Peripheral Nerve Stimulation Reduced Pain, Opioid Use After Ambulatory Orthopedic Surgery

Pain scores and opioid usage reduced during the first week after ambulatory orthopedic surgery with percutaneous peripheral nerve stimulation. These findings from a randomized, sham-controlled pilot study were published in Anesthesiology.

Patients (N=66) undergoing ambulatory orthopedic surgery at 7 centers in the US were recruited between January 2019 and September 2020 for this study. Prior to surgery, patients had a percutaneous lead inserted in the brachial plexus, femoral, or sciatic nerve using ultrasound guidance. Patients were randomly assigned to receive active electric stimulation (n=32) or sham (n=34) treatment. Opioid consumption and pain rating on a 10-point scale were assessed for 7 days after surgery.

Patients in the active and sham groups had a mean age of 56.8±15.8 and 55.4±15.9 years and 48% and 50% were women, respectively. Of the patients in each group, 42% and 24% underwent rotator cuff repair, 29% and 32% had hallux valgus correction, 13% and 15% had ankle arthroplasty, 13% and 21% had ankle arthrodesis, and 3% and 9% had anterior cruciate ligament reconstruction, respectively.

Median opioid consumption during the first 7 days was 5 (interquartile range [IQR], 0-30) mg among the treatment group and 48 (IQR, 25-90) mg among the sham group (estimated ratio of geometric means [GM], 0.20; 95% CI, 0.07-0.57; P <.001).

Reported average pain intensity was 1.1±1.1 among the treatment and 3.1±1.7 among the sham cohorts (difference in means from linear mixed effects model, -1.8; 97.5% CI, -2.6 to -0.9; P <.001).

No interaction effects for opioid consumption or pain scores were observed for gender (P =.61; P =.52) or surgical procedure (P =.99; P =.63), respectively.

When asked which treatment they received, only 1 sham recipient correctly guessed their group assignment.

Adverse events included unpleasant sensation in the nerve (n=1), erythema under the dressing (n=1), and lead fracture during removal (n=2).

This procedure was limited by the increased time patients required for surgery preparation due to the need for nerve lead insertion, which increased health care utilization.

The study authors concluded that this pilot study demonstrated the benefits of using peripheral nerve stimulation during ambulatory orthopedic surgery, justifying a larger trial.

Disclosure: Several study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see to the original reference for a full list of authors’ disclosures.

Reference

Ilfeld BM, Plunkett A, Vijjeswarapu AM, et al; PAINfRE Investigators. Percutaneous peripheral nerve stimulation (neuromodulation) for postoperative pain: a randomized, sham-controlled pilot study. Anesthesiology. Published online April 15, 2021. doi:10.1097/ALN.0000000000003776