pain Ther. 2021;10(2):985–1002.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat • Ilfeld BM, Plunkett A, Vijjeswarapu AM, Hackworth R, Dhanjal S, Turan A, et al. Percutaneous peripheral nerve stimulation (neuromodulation) for postoperative pain: a randomized, sham-controlled pilot study. Anesthesiology. 2021;135(1):95–110. One of the first studies regarding PNS in its use for acute postoperative pain found that PNS is effective in reducing pain scores and opioid consumption in the initial week after ambulatory orthopedic surgery. • Ilfeld BM, Plunkett A, Vijjeswarapu AM, Hackworth R, Dhanjal S, Turan A, et al. Percutaneous peripheral nerve stimulation (neuromodulation) for postoperative pain: a randomized, sham-controlled pilot study. Anesthesiology. 2021;135(1):95–110. One of the first studies regarding PNS in its use for acute postoperative pain found that PNS is effective in reducing pain scores and opioid consumption in the initial week after ambulatory orthopedic surgery.
18.
Zurück zum Zitat Ilfeld BM, Plunkett A, Vijjeswarapu AM, Hackworth R, Dhanjal S, Turan A, et al. Percutaneous neuromodulation of the brachial plexus and sciatic nerve for the treatment of acute pain following surgery: secondary outcomes from a multicenter, randomized, controlled pilot study. Neuromodulation. 2023;26(3):638–49.CrossRefPubMed Ilfeld BM, Plunkett A, Vijjeswarapu AM, Hackworth R, Dhanjal S, Turan A, et al. Percutaneous neuromodulation of the brachial plexus and sciatic nerve for the treatment of acute pain following surgery: secondary outcomes from a multicenter, randomized, controlled pilot study. Neuromodulation. 2023;26(3):638–49.CrossRefPubMed
19.
Zurück zum Zitat Ilfeld BM, Grant SA, Gilmore CA, Chae J, Wilson RD, Wongsarnpigoon A, et al. Neurostimulation for postsurgical analgesia: a novel system enabling ultrasound-guided percutaneous peripheral nerve stimulation. Pain Pract. 2017;17(7):892–901.CrossRefPubMed Ilfeld BM, Grant SA, Gilmore CA, Chae J, Wilson RD, Wongsarnpigoon A, et al. Neurostimulation for postsurgical analgesia: a novel system enabling ultrasound-guided percutaneous peripheral nerve stimulation. Pain Pract. 2017;17(7):892–901.CrossRefPubMed
20.
Zurück zum Zitat Ilfeld BM, Gilmore CA, Grant SA, Bolognesi MP, Del Gaizo DJ, Wongsarnpigoon A, et al. Ultrasound-guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study. J Orthop Surg Res. 2017;13(12):4.CrossRef Ilfeld BM, Gilmore CA, Grant SA, Bolognesi MP, Del Gaizo DJ, Wongsarnpigoon A, et al. Ultrasound-guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study. J Orthop Surg Res. 2017;13(12):4.CrossRef
21.
Zurück zum Zitat Char S, Jin MY, Francio VT, Hussain N, Wang EJ, Morsi M, et al. Implantable peripheral nerve stimulation for peripheral neuropathic pain: a systematic review of prospective studies. Biomedicines. 2022;10(10):2606.CrossRefPubMedPubMedCentral Char S, Jin MY, Francio VT, Hussain N, Wang EJ, Morsi M, et al. Implantable peripheral nerve stimulation for peripheral neuropathic pain: a systematic review of prospective studies. Biomedicines. 2022;10(10):2606.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Fogel HP, Winfree CJ. What’s new in peripheral nerve stimulation. Neurosurg Clin N Am. 2022;33(3):323–30.CrossRefPubMed Fogel HP, Winfree CJ. What’s new in peripheral nerve stimulation. Neurosurg Clin N Am. 2022;33(3):323–30.CrossRefPubMed
24.
Zurück zum Zitat Li AHY, Bhatia A, Gulati A, Ottestad E. Role of peripheral nerve stimulation in treating chronic neuropathic pain: an international focused survey of pain medicine experts. Reg Anesth Pain Med. 2023;48(6):312–8.CrossRefPubMed Li AHY, Bhatia A, Gulati A, Ottestad E. Role of peripheral nerve stimulation in treating chronic neuropathic pain: an international focused survey of pain medicine experts. Reg Anesth Pain Med. 2023;48(6):312–8.CrossRefPubMed
26.
27.
Zurück zum Zitat Klein J, Sandi-Gahun S, Schackert G, Juratli TA. Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain. Cephalalgia. 2016;36(5):445–53.CrossRefPubMed Klein J, Sandi-Gahun S, Schackert G, Juratli TA. Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain. Cephalalgia. 2016;36(5):445–53.CrossRefPubMed
28.
Zurück zum Zitat Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature. Pain Med. 2016;17(2):325–36.PubMed Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature. Pain Med. 2016;17(2):325–36.PubMed
29.
Zurück zum Zitat Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: a practical guide. Healthcare (Basel). 2021;9(3):333.CrossRefPubMed Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: a practical guide. Healthcare (Basel). 2021;9(3):333.CrossRefPubMed
30.
Zurück zum Zitat Ilfeld BM. Single-injection and continuous femoral nerve blocks are associated with different risks of falling. Anesthesiology. 2014;121(3):668–9.CrossRefPubMed Ilfeld BM. Single-injection and continuous femoral nerve blocks are associated with different risks of falling. Anesthesiology. 2014;121(3):668–9.CrossRefPubMed
32.
Zurück zum Zitat Gilmore CA, Ilfeld BM, Rosenow JM, Li S, Desai MJ, Hunter CW, et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2020;45(1):44–51.CrossRef Gilmore CA, Ilfeld BM, Rosenow JM, Li S, Desai MJ, Hunter CW, et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2020;45(1):44–51.CrossRef
33.
Zurück zum Zitat Chauhan G, Srinivasan SK, Khanduja S. Wireless high-frequency peripheral nerve stimulation for chronic refractory knee pain post-total knee replacement. Cureus. 15(3):e35759. Chauhan G, Srinivasan SK, Khanduja S. Wireless high-frequency peripheral nerve stimulation for chronic refractory knee pain post-total knee replacement. Cureus. 15(3):e35759.
Metadaten
Titel
Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review
verfasst von
Alan D. Kaye
Taylor R. Plaisance
Summer A. Smith
Amanda R. Ragland
Michael J. Alfred
Catherine G. Nguyen
Azem A. Chami
Saurabh Kataria
Kylie Dufrene
Sahar Shekoohi
Christopher L. Robinson
Publikationsdatum
20.04.2024
Verlag
Springer US
Erschienen in
Current Pain and Headache Reports
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-024-01257-z

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Eingreifen von Umstehenden rettet vor Erstickungstod

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.