Transcranial Direct Current Stimulation (tDCS) Reduces Postsurgical Opioid Consumption in Total Knee Arthroplasty (TKA)
Transcranial Direct Current Stimulation (tDCS) Reduces Postsurgical Opioid Consumption in Total Knee Arthroplasty (TKA)
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DOI：
10.1097/ajp.0b013e31827e32be
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发表时间：
2013-11-01
影响因子：
2.9
通讯作者：
George, Mark S.
中科院分区：
文献类型：
--
作者：
Borckardt, Jeffrey J.;Reeves, Scott T.;George, Mark S.
背景资料：虽然疼痛通常是全膝关节置换术（TKA）前的症状，但手术本身也会引起持续数天至数周的术后疼痛。术后疼痛控制是决定恢复时间、住院时间和康复成功的重要因素。包括经颅直流电刺激（tDCS）在内的几种脑刺激技术已被证明有希望治疗各种疼痛状况。本研究检查了4次tDCS对TKA术后疼痛和阿片类药物消耗的影响。材料和方法：40名接受单侧TKA的患者被随机分配接受总计80分钟的真实的（n = 20）或假tDCS（n = 20），阳极位于膝上代表运动带（C1 h或C2 h对应于目标膝关节）和右背外侧前额叶皮层上的阴极（F3;由EEG 10-20系统定位）。结果：真实的tDCS组患者平均使用氢吗啡酮6.6 mg（SD = 5.3），而假手术组患者平均使用氢吗啡酮12.3 mg（SD = 6.6; t（37）= 2.93，P = 0.006）。尽管使用较少的阿片类药物，在真实的tDCS组的参与者报告没有疼痛加剧或更糟的情绪与那些在假tDCS group.Conclusions：从这个试点可行性研究的结果表明，tDCS可能能够减少后TKA阿片类药物的需求。虽然这些结果是初步的，数据支持进一步研究在该地区的连续皮层刺激在术后疼痛的管理。
Background: Although pain is often a symptom that precedes total knee arthroplasty (TKA), the procedure itself is associated with considerable postoperative pain lasting days to weeks. Postoperative pain control is an important factor in determining recovery time, hospital length of stay, and rehabilitation success. Several brain stimulation technologies including transcranial direct current stimulation (tDCS) have demonstrated promise as treatments for a variety of pain conditions. The present study examined the effects of 4 sessions of tDCS on post-TKA pain and opioid consumption.Materials and Methods: Forty patients undergoing unilateral TKA were randomly assigned to receive a total of 80 minutes of real (n = 20) or sham tDCS (n = 20) with the anode over the knee representation of the motor strip (C1h or C2h corresponding to the target knee) and cathode over the right dorsolateral prefrontal cortex (F3; located by the EEG 10-20 System). Patient-controlled analgesia (hydromorphone) use was tracked during the similar to 48 hours postsurgery.Results: Patients in the real tDCS group used an average of 6.6 mg (SD = 5.3) of patient-controlled analgesia hydromorphone, whereas those in the sham group used 12.3 mg (SD = 6.6; t(37) = 2.93, P = 0.006). Despite using less opioid medication, participants in the real tDCS group reported no pain exacerbation or worse mood with respect to those in the sham tDCS group.Conclusions: Results from this pilot feasibility study suggest that tDCS may be able to reduce post-TKA opioid requirements. Although these results are preliminary, the data support further research in the area of adjunctive cortical stimulation in the management of postsurgical pain.