Role of peripheral nerve stimulation and percutaneous cryoneurolysis in preventing chronic postsurgical pain.

BACKGROUND: Poorly controlled pain during the acute postoperative period is associated with the development of persistent or 'chronic' pain lasting months or years after surgery. Relatively small trials suggest that local anesthetic-based peripheral nerve blocks lasting hours or a few days may decrease persistent postsurgical pain for some surgical procedures, but definitive data is lacking. Two possible alternatives-percutaneous cryoneurolysis and peripheral nerve stimulation-are analgesic modalities with the potential to provide weeks or months of pain relief following surgery. This increase in analgesic duration raises the possibility of decreased transition from acute to chronic postsurgical pain.

OBJECTIVE: This review aims to summarize the available evidence involving the use of percutaneous cryoneurolysis and peripheral nerve stimulation within the immediate perioperative period and its effects on decreasing chronic postoperative pain.

FINDINGS: Two randomized trials (n=66 and 16) comparing active percutaneous peripheral nerve stimulation to sham stimulation and two randomized trials (n=60 and 7) comparing percutaneous cryoneurolysis to a sham procedure for postoperative pain are described in this review. In each trial, participants were followed for at least three months.

CONCLUSION: This review describes percutaneous cryoneurolysis and peripheral nerve stimulation for perioperative analgesia as well as the available evidence supporting their use to prevent persistent postsurgical pain.