Auricular Percutaneous Electrical Nerve Field Stimulation for Postoperative Pain Control in Adults

Carrie Peterson, Medical College of Wisconsin

Impact of Auricular Neurostimulation in Patients Undergoing Colorectal Surgery with an Enhanced Recovery Protocol: A Pilot Randomized, Controlled Trial

Abstract

Background

Narcotics are the cornerstone of postoperative pain control, but the opioid epidemic and the negative physiological and psychological effects of narcotics implore physicians to utilize nonpharmacological methods of pain control.

Objective

This pilot study investigated a novel neurostimulation device for postoperative analgesia. We hypothesized that active neurostimulation would decrease postoperative narcotic requirements.

Design

This was a placebo-controlled, double-blinded trial.

Settings

This trial was conducted at an academic medical center and a Veterans Affairs hospital.

Patients

This trial included adult patients who underwent elective bowel resection between December 2016 and April 2018.

Interventions

Patients were randomly assigned to receive an active or inactive (sham) device, which was applied to the right ear before surgery and continued for 5 days.

Main outcome measures

The primary outcome was total opioid consumption. The secondary outcomes included pain, nausea, anxiety, return of bowel function, complications, 30-day readmissions, and opioid consumption at 2 weeks and 30 days.

Results

A total of 57 patients participated and 5 withdrew; 52 patients were included in the analysis. Twenty-eight patients received an active device and 24 received an inactive device. There was no difference in total narcotic consumption between active and inactive devices (90.79 ± 54.93 vs 90.30 ± 43.03 oral morphine equivalents/day). Subgroup analyses demonstrated a benefit for patients after open surgery (p = 0.0278). When patients were stratified by decade, those aged 60 to 70 and >70 years derived a benefit from active devices in comparison with those aged 30 to 40, 40 to 50, and 50 to 60 years old (p = 0.01092). No serious adverse events were related to this study.

Limitations

This study was limited by the small sample sizes.

Conclusions

No difference in opioid use was found with auricular neurostimulation. However, this pilot study suggests that older patients and those with larger abdominal incisions may benefit from auricular neurostimulation. Further investigation in these high-risk patients is warranted.

See Video Abstract at http://links.lww.com/DCR/B452.

ClinicalTrials.gov identifier: NCT02892513.

Blank, Jacqueline J et al. “Impact of Auricular Neurostimulation in Patients Undergoing Colorectal Surgery with an Enhanced Recovery Protocol: A Pilot Randomized, Controlled Trial.” Diseases of the colon and rectum vol. 64,2 (2021): 225-233. doi:10.1097/DCR.0000000000001752