“Neuralgia” after surgery may reduce the need for opioids


Sarah D. Collins
Health Day reporter

Wednesday, April 21, 2021 (HealthDay News)-An emerging technology may disrupt your development afterwards pain Leave-little or no Opioids need.

This technique is called percutaneous peripheral nerve stimulation. It involves inserting a thin wire next to the nerve and using a stimulator to deliver a gentle current to the affected area, interrupting the spread of pain.

A team led by Dr. Brian Ilfeld of the University of California, San Diego tested patients undergoing foot, ankle or knee surgery or major shoulder surgery. The wires can be placed when the patient is awake without sedation.

Ilfeld said: “It’s very simple.” “You numb your skin, then pass the needle through that location… and use Ultrasound The machine guides the needle to the target nerve and about one centimeter away from the target nerve, and then unfolds the wire (located inside the lead). Therefore, you basically only need to pull out the needle to leave the wire in place. “

carry on

The patient will then undergo surgery and be ready to wake up with the device. They are already very comfortable because the doctor used nerve blocks to relieve the pain for 10 to 12 hours, Ilfeld said.

He said: “When they are in the recovery room, we will install a stimulator the size of two half-dollars placed next to each other.” “It is small enough that you can stick it on the patient.”

At home, participants used battery-powered pulse generators to control electrical stimulation.

65 volunteers participated in the pilot study, 31 of them were in the active device group, and the rest received virtual devices. Just in case, everyone received opioid analgesics. Two weeks later, the lead was removed during the postoperative examination. The patient was followed up for four months.

The research results were recently published online in the journal Anesthesiology Better than the doctor hoped.

Ilfeld said: “We have drastically reduced the use of opioids by 80% and reduced the pain score by about 60%.” “So it is much stronger than we expected.”

carry on

Ilfeld said the possibility is promising, but the scale of this preliminary study is too small to make a clear claim. He explained that in addition, the device can only work on a relatively small area of ​​the body and is not effective for surgery involving multiple nerve areas.

A more extensive study is currently underway to understand whether neurostimulation techniques can be integrated into future surgical pain relief practices.

According to Dr. David Dickerson, chairman of the Pain Medicine Committee of the American Academy of Anesthesiologists, if the method becomes routine, its implications could be revolutionary.

Dixon said: “Even though we have developed a variety of new anti-inflammatory drugs and nerve blockers, patients after surgery still have almost the same morbidity or uncontrolled moderate to severe pain as 15 to 20 years ago. He added that the reason for the pain reduction by more than 50% and the 80% reduction in opioid exposure is that “this will move the needle for the first time.”

carry on

Dixon said that SPR Therapeutics, the manufacturer of the stimulation system, paid him to tell other doctors how to use the device to treat chronic pain. He added that he has no other financial connections with the company.

The breakthrough may help alleviate the opioid epidemic in the country.

An estimated 2 million Americans abuse drugs, and 90 people die from opioid overdose every day. Many people start to use them in the hospital to control pain and then cannot stop.

Ilfeld said: “One way to make people addicted to opioids is to actually use them for postoperative pain control after surgery, and then continue to use them and continue to need them.”

The doctor said that although some patients in the study do need opioids in addition to nerve stimulation, any technology that reduces drug use can save lives.

More information

For more information about post-operative care, please visit National Institutes of Health.

Source: Brian Ilfeld, MD, MS, Professor of Anesthesiology, University of California, San Diego; David Dickerson, MD, Chairman of the Pain Medicine Committee of the American Society of Anesthesiologists, North Shore University, Evanston, Illinois Head of the Pain Medicine Department of the Health System; Anesthesiology, April 15, 2021, online


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