Ilfeld Brian M, Gilmore Christopher A, Grant Stuart A, Bolognesi Michael P, Del Gaizo Daniel J, Wongsarnpigoon Amorn, Boggs Joseph W
Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA, 92103-8770, USA.
Department of Anesthesiology, Wake Forest University Baptist Medical Center, 145 Kimel Park Drive, Ste 330, Winston-Salem, NC, 27103, USA.
J Orthop Surg Res. 2017 Jan 13;12(1):4. doi: 10.1186/s13018-016-0506-7.
Peripheral nerve stimulation has been used for decades to treat chronic pain but has not been used for postoperative analgesia due to multiple limitations, beginning with invasive electrode placement. With the development of small-diameter/gauge leads enabling percutaneous insertion, ultrasound guidance for accurate introduction, and stimulators small enough to be adhered to the skin, neurostimulation may now be provided in a similar manner to continuous peripheral nerve blocks. Here, we report on the use of ultrasound-guided percutaneous peripheral nerve stimulation to treat postoperative pain.
Subjects within 60 days of a total knee arthroplasty with pain insufficiently treated with oral analgesics had a 0.2-mm-diameter electrical lead (pre-loaded into a 20 gauge needle) introduced percutaneously using ultrasound guidance with the tip located approximately 0.5-1.0 cm from the femoral nerve (a second lead was inserted approximately 1.0-3.0 cm from the sciatic nerve for posterior knee pain). An external stimulator delivered current. Endpoints were assessed before and after lead insertion and the leads subsequently removed. Due to the small sample size for this pilot/feasibility study, no statistics were applied to the data.
Leads were inserted in subjects (n = 5) 8-58 days postoperatively. Percutaneous peripheral nerve stimulation decreased pain an average of 93% at rest (from a mean of 5.0 to 0.2 on a 0-10 numeric rating scale), with 4 of 5 subjects experiencing complete resolution of pain. During passive and active knee motion pain decreased an average of 27 and 30%, respectively. Neither maximum passive nor active knee range-of-motion was consistently affected.
Ultrasound-guided percutaneous peripheral nerve stimulation may be a practical modality for the treatment of postoperative pain following orthopedic surgical procedures, and further investigation appears warranted.
外周神经刺激已被用于治疗慢性疼痛数十年，但由于存在多种限制，包括侵入性电极放置等问题，尚未用于术后镇痛。随着能够经皮插入的小直径/规格导线的发展、用于精确导入的超声引导以及小到足以粘贴在皮肤上的刺激器的出现，神经刺激现在可以以类似于连续外周神经阻滞的方式提供。在此，我们报告超声引导下经皮外周神经刺激用于治疗术后疼痛的情况。
全膝关节置换术后60天内、口服镇痛药治疗疼痛效果不佳的受试者，在超声引导下经皮插入一根直径0.2毫米的电导线（预先装入20号针中），导线尖端位于距股神经约0.5 - 1.0厘米处（对于膝关节后部疼痛，在距坐骨神经约1.0 - 3.0厘米处插入第二根导线）。外部刺激器输送电流。在导线插入前后评估终点指标，随后移除导线。由于本试点/可行性研究的样本量较小，未对数据进行统计分析。
在术后8 - 58天对受试者（n = 5）插入导线。经皮外周神经刺激使静息时疼痛平均降低93%（从0 - 10数字评分量表上的平均5.0降至0.2），5名受试者中有4名疼痛完全缓解。在膝关节被动和主动活动期间，疼痛分别平均降低27%和30%。膝关节最大被动和主动活动范围均未持续受到影响。
超声引导下经皮外周神经刺激可能是治疗骨科手术后疼痛的一种实用方法，似乎有必要进行进一步研究。
