Chronic Postoperative Pain After Hypoglossal Nerve Stimulation Implant Surgery: Analgesia Options When Traditional...

Hypoglossal nerve stimulation implant surgery (HNSIS) is generally associated with minimal postoperative pain; however, persistent postsurgical pain can occur and may significantly limit use of therapy. Opioid-induced hyperalgesia (OIH) is a known phenomenon that has not been previously described in the setting of HNSIS. We review proposed mechanisms underlying OIH and chronic postsurgical pain following HNSIS, including aberrant nociceptor re-innervation, nociceptor hyperexcitability, and neuroplastic changes associated with cranial nerve 12, cervical spinal nerve 1, and branches of trigeminal nerve V3. This commentary discusses the potential role of targeted regional nerve blocks for these cases. Specifically, blockade of the C2/C3 cervical nerve distributions and the trigeminal nerve V3 branch may provide effective analgesia when the traditional oral medications fail to provide adequate relief. This approach may offer a treatment option for select patients with chronic pain following HNSIS and must be considered in cases of complex postoperative pain management.