Efficacy of Electrical Spinal Cord Stimulation with Neuromodulating Medications: A Systematic Review.

Background: Chronic pain is a prevalent and debilitating problem for millions of people and spinal cord stimulation (SCS) is one option for treatment. It has been shown to have membrane stabilizing properties and is often used in conjunction with medications that are also believed to offer pain control through membrane stabilization. Objective: The goal of this review is to analyze the effects of SCS combined with medications to evaluate for augmentative therapeutic effect. Setting: Systematic review. Methods: A systematic computerized search of the literature was conducted using PubMed, the Cochrane Library, and EMBASE for articles published in English. Results: We report three articles that discuss the potential for augmentative effects of medication in combination with SCS. Located articles related primarily to SCS combined with Gabapentin, TCA, or SNRI. Limitations: The limited number of articles reflects a need for more investigation in this area. Conclusion: Based on the suspected mechanisms for SCS and neuromodulating medications, there is reason to believe adding these medical therapies may enhance the effects of SCS.

Periprocedural Considerations for Patients with Gastric Electrical Stimulators.

OBJECTIVES: Gastric electrical stimulation (GES) is a technology that uses neurostimulation for the modulation of gastric activity. In clinical practice, the most commonly encountered form of GES is high frequency GES. GES devices are typically used for the treatment of refractory gastroparesis, although they have also been investigated for obesity management and the treatment of refractory gastroesophageal reflux disease. Just as many patients with chronic diseases require surgery, patients with an implanted GES device may encounter the need for periprocedural care. Therefore, the purpose of this review is to address the special needs of patients with an implanted GES device. MATERIALS AND METHODS: A systematic computerized search of the literature was performed to consolidate existing knowledge on GES management in the periprocedural setting. Duplicate results were eliminated, and results were further narrowed based on title and abstract. All articles with possible relevance were then reviewed in full. Manufacturer information including pamphlets and websites were also reviewed. RESULTS: A total of 1201 articles were identified for initial review, and 33 met inclusion criteria. CONCLUSIONS: Available data suggests GES is a technology with increasing prevalence. When patients with an implanted GES device present for periprocedural care, the anesthesia staff must consider the device when planning for the procedure. Topics addressed include general anesthetic considerations, nerve localization, radiation exposure, electrocautery, diathermy, emergency external defibrillation, and MRI compatibility.