Giuliano Lo Bianco1,2,3,4, Alfonso Papa1, Giuseppe Gazzerro1, Marco Rispoli5, Dario Tammaro1,5, Maria Teresa Di Dato1, Federica Vernuccio6, Michael Schatman7,8. 1. Pain Department, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy. 2. Università di Catania, Dipartimento di Scienze Biomediche e Biotecnologiche (BIOMETEC), Catania, Italy. 3. Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy. 4. Pain Management and Neuromodulation, Basildon and Thurrock University Hospitals NHSFT, Orsett Hospital, London, UK. 5. Anesthesiology Department, Thoracic Surgery, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy. 6. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy. 7. Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA. 8. Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Abstract
OBJECTIVES: Post-thoracotomy pain syndrome (PTPS) is defined as persistent pain following a thoracotomy and has an incidence of 21-61%. Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that modulates pain signal transmission to the spinal cord. The aims of this study were to investigate the efficacy of DRG-S for the management of PTPS and to assess the role of thoracic paravertebral blocks (t-PVB) as a tool for prediction of success of DRG-S. MATERIALS AND METHODS: In this prospective study, we included all patients undergoing thoracic surgery, with PTPS not responding to pharmacotherapy and treated with DRG-S from September 2018 to February 2019. t-PVB followed by a percutaneous DRG-S trial was performed on all patients. Pain intensity was assessed through a numeric rating scale (NRS) and Douleur Neuropathique en 4 Questions (DN4) at baseline, post-trial, at 14 days, 90 days, and at one year after DRG-S implantation. Data summarized as continuous variables were expressed as means and standard deviations (SDs), and categorical variables were expressed as raw numbers and percentages. RESULTS: Four patients out of 51 who underwent thoracic surgery at our institution surveyed were included (mean age ± SD, 56 ± 16 years old). Mean NRS and DN4 were, respectively, 7.2 ± 0.96 SD and 8.2 ± 0.5 SD at baseline, 2.5 ± 0.6 SD and 3.2 ± 0.5 SD after t-PVB, 2.2 ± 0.5 SD and 2.2 ± 0.5 SD at 14 days, 90 days, and at one year after DRG-S implantation. No complications or side effects were reported. CONCLUSIONS: Our preliminary results show that DRG-S is an effective therapy for PTPS after thoracic surgery. In addition, thoracic paravertebral blocks performed prior to DRG-S correlated with a positive outcome with treatment.
OBJECTIVES: Post-thoracotomy pain syndrome (PTPS) is defined as persistent pain following a thoracotomy and has an incidence of 21-61%. Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that modulates pain signal transmission to the spinal cord. The aims of this study were to investigate the efficacy of DRG-S for the management of PTPS and to assess the role of thoracic paravertebral blocks (t-PVB) as a tool for prediction of success of DRG-S. MATERIALS AND METHODS: In this prospective study, we included all patients undergoing thoracic surgery, with PTPS not responding to pharmacotherapy and treated with DRG-S from September 2018 to February 2019. t-PVB followed by a percutaneous DRG-S trial was performed on all patients. Pain intensity was assessed through a numeric rating scale (NRS) and Douleur Neuropathique en 4 Questions (DN4) at baseline, post-trial, at 14 days, 90 days, and at one year after DRG-S implantation. Data summarized as continuous variables were expressed as means and standard deviations (SDs), and categorical variables were expressed as raw numbers and percentages. RESULTS: Four patients out of 51 who underwent thoracic surgery at our institution surveyed were included (mean age ± SD, 56 ± 16 years old). Mean NRS and DN4 were, respectively, 7.2 ± 0.96 SD and 8.2 ± 0.5 SD at baseline, 2.5 ± 0.6 SD and 3.2 ± 0.5 SD after t-PVB, 2.2 ± 0.5 SD and 2.2 ± 0.5 SD at 14 days, 90 days, and at one year after DRG-S implantation. No complications or side effects were reported. CONCLUSIONS: Our preliminary results show that DRG-S is an effective therapy for PTPS after thoracic surgery. In addition, thoracic paravertebral blocks performed prior to DRG-S correlated with a positive outcome with treatment.
Authors: J Maloney; C Wie; S Pew; S Covington; M Maita; R Kozinn; M Sabin; J Freeman; M Kraus; N Strand Journal: Curr Pain Headache Rep Date: 2022-07-11
Authors: Giuliano Lo Bianco; Alfonso Papa; Michael E Schatman; Andrea Tinnirello; Gaetano Terranova; Matteo Luigi Giuseppe Leoni; Hannah Shapiro; Sebastiano Mercadante Journal: J Clin Med Date: 2021-05-25 Impact factor: 4.241