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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Author Spotlight: Regenerative Peripheral Nerve Interface (RPNI) Surgery in Postamputation Pain Management
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Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled

Brian M Ilfeld, Anthony Plunkett, Alice M Vijjeswarapu

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    Percutaneous peripheral nerve stimulation significantly reduced postoperative pain and opioid use in ambulatory orthopedic surgery patients. This analgesic technique offers a promising alternative to traditional pain management methods.

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    Area of Science:

    • Pain Management
    • Neurosurgery
    • Anesthesiology

    Background:

    • Percutaneous peripheral nerve stimulation (PPNS) is an analgesic method using implanted leads and external pulse generators.
    • While established for chronic pain, its use for acute postoperative pain lacks robust evidence, with only uncontrolled studies published.
    • This multicenter study aimed to assess PPNS feasibility and treatment effects for acute postoperative pain.

    Purpose of the Study:

    • To determine the feasibility and optimize protocols for a future clinical trial on PPNS for acute postoperative pain.
    • To estimate the treatment effect of PPNS on postoperative pain intensity and opioid consumption.

    Main Methods:

    • A percutaneous electrical lead was implanted targeting specific nerves (sciatic, femoral, brachial plexus) based on surgery type.
    • Participants received either active PPNS or sham stimulation for 14 days post-surgery in a double-masked, randomized controlled trial.
    • Primary outcomes included cumulative opioid consumption and average daily pain scores (Numeric Rating Scale) over the first 7 postoperative days.

    Main Results:

    • Active PPNS significantly reduced opioid consumption compared to sham treatment (median 5 mg vs. 48 mg oral morphine equivalents).
    • Average pain intensity was substantially lower in the active PPNS group (1.1 vs. 3.1 on a 0-10 scale).
    • Both outcomes showed statistically significant differences (P < 0.001).

    Conclusions:

    • Percutaneous peripheral nerve stimulation effectively reduced pain scores in the initial week after ambulatory orthopedic surgery.
    • PPNS demonstrated a significant decrease in opioid requirements without reported systemic side effects.
    • The findings support PPNS as a viable analgesic option for postoperative pain management.