Neuromodulation using a hybrid technique of combined perineural local anesthetic and nerve stimulation in six challenging clinical scenarios
© 2022. Canadian Anesthesiologists' Society..
PURPOSE: Postamputation pain is challenging because of complex mechanisms involving a multitude of pain pathways and psychological factors. This patient population also tends to have extensive comorbidities with or without a background of chronic pain. Electrical neuromodulation such as peripheral nerve stimulation has gained traction in the realm of chronic pain. Recently, the off-label use of hybrid perineural nerve stimulation in combination with locoregional block via the stimulating nerve block catheter has been described in single-center case reports.
CLINICAL FEATURES: Herein, we present a case series of six patients from two different Canadian hospitals using such a hybrid technique in three different clinical scenarios. These scenarios were (1) local anesthetic dose minimization in the presence of multiple nerve block catheters, (2) analgesia augmentation when local anesthetic alone is insufficient, and (3) provision of an analgesic adjunct as part of a multimodal regimen. A stimulating sciatic nerve block catheter was inserted under ultrasound and nerve stimulation guidance for these cases. Patients tended to experience pain on the subsequent postoperative days whereby the off-label use of nerve stimulation successfully reduced their pain score and stabilized or decreased their opioid consumption or minimized the need to increase the local anesthetic dose when doing so could have precipitated local anesthetic toxicity.
CONCLUSION: Our case series supports the feasibility of using a combination of low-frequency perineural stimulation and local anesthetic infusion via a single perineural nerve block catheter to manage challenging postamputation pain.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:70 |
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| Enthalten in: |
Canadian journal of anaesthesia = Journal canadien d'anesthesie - 70(2023), 2 vom: 24. Feb., Seite 273-279 |
| Sprache: |
Englisch |
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| Weiterer Titel: |
Neuromodulation à l’aide d’une technique hybride d’anesthésie locale périnerveuse combinée et de stimulation nerveuse dans six scénarios cliniques difficiles |
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| Beteiligte Personen: |
Ip, Vivian H Y [VerfasserIn] |
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| Links: |
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| Themen: |
Anesthetics, Local |
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| Anmerkungen: |
Date Completed 28.02.2023 Date Revised 26.12.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s12630-022-02373-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Neuromodulation using a hybrid technique of combined perineural local anesthetic and nerve stimulation in six challenging clinical scenarios |
| 246 | 3 | 3 | |a Neuromodulation à l’aide d’une technique hybride d’anesthésie locale périnerveuse combinée et de stimulation nerveuse dans six scénarios cliniques difficiles |
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| 500 | |a Date Revised 26.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. Canadian Anesthesiologists' Society. | ||
| 520 | |a PURPOSE: Postamputation pain is challenging because of complex mechanisms involving a multitude of pain pathways and psychological factors. This patient population also tends to have extensive comorbidities with or without a background of chronic pain. Electrical neuromodulation such as peripheral nerve stimulation has gained traction in the realm of chronic pain. Recently, the off-label use of hybrid perineural nerve stimulation in combination with locoregional block via the stimulating nerve block catheter has been described in single-center case reports | ||
| 520 | |a CLINICAL FEATURES: Herein, we present a case series of six patients from two different Canadian hospitals using such a hybrid technique in three different clinical scenarios. These scenarios were (1) local anesthetic dose minimization in the presence of multiple nerve block catheters, (2) analgesia augmentation when local anesthetic alone is insufficient, and (3) provision of an analgesic adjunct as part of a multimodal regimen. A stimulating sciatic nerve block catheter was inserted under ultrasound and nerve stimulation guidance for these cases. Patients tended to experience pain on the subsequent postoperative days whereby the off-label use of nerve stimulation successfully reduced their pain score and stabilized or decreased their opioid consumption or minimized the need to increase the local anesthetic dose when doing so could have precipitated local anesthetic toxicity | ||
| 520 | |a CONCLUSION: Our case series supports the feasibility of using a combination of low-frequency perineural stimulation and local anesthetic infusion via a single perineural nerve block catheter to manage challenging postamputation pain | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a neuromodulation | |
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| 700 | 1 | |a Kotteeswaran, Yuvaraj |e verfasserin |4 aut | |
| 700 | 1 | |a Prete, Savannah |e verfasserin |4 aut | |
| 700 | 1 | |a Sondekoppam, Rakesh V |e verfasserin |4 aut | |
| 700 | 1 | |a Tsui, Ban C H |e verfasserin |4 aut | |
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