Neuromodulation using a hybrid technique of combined perineural local anesthetic and nerve stimulation in six challenging clinical scenarios

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

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:70

Enthalten in:

Canadian journal of anesthesia - 70(2022), 2 vom: 13. Dez., Seite 273-279

Sprache:

Englisch

Beteiligte Personen:

Ip, Vivian H. Y. [VerfasserIn]
Kotteeswaran, Yuvaraj [VerfasserIn]
Prete, Savannah [VerfasserIn]
Sondekoppam, Rakesh V. [VerfasserIn]
Tsui, Ban C. H. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Hybrid technique
Nerve stimulation
Neuromodulation

Anmerkungen:

© Canadian Anesthesiologists' Society 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s12630-022-02373-3

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2134151218

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