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Combining Awake Anesthesia with Minimal Invasive Surgery Optimizes Intraoperative Surgical Spinal Cord Stimulation Lead Placement
- Source :
- Journal of Clinical Medicine; Volume 11; Issue 19; Pages: 5575
- Publication Year :
- 2022
- Publisher :
- MDPI AG, 2022.
-
Abstract
- Spinal cord stimulation (SCS) is an effective and validated treatment to address chronic refractory neuropathic pain in persistent spinal pain syndrome-type 2 (PSPS-T2) patients. Surgical SCS lead placement is traditionally performed under general anesthesia due to its invasiveness. In parallel, recent works have suggested that awake anesthesia (AA), consisting of target controlled intra-venous anesthesia (TCIVA), could be an interesting tool to optimize lead anatomical placement using patient intra-operative feedback. We hypothesized that combining AA with minimal invasive surgery (MIS) could improve SCS outcomes. The goal of this study was to evaluate SCS lead performance (defined by the area of pain adequately covered by paraesthesia generated via SCS), using an intraoperative objective quantitative mapping tool, and secondarily, to assess pain relief, functional improvement and change in quality of life with a composite score. We analyzed data from a prospective multicenter study (ESTIMET) to compare the outcomes of 115 patients implanted with MIS under AA (MISAA group) or general anesthesia (MISGA group), or by laminectomy under general anesthesia (LGA group). All in all, awake surgery appears to show significantly better performance than general anesthesia in terms of patient pain coverage (65% vs. 34–62%), pain surface (50–76% vs. 50–61%) and pain intensity (65% vs. 35–40%), as well as improved secondary outcomes (quality of life, functional disability and depression). One step further, our results suggest that MISAA combined with intra-operative hypnosis could potentialize patient intraoperative cooperation and could be proposed as a personalized package offered to PSPS-T2 patients eligible for SCS implantation in highly dedicated neuromodulation centers.
- Subjects :
- Treatment
surgery
PSPS
FBSS
SCS
surgical lead
SCS implantation
MAST (for minimal access spine technologies)
TCIVA (for target controlled intra-venous anesthesia)
composite score
pain mapping
neuropathic pain
chronic pain
quality of life
anesthesia
hypnosis
spinal cord stimulation
Radiology Nuclear Medicine and imaging
Neuroscience(all)
chronic refractory neuropathic pain
PSPS-T2
General Medicine
anesthesiology
Subjects
Details
- ISSN :
- 20770383
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Medicine
- Accession number :
- edsair.doi.dedup.....4be5c1b3f8a8bbe6c2d0ef70ead83624