Percutaneous Neuromodulation of the Brachial Plexus and Sciatic Nerve for the Treatment of Acute Pain Following Surgery: Secondary Outcomes From a Multicenter, Randomized, Controlled Pilot Study.

Abstract

OBJECTIVES:

We recently reported that percutaneous peripheral nerve stimulation (PNS or "neuromodulation") decreased pain and opioid consumption within the first two weeks following ambulatory surgery. However, the anatomic lead locations were combined for the analysis, and benefits for each location remain unknown. We therefore now report the effects of percutaneous PNS for brachial plexus and sciatic nerve leads separately.

MATERIALS AND METHODS:

Before surgery, leads were implanted percutaneously to target the brachial plexus (N = 21) for rotator cuff repair or sciatic nerve (N = 40) for foot/ankle surgery, followed by a single injection of local anesthetic. Postoperatively, subjects were randomized in a double masked fashion to 14 days of electrical stimulation (N = 30) or sham/placebo (N = 31) using an external pulse generator. The primary outcome of interest was opioid consumption and pain scores evaluated jointly. Thus, stimulation was deemed effective if superior on either outcome and at least noninferior on the other.

RESULTS:

For brachial plexus leads, during the first seven postoperative days pain measured with the numeric rating scale in participants given active stimulation was a median [interquartile range] of 0.8 [0.5, 1.6] versus 3.2 [2.7, 3.5] in patients given sham (p < 0.001). For this same group, opioid consumption in participants given active stimulation was 10 mg [5, 20] versus 71 mg [35, 125] in patients given sham (p = 0.043). For sciatic nerve leads, pain scores for the active treatment group were 0.7 [0, 1.4] versus 2.8 [1.6, 4.6] in patients given sham (p < 0.001). During this same period, participants given active stimulation consumed 5 mg [0, 30] of opioids versus 40 mg [20, 105] in patients given sham (p = 0.004). Treatment effects did not differ statistically between the two locations.

CONCLUSIONS:

Ambulatory percutaneous PNS of both the brachial plexus and sciatic nerve is an effective treatment for acute pain free of systemic side effects following painful orthopedic surgery.

• Authors: Brian M Ilfeld, Anthony Plunkett, Alice M Vijjeswarapu, Robert Hackworth, Sandeep Dhanjal, Alparslan Turan, Steven P Cohen, James C Eisenach, Scott Griffith, Steven Hanling, Daniel I Sessler, Edward J Mascha, Yanyan Han, Joseph W Boggs, Amorn Wongsarnpigoon, Harold Gelfand, PAINfRE Investigators
• Journal: Neuromodulation : journal of the International Neuromodulation Society (Neuromodulation) Vol. 26 Issue 3 Pg. 638-649 (Apr 2023) ISSN: 1525-1403 [Electronic] United States
• PMID: 34343394 (Publication Type: Randomized Controlled Trial, Multicenter Study, Journal Article)
• Copyright: Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid

Topics

• Humans
• Analgesics, Opioid (therapeutic use)
• Pilot Projects
• Transcutaneous Electric Nerve Stimulation
• Pain
• Sciatic Nerve
• Brachial Plexus