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Perioperative and anesthetic considerations for the management of neuromodulation systems
  1. Vwaire Orhurhu1,2,
  2. Nasir Hussain3,
  3. Jay Karri4,
  4. Edward R Mariano5,6 and
  5. Alaa Abd-Elsayed7
  1. 1 Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, USA
  2. 2 Pain Medicine, MVM Health, East Stroudsburg, Pennsylvania, USA
  3. 3 Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  4. 4 Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
  5. 5 Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
  6. 6 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  7. 7 Department of Anesthesia, Divsion of Pain Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Dr Vwaire Orhurhu, Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, 17701, USA; vwo569{at}


The use of neuromodulation systems is increasing for the treatment of various pathologies ranging from movement disorders to urinary incontinence to chronic pain syndromes. While the type of neuromodulation devices varies, they are largely categorized as intracranial (eg, deep brain stimulation), neuraxial (eg, spinal cord stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery systems), or peripheral (eg, sacral nerve stimulation and peripheral nerve stimulation) systems. Given the increasing prevalence of these systems in the overall population, it is important for anesthesiologists, surgeons, and the perioperative healthcare team to familiarize themselves with these systems and their unique perioperative considerations. In this review, we explore and highlight the various neuromodulation systems, their general perioperative considerations, and notable special circumstances for perioperative management.

  • Pain Measurement
  • Spinal Cord Stimulation
  • Pain, Postoperative

Data availability statement

Data are available upon reasonable request. Not applicable.

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Data availability statement

Data are available upon reasonable request. Not applicable.

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  • VO and NH are joint first authors.

  • Twitter @EMARIANOMD

  • Contributors All authors contributed to this manuscript to warrant authorship. Vwaire Orhurhu is the guarantor for this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AA-E is a consultant of Medtronic, Avanos and Averitas. VO is a consultant of Medtronic and Boston Scientific.

  • Provenance and peer review Not commissioned; externally peer reviewed.