For the purposes of this article we’ll focus on stimulators for low back and leg pain. Position the patient in a basic prone position so that the bottom of the c-arm can go under the table below the lumbar and thoracic spine. Device supplies (leads, anchor devices).1-2 14g tuohy needles for epidural space access.10cc 1% lidocaine in a 10cc syringe attached to a 25g x 1.5″ hypodermic needle for subcutaneous local anesthetic.Special items and suggested setup for this procedure: Typically spinal cord stimulator trials are placed with the kit provided by the manufacturer and everything needed should be in there. Then steer a needle to direct it under the skin. During the 1 week trial phase blood thinners remain held.Ĭore Skills: See our guides to obtain images of the cervical, thoracic, or lumbar spine. So blood thinner hold times are before the insertion and restart times are after lead removal.Because a trial leaves something in the epidural space for about a week, we treat the lead insertion as the beginning of the procedure and the lead removal as the end of the procedure.See details on how to handle blood thinners for various procedures based on ASRA guidelines.IndicationsĪ variety of pain can be treated with spinal cord stimulators but commonly for radicular pain, CRPS, peripheral neuropathy. To place midline (as opposed to dorsal root ganglion) spinal cord stimulator leads as part of a trial phase before a spinal cord stimulator implant. Percutaneous Spinal Cord Stimulator Trial Lead Placement.More research is necessary to articulate specific management guidelines before surgery, during surgery and after surgery for DCSs, DRG stimulation, peripheral nerve stimulator and intrathecal pump implantation. There is little information in the literature on appropriate anesthetic management during these forms of neuromodulation. For peripheral nerve stimulation and intrathecal pump implementation, monitored anesthesia care is preferred. For dorsal column and DRG stimulation, monitored anesthesia care, where patients are awake but very relaxed, or general anesthesia with neuromonitoring during the operation (so that surgeons can check the function of the nerves in real time) is recommended. Generally, starting antibiotics before the surgery and then stopping the antibiotics within 24 h after the surgery is recommended. We searched various online databases to find papers that discussed anesthetic management around these surgeries. We review management for different forms of neuromodulation including dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators and intrathecal pumps. This paper reviews current literature and provides guidelines based on our single center experience to discuss anesthetic management of patients before surgery, during surgery and after the surgery. The implantation of neuromodulation devices requires surgery. Neuromodulation is a procedure wherein the nerves that are responsible for pain are stimulated, for example with electrical pulses, to reduce the pain signals originating from that nerve. More research is necessary to articulate specific pre-operative, intra-operative and postoperative management guidelines and recommendations for dorsal column stimulator, DRG stimulation, PNS and intrathecal pump implantation.Īnesthetic management dorsal column stimulation dorsal root ganglion stimulation intrathecal drug delivery neuromodulation peripheral nerve stimulation. There is little information on appropriate anesthetic management during these forms of neuromodulation. For dorsal column and DRG stimulation, monitored anesthesia care or general anesthesia with intra-operative neuromonitoring is recommended for peripheral nerve stimulation and intrathecal pump implementation, monitored anesthesia care is preferred. Generally, pre-operative antibiotics are recommended with discontinuation within 24 h postoperatively. This paper performs a review of current literature as well as uses our single-center experience to discuss pre-operative, intra-operative and, briefly, postoperative management for dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators (PNSs) and intrathecal pumps.
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