‘Nerve Zap’ for Pain After Surgery May Reduce Need for Opioids
WEDNESDAY April 21, 2021 (HealthDay News) – Emerging technology could eliminate your postoperative pain – little to no opioids needed.
The technique is called percutaneous peripheral nerve stimulation. This involves inserting a small wire next to a nerve and using a stimulator to deliver a slight electric current to the affected area, interrupting the transmission of pain.
A team led by Dr. Brian Ilfeld, of the University of California, San Diego, tested the device in patients who were undergoing foot, ankle or knee surgery or major shoulder surgery. The wire can be placed while the patient is awake, without the need for sedation.
“It’s pretty straightforward,” Ilfeld said. “You numb the skin and put the needle there… then you use an ultrasound machine to guide the needle to the target nerve and about an inch away from it, you deploy the probe, which is at the end of it. inside the needle. So you just pull the needle out, leaving the thread in place. “
Patients then have their procedure and wake up with the device ready for use. They’re already comfortable because doctors use nerve blocks to relieve their pain for 10 to 12 hours, Ilfeld said.
“When they’re in the recovery room, we attach a pacemaker, which is about the size of two half dollars placed next to each other,” he said. “It’s small enough that you can just stick it on the patient.”
At home, participants used a battery-powered pulse generator to control electrical stimulation.
Sixty-five volunteers participated in this pilot study, 31 in the active device group and the rest receiving a dummy device. All received opioid pain relievers just in case. Two weeks later, the probe was removed during a postoperative check-up. The patients were followed for up to four months.
The results, recently published online in the journal Anesthesiology, were better than doctors could have hoped for.
“We have significantly reduced opioid use, by 80%, and we have decreased pain scores by approximately 60%,” said Ilfeld. “So it was a lot more powerful than we expected.”
The possibilities are promising, but the size of this initial study was too small to make definitive claims, Ilfeld said. Additionally, the device can only work on relatively small areas of the body and would not be effective for a procedure that encompasses multiple nerve regions, he explained.
Further study is underway to see if the nerve stimulation technique could be incorporated into future pain relief surgical practices.
If the method becomes the norm, the implications could be revolutionary, according to Dr. David Dickerson, chair of the Pain Medicine Committee of the American Society of Anesthesiologists.
“Even though we have developed all kinds of new anti-inflammatory drugs and new nerve blockages, patients after surgery still have the exact same incidence or likelihood of having moderate to severe uncontrolled pain” as there are 15 to 20 years old, Dickerson said. Something that leads to over 50% reduction in pain and 80% reduction in opioid exposure is, “for the first time, something that will move that needle,” he added.
Dickerson said SPR Therapeutics, maker of the stimulation system, had paid him to show other doctors how to use the device for chronic pain. He added that he had no other financial connection with the company.
This breakthrough could help alleviate the opioid epidemic in the country.
It is estimated that 2 million Americans abuse it and 90 people die every day from an opioid overdose. Many start using them in the hospital to manage pain and cannot stop.
Ilfeld said: “One of the ways people get addicted to opioids is by having them first after surgery for postoperative pain control, then they just keep using them and keep wanting them.”
While some patients in the study needed opioids in addition to nerve stimulation, any technology that reduces drug use could save lives, doctors said.
To learn more about postoperative care, visit the US National Institutes of Health.
SOURCES: Brian Ilfeld, MD, MS, professor, anesthesiology, University of California, San Diego; David Dickerson, MD, chair, Committee on Pain Medicine, American Society of Anesthesiologists, and Section Head for Pain Medicine, NorthShore University Health System, Evanston, Illinois; Anesthesiology, April 15, 2021, online
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