Anaesthesiologic Department, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
Centre for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.
Clin Neurophysiol. 2023 May;149:81-87. doi: 10.1016/j.clinph.2023.02.174. Epub 2023 Mar 9.
Repetitive transcranial magnetic stimulation (rTMS) may be a relevant method to assist postoperative pain. However, studies to date have only used conventional 10 Hz rTMS and targeted the DLPFC for postoperative pain. A more recent form of rTMS, termed intermittent Theta Burst Stimulation (iTBS), enables to increase cortical excitability in a short period of time. This preliminary double-blind, randomised, sham controlled study was designed to evaluate the efficacy of iTBS in postoperative care across two distinct stimulation targets.
A group of 45 patients post laparoscopic surgery were randomised to receive a single session of iTBS over either the dorsolateral prefrontal cortex (DLPFC), primary motor cortex (M1), or Sham stimulation (1:1:1 ratio). Outcome measurements were number of pump attempts, total anaesthetic volume used, and self-rated pain experience, assessed at 1 hour, 6 hours, 24 hours, and 48 hours post stimulation. All randomised patients were analysed (n = 15 in each group).
Compared to Sham stimulation, DLPFC-iTBS reduced pump attempts at 6 (DLPFC = 0.73 ± 0.88, Sham = 2.36 ± 1.65, P = 0.031), 24 (DLPFC = 1.40 ± 1.24, Sham = 5.03 ± 3.87, P = 0.008), and 48 (DLPFC = 1.47 ± 1.41, Sham = 5.87 ± 4.34, P = 0.014) hours post-surgery, whereby M1 stimulation had no effect. No group effect was observed on total anaesthetics, which was mainly provided through the continuous administration of opioids at a set speed for each group. There was also no group or interaction effect on pain ratings. Pump attempts were positively associated with pain ratings in the DLPFC (r = 0.59, P = 0.02) and M1 (r = 0.56, P = 0.03) stimulation.
Our findings show that iTBS to the DLPFC reduces pump attempts for additional anaesthetics following a laparoscopic surgery. However, reduced pump attempts by DLPFC stimulation did not translate into a significantly smaller volume of total anaesthetic, due to the continuous administration of opioids at a set speed for each group.
Our findings therefore provide preliminary evidence for iTBS targeting the DLPFC to be used to improve postoperative pain management.
重复经颅磁刺激（rTMS）可能是一种辅助术后疼痛的相关方法。然而，迄今为止的研究仅使用常规的 10Hz rTMS 并针对 DLPFC 进行术后疼痛。rTMS 的一种较新形式，称为间歇 theta 爆发刺激（iTBS），能够在短时间内增加皮质兴奋性。这项初步的双盲、随机、假对照研究旨在评估两种不同刺激靶点的 iTBS 在术后护理中的疗效。
一组 45 例腹腔镜手术后的患者被随机分为接受单次 iTBS 治疗，刺激部位分别为背外侧前额叶皮层（DLPFC）、初级运动皮层（M1）或假刺激（1:1:1 比例）。在刺激后 1 小时、6 小时、24 小时和 48 小时，通过泵尝试次数、总麻醉量和自我报告的疼痛体验进行评估。所有随机患者均进行了分析（每组 15 名）。
与假刺激相比，DLPFC-iTBS 在术后 6 小时（DLPFC=0.73±0.88，Sham=2.36±1.65，P=0.031）、24 小时（DLPFC=1.40±1.24，Sham=5.03±3.87，P=0.008）和 48 小时（DLPFC=1.47±1.41，Sham=5.87±4.34，P=0.014）时减少了泵尝试次数，而 M1 刺激则没有效果。在总麻醉量方面，没有观察到组间效应，这主要是通过为每组以设定速度持续给予阿片类药物来实现的。在疼痛评分方面也没有组间或交互作用。在 DLPFC（r=0.59，P=0.02）和 M1（r=0.56，P=0.03）刺激时，泵尝试次数与疼痛评分呈正相关。
我们的研究结果表明，DLPFC 的 iTBS 可减少腹腔镜手术后额外麻醉的泵尝试次数。然而，由于为每组以设定速度持续给予阿片类药物，因此 DLPFC 刺激减少泵尝试次数并没有转化为总麻醉量的显著减少。
因此，我们的研究结果为使用 DLPFC 靶向 iTBS 改善术后疼痛管理提供了初步证据。
