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Percutaneous auricular nerve stimulation (neuromodulation) for the treatment of pain: A proof-of-concept case report using total joint arthroplasty as a surrogate for battlefield trauma

May 28, 2023

BACKGROUND:
There are few effective pain treatments following trauma on the battlefield other than opioids, which are limited by respiratory de- pression. Ultrasound-guided percutaneous peripheral nerve stimulation (“neuromodulation”) has been proposed as an analgesic, but requires physician-level skills, advanced equipment, and an hour to administer. In contrast, percutaneous auricular neuromod- ulation may be placed by a medic in the field under nonsterile conditions in a few minutes, theoretically provides analgesia for any anatomic location, has no side effects, and no significant risks. It therefore offers the potential to be applied quickly on the battle- field without any of the limitations of opioids. We propose total joint replacement as a surrogate for battlefield trauma and here present a case report to demonstrate proof of concept.
METHODS:
Following open total knee or hip arthroplasty under spinal anesthesia, two patients had an auricular neuromodulation device applied within the recovery room. Patients were discharged with the unit and contacted daily for 7 days.
RESULTS:
The devices were each applied in under 3 minutes without difficulty, were well tolerated during use, and removed without compli- cation at home on Day 5. During use, neither patient experienced pain while lying, sitting, or ambulating. Neither required anal- gesics other than scheduled celecoxib; and a single tablet (50 mg) of tramadol for one patient on postoperative Days 3 and 4 for pain while lowering herself to a seated position. On Days 6 and 7, both patients experienced an increase in pain, one of whom re- quired around-the-clock tramadol.
CONCLUSION:
Ambulatory postoperative percutaneous auricular neuromodulation is feasible. In these two cases, it appears to have markedly re- duced pain scores and opioid requirements free of systemic side effects during the week following major orthopedic surgery. Con- sidering the potential of this modality to treat trauma on the battlefield without systemic side effects, additional investigation ap- pears warranted. (J Trauma Acute Care Surg. 2022;93: S165–S168. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.)
LEVEL OF EVIDENCE: Therapeutic/care management; Level V.
KEY WORDS:
Neuromodulation; percutaneous auricular nerve stimulation; percutaneous nerve stimulation; vagus nerve stimulation; battlefield trauma; case report.