Nerve stimulation reduces pain and opioid use after orthoped
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A technique called percutaneous peripheral nerve stimulation yields "impressive" reductions in pain scores and opioid use during the first week after common orthopedic surgery procedures, concludes a randomized clinical trial published in Anesthesiology.

Percutaneous peripheral nerve stimulation is an analgesic technique involving the percutaneous implantation of a lead followed by the delivery of electric current using an external pulse generator.

The current multicenter study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent clinical trial and (2) estimate the treatment effect of percutaneous peripheral nerve stimulation on postoperative pain and opioid consumption.

Preoperatively, an electrical lead was percutaneously implanted to target the sciatic nerve for major foot/ankle surgery, the femoral nerve for anterior cruciate ligament reconstruction, or the brachial plexus for rotator cuff repair, followed by a single injection of long-acting local anesthetic along the same nerve/plexus. Postoperatively, participants were randomized to 14 days of either electrical stimulation (n = 32) or sham stimulation (n = 34) using an external pulse generator in a double-masked fashion. The dual primary treatment effect outcome measures were (1) cumulative opioid consumption and (2) mean values of the “average” daily pain scores measured on the 0 to 10 Numeric Rating Scale within the first 7 postoperative days.

--During the first 7 postoperative days, opioid consumption in participants given active stimulation was a median of 5 mg versus 48 mg in patients given sham treatment.

--During this same period, the average pain intensity in patients given active stimulation was a mean ± SD of 1.1 ± 1.1 versus 3.1 ± 1.7 in those given sham.

In conclusion, percutaneous peripheral nerve stimulation reduced pain scores and opioid requirements free of systemic side effects during at least the initial week after ambulatory orthopedic surgery.