Percutaneous peripheral nerve stimulation yields impressive reductions in pain scores and opioid use during the first week after common orthopaedic surgery procedures, according to a study published online first in the journal Anesthesiology.
The benefits of postoperative nerve stimulation were “much greater than what we had anticipated, concurrently reducing pain scores by more than 50% and opioid consumption by 80%,” wrote Brian M. Ilfeld, MD, University of California at San Diego, San Diego, California, and colleagues.
The authors believe that peripheral nerve stimulation could be a safe, effective, opioid reducing, non-drug adjunct for pain management after surgery.
In percutaneous peripheral nerve stimulation, a tiny electrical lead is placed alongside a nerve and connected to a battery-powered pulse generator. The generator delivers mild electrical stimulation to the nerve, interrupting pain transmission. Although this neuromodulation technique has been widely used for patients with chronic pain, the current study is the first randomised controlled trial to evaluate its use for acute pain after surgery.
The double-blinded study enrolled 65 patients undergoing common outpatient joint surgery, such as bunion surgery in the foot or rotator cuff repair in the shoulder. All patients underwent lead placement near the nerve(s) serving the surgical joint. Half of the patients were randomised to active electrical stimulation, adjusted to achieve the desired sensory change, and the other half received an inactive sham treatment. After 1 week, pain scores and opioid use were compared between groups.
The results showed significantly lower pain ratings in the active nerve stimulation group. Mean pain score (on a 0 to 10 scale) was 1.1 in patients receiving active treatment, compared with 3.1 in the sham group.
Active nerve stimulation was also associated with a much lower use of opioids to control postoperative pain. Median opioid dose (oral morphine equivalents) for the entire first week after surgery was 5 mg in the active treatment group, compared with 48 mg in the sham group.
Although the trial was designed as a pilot study, the results “stand on their own and indicate that percutaneous peripheral nerve stimulation is highly effective for acute pain,” the authors wrote.