Ter Bruggen Feline F J A, Redekop W Ken, Stronks Dirk L, Huygen Frank J P M
Department of Anesthesiology, Center for Pain Medicine, Erasmus MC, Rotterdam, the Netherlands.
Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
J Pain Res. 2021 Nov 30;14:3631-3636. doi: 10.2147/JPR.S323961. eCollection 2021.
The success of neurostimulation depends partly on the amount of coverage of the neurostimulation-induced paresthesia of the painful area. This is often achieved by asking feedback from patients intraoperatively. If sedation analgesia is used, it is important that the patient is comfortable during sedation and easily arousable. If the patient is not well sedated or experiences residual effects of the sedation during testing, this can directly influence the ideal placement of the leads and indirectly the long-term effect of the treatment. It is our hypothesis that the quality of the sedation is directly coupled to the adequacy of lead placement and in this way in the result of the treatment. Dexmedetomidine is known for its easy production of arousable sedation. The aim of the present study was to compare the long-term effect of using dexmedetomidine versus propofol during the implantation of a neurostimulator.
This is a post-trial follow-up analysis of the DexMedPro cohort. The primary outcome was global perceived effect (GPE). The secondary outcomes were the course of pain intensity, the emotional and physical functioning at the time of follow-up, and the course of neurostimulation treatment. In this study, we used the patient satisfaction with sedation as a measure for sedation quality.
Regarding the GPE, no statistically significant differences were found between the experimental groups in either subscale (ie, recovery (p=0.82) and satisfaction with the neurostimulation treatment at follow-up (p=0.06)). The same was found regarding the secondary parameters. A correlation was found between patient satisfaction with sedation during the lead implantation (side effects and procedural recall) and satisfaction at follow-up.
Regarding the long-term efficacy of neurostimulation treatment, no statistically significant differences were found between the dexmedetomidine and the propofol group. We observed a trend towards greater satisfaction with the neurostimulation treatment at follow-up in the dexmedetomidine group, compared to the propofol group.
神经刺激的成功部分取决于神经刺激诱发的疼痛区域感觉异常的覆盖范围。这通常是通过术中询问患者反馈来实现的。如果使用镇静镇痛，重要的是患者在镇静期间感觉舒适且容易唤醒。如果患者镇静不佳或在测试期间经历镇静的残留效应，这会直接影响导线的理想放置，并间接影响治疗的长期效果。我们的假设是镇静质量与导线放置的充分性直接相关，并以此方式影响治疗结果。右美托咪定以易于产生可唤醒的镇静而闻名。本研究的目的是比较在植入神经刺激器期间使用右美托咪定与丙泊酚的长期效果。
这是对右美托咪定 - 丙泊酚队列的试验后随访分析。主要结局是总体感知效果（GPE）。次要结局是疼痛强度的变化过程、随访时的情绪和身体功能以及神经刺激治疗的过程。在本研究中，我们将患者对镇静的满意度作为镇静质量的衡量指标。
关于总体感知效果，在任何一个子量表中，实验组之间均未发现统计学上的显著差异（即恢复情况（p = 0.82）和随访时对神经刺激治疗的满意度（p = 0.06））。次要参数方面也是如此。在导线植入期间患者对镇静的满意度（副作用和操作回忆）与随访时的满意度之间发现了相关性。
关于神经刺激治疗的长期疗效，右美托咪定组和丙泊酚组之间未发现统计学上的显著差异。与丙泊酚组相比，我们观察到右美托咪定组在随访时对神经刺激治疗的满意度有更高的趋势。
