Neuromodulación eléctrica en el tratamiento del dolor neuropático refractario. Colocación del primer estimulador medular en Cuba / Electric neuromodulation in the treatment of refractory pain. Placement of the first spinal stimulator in Cuba

El dolor es una causa importante de sufrimiento físico y emocional. El tratamiento médico de los pacientes con dolor crónico refractario es un gran reto. Se presenta el caso de una paciente de 19 años con un cuadro radicular compresivo secundario a Hernia discal L5-S1 derecha, que se le aplicó una discectomía L5-S1 por técnica de Caspar. Al mes de evolución regresa con igual sintomatología. A pesar de múltiples terapias farmacológicas y procederes intervencionistas, el dolor neuropático no mejora, después de múltiples estudios y discusiones en colectivo se determina la posibilidad de la colocación de un neuroestimulador medular, proceder que se lleva a cabo con mejoría considerable de su cuadro doloroso(AU)

Pain is a major cause of physical and emotional suffering. The management of patients with refractory chronic pain is a great challenge. The case is presented of a 19-year-old female patient with compressive radicular symptoms secondary to right L5-S1 disc herniation, who underwent L5-S1 discectomy with Caspar technique. After one month of evolution, she returned with the same symptoms. Despite multiple pharmacological therapies and interventional procedures, the neuropathic pain did not improve. After multiple studies and collective discussions, the possibility of placing a spinal neurostimulator was decided. After the procedure, the patient improved considerably with respect to her painful symptoms(AU)

Bloqueio do plexo braquial em jumento - relato de caso / Brachial plexus block in donkey - case report

A anestesia locorregional reduz o requerimento de agentes inalatórios e diminui as respostas autonômicas a estímulos cirúrgicos nocivos. Objetiva-se descrever um bloqueio anestésico do plexo braquial guiado por neuroestimulador em jumento, submetido à amputação do membro anterior direito. Foi realizada medicação pré-anestésica com detomidina 0,01mg.kg-1, indução com diazepam 0,05mg.kg-1 e cetamina 2mg.kg-1, todos pela via intravenosa (IV), e a manutenção da anestesia com isoflurano. O plexo braquial foi bloqueado por acesso subescapular, sendo usado neuroestimulador. Utilizou-se 1mg.kg-1 de bupivacaína 0,5% sem vasoconstritor, associada a 1mg.kg-1 de lidocaína 2% sem vasoconstrictor. Os valores de FC e ƒ durante o procedimento cirúrgico variaram de 62 a 78bpm e de 24 a 32rpm, respectivamente. Foram coletadas quatro amostras de sangue para dosagem de cortisol. Este, antes da aplicação da medicação pré-anestésica, foi de 6,4µg/dL e, 30 minutos após a MPA, foi de 2,8µg/dL. A recuperação anestésica foi rápida e sem complicações. O bloqueio do plexo braquial guiado por neuroestimulador mostrou-se eficaz em jumentos, fornecendo analgesia e anestesia satisfatória.(AU)

Locoregional anesthesia reduces the requirement for inhaled agents and reduces the autonomic responses to noxious surgical stimuli. The aim of this study was to describe an anesthetic block of the brachial plexus guided by a neurostimulator in a donkey submitted to right limb amputation. Preanesthetic medication was performed with detomidine 0.01mg.kg-1 induction with diazepam 0.05mg.kg-1 and ketamine 2mg.kg-1 all intravenously, and maintenance of anesthesia with isoflurane. The brachial plexus was blocked by subscapular access, using a neurostimulator. For this purpose, 1mg.kg -1 of bupivacaine 0.5%, without vasoconstrictor, and 1mg.kg- 1 of lidocaine 2%, without vasoconstrictor were used. The values of HR and ƒ during the surgical procedure ranged from 62 to 78bpm, and 24 to 32bpm, respectively. Four blood samples were collected for cortisol dosing. This, prior to the application of the pre-anesthetic medication was 6.4µg/dL and 30 minutes was 2.8µg/dL. Anesthesia recovery was rapid and uncomplicated. Neurostimulator-guided brachial plexus blockade proved to be effective in donkeys, providing satisfactory analgesia and anesthesia.(AU)

Interpretation of the International Standard 2017 Version of Implantable Neurostimulators / 中国医疗器械杂志

ISO 14708-3 "Implants for surgery-active implantable medical devices-Part 3:implantable neurostimulators" 2017 version and 2008 version are compared, and changes in the standard are interpreted combined with the characteristics of the neurostimulator. The new version of the standard for the first time in the introduction mentioned a new type of non-electrode or extension's neurostimulator. Key issues that have significant impact on safety concerns such as wireless charging temperature rise, MRI acceptance criteria, etc., are given for the first time in the new version. New requirements to the wireless communication section are added, and the electromagnetic compatibility part is greatly adjusted. With more miniature non-electrode or extension's neurostimulator entering the market, standards such as electromagnetic compatibility and MRI, there will be greater adjustments.

A Torso Simulator Design for Implantable Nerve Stimulator Test / 中国医疗器械杂志

This paper introduces ISO 14708-3:2017, the new edition of the international standard for implantable neurostimulator, and emphasizes the new requirements in the clause of protection from RF electromagnetic interference. To meet this new requirements, this paper presents a design of torso simulator for the testing of implantable neurostimulator. The design includes volume conductor, electrodes and grids, which can simulate the actual operating environment of implantable neurostimulator in RF electromagnetic interference testing. The torso simulator is verified by performance in the last part of the paper.

