Background Following outpatient surgery, it is often difficult to provide adequate analgesia while concurrently minimizing opioid requirements. Ultrasound-guided percutaneous peripheral nerve stimulation has been proposed as an analgesic, but requires physician-level skills, advanced equipment, up to an hour to administer, and is frequently cost prohibitive. In contrast, percutaneous auricular neuromodulation may be placed by nursing staff in a few minutes without additional equipment, theoretically provides analgesia for nearly any anatomic location, lacks systemic side effects, and has no significant risks. We now present a case report to demonstrate proof of concept for the off-label use of an auricular neuromodulation device—originally developed to treat symptoms associated with opioid withdrawal—to instead provide analgesia following outpatient surgery.
Case presentation Following moderately painful ambulatory orthopedic and breast surgery, seven patients had an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) affixed within the recovery room in approximately 5 min and discharged home. Average resting and dynamic pain scores measured on the 0–10 Numeric Rating Scale were a median of 1 over the first 2 days, subsequently falling to 0. Five patients avoided opioid use entirely, while the remaining two each consumed 5 mg of oxycodone during the first 1–2 postoperative days. After 5 days, the devices were removed at home and discarded.
Conclusions These cases demonstrate that ambulatory percutaneous auricular neuromodulation is feasible and may be an effective analgesic and decreasing or even negating opioid requirements following outpatient surgery. Considering the lack of systemic side effects, serious adverse events, and misuse/dependence/diversion potential, further study with a randomized, controlled trial appears warranted.
- Postoperative Pain
- Ambulatory Care
- Pain, Postoperative
- Acute Pain
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Collaborators not applicable.
Contributors BMI: identified the intervention, identified and contacted potential patients, followed patients, collected data, wrote the initial manuscript draft, and approved the final draft. JJF: helped develop the intervention pathway, administered the intervention, helped revise the manuscript, and approved the final draft. DD: helped develop the intervention pathway, following patients, helped revise the manuscript, and approved the final draft. AMW: helped develop the intervention pathway, following patients, helped revise the manuscript, and approved the final draft. BA: assisted in patient management, helped revise the manuscript, and approved the final draft. ETS: helped develop the intervention pathway, administered the intervention, helped revise the manuscript, and approved the final draft.
Funding Funding for this project provided by the University California San Diego Department of Anesthesiology (San Diego, California, USA).
Disclaimer The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding entity. None of the authors has a personal financial interest in this research.
Competing interests The University of California San Diego has received funding and/or product from the following companies for other research studies of the authors: Epimed International (Farmers Branch, Texas, USA), SPR Therapeutics (Cleveland, Ohio, USA), Infutronix (Natick, Massachusetts, USA), and Avanos Medical (Irvine, California, USA).
Provenance and peer review Not commissioned; internally peer reviewed.