Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use.
Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use.
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DOI：
10.1016/j.brs.2017.09.006
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发表时间：
2017-11
影响因子：
7.7
通讯作者：
George MS
中科院分区：
文献类型：
--
作者：
Borckardt JJ;Reeves ST;Milliken C;Carter B;Epperson TI;Gunselman RJ;Madan A;Del Schutte H;Demos HA;George MS
疼痛通常是全膝关节置换术(TKA)前的主诉，但手术本身与持续数天至数周的相当大的术后疼痛有关，这可以预测较长期的手术结果。此前，我们通过一项单盲试验报告了运动皮质经颅直流电刺激对阿片类药物的显著戒除作用。在本研究中，我们使用双盲方法比较了运动皮质tdcs和前额叶tdcs与假手术组和主动对照(非痛觉调制脑区的有源电极)tdcs。58例行单侧全膝关节置换术的患者，随机分为4组，每组20分钟，每组20分钟，共80分钟，电极放置电极：1)运动组(n=14)；2)阳极组(n=16)；2)阳极组(n=16)；3)主动控制组(n=15)；3)主动控制组(n=15)；4)假刺激组(4)组(n=13)；0 mA-电流刺激组(junction/cathode-medial-anterior-premotor-area，)。在术后72小时的∼中追踪氢化吗啡的使用情况。假手术组和主动对照组分别使用15.4 mg(SD=14.1)和16.0 mg(SD=9.7)的PCA氢吗啡酮。这两组之间的累积PCA使用曲线的斜率没有差异(p=0.25；ns)。前额叶tdcs组患者平均使用了11.7 mg(SD=5.0)的PCA氢氧化铝，累积的PCA使用曲线的斜率显著低于Sham(p<；0.0001)。然而，运动型tdcs组患者平均使用19.6 mg(SD=11.9)氢吗啡，PCA使用曲线的斜率显著高于Sham组(p<；.0001)。这项双盲皮质靶点优化研究的结果表明，左侧前额叶皮质的阳极经颅直流电刺激(TDC)可能是减少TKA术后阿片类药物需求的合理方法。鉴于在这项后续试验中，运动皮质未能产生阿片类药物节约作用的意外发现，仍需在术后皮质刺激领域进行进一步研究。
Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation from a single-blind trial. In the present study, we used double-blind methodology to compare motor cortex tDCS and prefrontal cortex tDCS to both sham and active-control (active electrodes over non-pain modulating brain areas) tDCS. 58 patients undergoing unilateral TKA were randomly assigned to receive 4 20-minute sessions (a total of 80 minutes) of tDCS (2mA) post-surgery with electrodes placed to create 4 groups: 1) MOTOR (n=14); anode-motor/cathode-right prefrontal, 2) PREFRONTAL (n=16); anode-left-prefrontal/cathode-right-sensory, 3) ACTIVE-CONTROL (n=15); anode-left-temporal-occipital junction/cathode-medial-anterior-premotor-area, and 4) SHAM (n=13); 0mA-current stimulation using placements 1 or 2. Patient controlled analgesia (PCA; hydromorphone) use was tracked during the ∼72-hours post-surgery. Patients in the sham group and the active-control group used 15.4mg (SD=14.1) and 16.0mg (SD=9.7) of PCA hydromorphone respectively. There was no difference between the slopes of the cumulative PCA usage curves between these two groups (p=.25; ns). Patients in the prefrontal tDCS group used an average of 11.7mg (SD=5.0) of PCA hydromporhone, and the slope of the cumulative PCA usage curve was significantly lower than sham (p<.0001). However, patients in the motor tDCS group used an average of 19.6mg (SD=11.9) hydromorphone and the slope of the PCA use curve was significantly higher than sham (p<.0001). Results from this double-blind cortical-target-optimization study suggest that anodal transcranial direct current stimulation (tDCS) over the left prefrontal cortex may be a reasonable approach to reducing post-TKA opioid requirements. Given the unexpected finding that motor cortex failed to produce an opioid sparing effect in this follow-up trial, further research in the area of post-operative cortical stimulation is still needed.
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影响因子：
2.9
作者：
Borckardt, Jeffrey J.;Reeves, Scott T.;George, Mark S.
通讯作者：
George, Mark S.
影响因子：
7.7
作者：
Borckardt, Jeffrey J.;Reeves, Scott T.;George, Mark S.
通讯作者：
George, Mark S.
影响因子：
8.8
作者：
Capdevila, X;Barthelet, Y;d'Athis, F
通讯作者：
d'Athis, F
影响因子：
3.3
作者：
Talmo, Carl T.;Robbins, Claire E.;Bono, James V.
通讯作者：
Bono, James V.
影响因子：
3.5
作者：
Chelly, JE;Greger, J;Criswell, A
通讯作者：
Criswell, A