Comparison of the anesthesia effects of nerve stimulator localization and blind exploration method in nerve block / 中国基层医药

Objective To compare the clinical effects of neurostimulator positioning nerve block and blind exploration in anesthesia.Methods One hundred and thirty -two patients undergoing upper extremity surgery in the People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture were enrolled in this study .According to the digital table,the patients were randomly divided into two groups :blind probing nerve block group ( B group,n＝66) and neurological stimulator locating nerve block group (N group,n＝66).The good rate of anesthesia and compli-cations of the two groups and so on were observed.Results The dosage of anesthetic in B group was (17.6 ± 4.1)mL for anesthesia with 1% lidocaine and 0.375% ropivacaine,which in N group was (18.1 ±4.8)mL,there was no statistically significant difference between the two groups (t＝-0.66,P＞0.05).The good rate of anesthesia in N group was 79.0%,which was higher than that in B group (53.0%),the difference between the two groups was statistically significant(χ2＝9.74,P＜0.05).There were 5 cases(7.6%) turned to general anesthesia because of severe pain in B group,there was no change of anesthesia in N group ,the difference was statistically significant (χ2＝5.20,P＜0.05).The incidence rate of complications in N group was 1.5%,which was lower than 6.1%in B group, the difference was statistically significant (χ2＝4.16,P＜0.05).Conclusion Nerve stimulator has good application value in nerve block anesthesia as a good and cheap tool.

Ultrasound-guided placement of a permanent peripheral nerve stimulator in a patient with complex regional pain syndrome: A case report

A 56-year-old man complained of continuous pain in the right foot that began 6 months after undergoing surgery on the right calcaneus bone. The patient was diagnosed with complex regional pain syndrome (CRPS) type I and was treated with medication, lumbar sympathetic ganglion blocks, epidural nerve blocks, and spinal cord stimulation. However, all treatments were halted because they were ineffective or complications developed. Peripheral nerve stimulation (PNS) was planned after confirming the analgesic effects of a sciatic nerve block, and the patient received PNS via minimally invasive ultrasound-guided electrode placement. PNS reduced the pain intensity and the incidence of paroxysmal pain. Other than discomfort at the battery insertion site (resolved with re-implantation), the patient developed no complications. These results suggest that ultrasound-guided minimally invasive PNS is a safe and effective treatment for patients with CRPS in the lower extremities.

Caudal Neuromodulation with the Transforaminal Sacral Electrode (InterStim(R)): Experience in a Pain Center Regarding 12 Implants

BACKGROUND: Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode (InterStim(R), Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. METHODS: We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. RESULTS: Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. CONCLUSIONS: The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.

Empleo del neuroestimulador KWD 80811 para el bloqueo del plexo braquial por vía axilar

INTRODUCCIÓN: La anestesia del plexo braquial por vía axilar es un proceder frecuentemente empleado para la cirugía del miembro superior; disponer de un neuroestimulador para identificar las estructuras a bloquear ofrece múltiples ventajas. OBJETIVOS: Evaluar la efectividad del bloqueo por esta vía utilizando el neuroestimulador KWD 80811. MATERIAL Y MÉTODO: Se realizó un estudio descriptivo longitudinal y prospectivo en 100 pacientes adultos, de uno u otro sexo, ASA I-III, programados para cirugía de la mano, antebrazo y tercio inferior del brazo, en el Hospital Universitario¼ Dr. Carlos J. Finlay¼ en el período comprendido entre enero-septiembre de 2008. El neuroestimulador KWD 80811 fue empleado para la detección del plexo braquial, y la técnica utilizada para el bloqueo fue la perivascular de Burnham. Como anestésico local se empleó lidocaína al 1 %(7 mg por kg de peso) asociado con adrenalina 1:200 000. RESULTADOS: Se registró período de latencia media de 19.2 min., la calidad de la analgesia quirúrgica fue excelente en el 93 % de los casos y mala en 1 %. Reportamos una sola complicación sin interferencia con el proceder ni secuelas para el paciente. CONCLUSIONES: Esta técnica constituye una alternativa con elevada eficacia, confortable para el paciente y con muy bajo índice de complicaciones.

Introduction: Anesthesia of brachial plexus by axillary route is a frequent surgical procedure for upper extremity; availability of a neurostimulator to identify structures to be blockaded offer many advantages. Objectives: To assess the effectiveness of blockade by this route using the KWD90811 neurostimulator. Material and Methods: A prospective, longitudinal and descriptive study was conducted in 100 adult patients of both sexes, ASA I-III programmed for hand, forearm and inferior third of the arm surgery in "Dr. Carlos J. Finlay" University Hospital from January to September, 2008. Above mentioned neurostimulator was used to detect of brachial plexus and the technique used for blockade was the Burnham's perivascular one. As local anesthesia 1% lidocaine was used (7 mg /kg/bw) associated with adrenaline 1: 200.000. Results: There was an average latency period of 19.2 min; quality of surgical anesthesia was excellent in 93% of cases and poor in 1% with an only one complication without interference in the procedure and sequelae for patient. Conclusions: This technique is a high performance alternative suitable for patient and with a very low rate of complications.