Percutaneous auricular nerve stimulation (neuromodulation) for the treatment of pain following outpatient surgery: a proof-of-concept case series.

Autor:	Ilfeld BM; Department of Anesthesiology, University of California San Diego, La Jolla, California, USA bilfeld@health.ucsd.edu., Finneran Iv JJ; Department of Anesthesiology, University of California San Diego, La Jolla, California, USA., Dalstrom D; Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, USA., Wallace AM; Department of Surgery, University of California San Diego, La Jolla, California, USA., Abdullah B; Department of Anesthesiology, University of California San Diego, La Jolla, California, USA., Said ET; Department of Anesthesiology, University of California San Diego, La Jolla, California, USA.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2022 Jun 17. Date of Electronic Publication: 2022 Jun 17.
DOI:	10.1136/rapm-2022-103777
Abstrakt:	Background: Following outpatient surgery, it is often difficult to provide adequate analgesia while concurrently minimizing opioid requirements. Ultrasound-guided percutaneous peripheral nerve stimulation has been proposed as an analgesic, but requires physician-level skills, advanced equipment, up to an hour to administer, and is frequently cost prohibitive. In contrast, percutaneous auricular neuromodulation may be placed by nursing staff in a few minutes without additional equipment, theoretically provides analgesia for nearly any anatomic location, lacks systemic side effects, and has no significant risks. We now present a case report to demonstrate proof of concept for the off-label use of an auricular neuromodulation device-originally developed to treat symptoms associated with opioid withdrawal-to instead provide analgesia following outpatient surgery. Case Presentation: Following moderately painful ambulatory orthopedic and breast surgery, seven patients had an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) affixed within the recovery room in approximately 5 min and discharged home. Average resting and dynamic pain scores measured on the 0-10 Numeric Rating Scale were a median of 1 over the first 2 days, subsequently falling to 0. Five patients avoided opioid use entirely, while the remaining two each consumed 5 mg of oxycodone during the first 1-2 postoperative days. After 5 days, the devices were removed at home and discarded. Conclusions: These cases demonstrate that ambulatory percutaneous auricular neuromodulation is feasible and may be an effective analgesic and decreasing or even negating opioid requirements following outpatient surgery. Considering the lack of systemic side effects, serious adverse events, and misuse/dependence/diversion potential, further study with a randomized, controlled trial appears warranted. Competing Interests: Competing interests: The University of California San Diego has received funding and/or product from the following companies for other research studies of the authors: Epimed International (Farmers Branch, Texas, USA), SPR Therapeutics (Cleveland, Ohio, USA), Infutronix (Natick, Massachusetts, USA), and Avanos Medical (Irvine, California, USA). (© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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