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Table 1.
Cumulative data for all studies fitting inclusion criteria.
| Study | Non-pharmacologic modality | Number of patients (N) | Time period of intervention | Operation (TKA or ACL reconstruction) | Postoperative opioid use | Other postoperative analgesic use | Pain scores | Clinical outcomes | Functional outcomes |
|---|---|---|---|---|---|---|---|---|---|
| Ilfeld et al., 2019 | Percutaneous peripheral nerve stimulation | 7 | Immediate post-op period (leads inserted by 20 h PO); continued until up to 6 weeks postoperatively | TKA | 4/7 patients discontinued opioid use within the first week; median time to opioid cessaction = 6 days | – | Avg pain score during the first PO week was mild (<4/10) in 6/7 patients and continued to be so through PO week 4 | WOMAC scores increased by avg of 46% by PO week 2 with 5/7 patients showing clinical improvement; 7/7 patients showed clinically significant improvement by PO week 12 with an avg improvement of 85% | 6/7 patients completed the TUG walking test on day of hospital discharge; 5/7 patients reached preoperative level or better by PO week 2 for TUG walk test; 6/7 reached preoperative level or better on 6MWT by PO week 2; 6/7 showed >10% improvement on 6MWT compared to preoperative score by PO week 12 |
| He et al., 2013 | Auricular Acupressure | 90 (45 treatment, 45 sham control) | Administered 4 times per day from POD 0–7 | TKA | Treatment group used significantly less opioids delivered via PCA at all time points measured | – | No difference in PO pain intensity scores for the first 48 h after surgery; treatment group showed significantly lower PO pain intensity scores at PO days 3, 4, 5, and 7 | Treatment group showed significantly better HSS scores at PO week 2; no difference was seen preoperatively or at 3 months PO | No ROM differences between groups |
| Dasa et al., 2016 | Cryoneurolysis (percutaneous freezing of sensory nerves) using novel handheld device, “Iovera” | 100 (50 treatment, 50 control) | Administered 5 days preoperatively and remained effective through the perioperative period | TKA | Treatment group showed significantly lower opioid use (45% less than control) for 12 weeks PO | – | Treatment group showed significantly lower PROMIS pain intensity scores at all measures PO | Treatment group showed significantly greater reductions in KOOS symptoms subscale scores from baseline at 6- and 12–week PO visits; treatment group showed significantly shorter PO LOS than control | – |
| Ilfeld et al. [30] | Percutaneous peripheral nerve stimulation | 18 (case series); 10 series one, 8 series 2 | Series 1: 6 patients tested one time <14 days after surgery; 4 patients tested >40 days after surgery; Series 2: beginning directly preoperatively, continuing up to 6 weeks PO | TKA | 4/8 patients in series 2 discontinued opioid use within 1 week PO; Median time to opioid cessation was POD 16.5 | – | Series 1: immediate pain relief of ≥ 50% reported in 9/10 patients, with average reduction of 75%; complete immediate pain relief was seen in 5/10 patients. Series 2: Mild (<4/10) average daily pain scores in majority of patients at rest, while walking and overall, during PO week 1; by PO week 12, 7/8 patients had well-controlled pain and 5/8 were pain-free | Series 2: By 6 weeks PO 8/8 patients had reached clinically significant improvement of WOMAC scores (at least 33% improvement), with an average improvement of 76%; Average improvement had increased to 86% by PO week 12 | Series 2: By 2 weeks PO, 6/7 patients had reached preoperative level of 6MWT scores; by 12 weeks PO, 7/8 patients had improved scores by at least 10%, with an average improvement of 24% |
| Ilfield et al., 2017 | Ultrasound-Guided Percutaneous Cryoneurolysis | 3 (case series) | – | TKA | All 3 patients showed significantly less opioid use over a significantly decreased time period as compared to historical controls | – | All patients reported bring <2/10 on self-reported pain scale consistently for first 2–3 weeks PO | – | No gross motor deficit noted as compared to historical controls |
| Ilfeld et al., 2019 | Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation | 10 | Group 1 (5/10 patients) received stimulation for 5 min on POD 0, then sham stimulation for the subsequent 5 min, followed by constant stimulation for 30 min; Group 2 (5/10 patients) received sham stimulation for the initial 5 min on POD 0, then received stimulation for the next 5 min, then received constant stimulation for the following 30 min | ACL reconstruction | 5/10 patients requested opioids after initial PO stimulation period | 7/10 patients elected to initiate their canal nerve block for extra analgesia after initial PO stimulation period and before discharge; 8/10 patients used an optional perineural injection analgesic on POD 1 and 2, but only 3/10 patients used the same device on POD 3. | Both groups showed downward trend in pain scores over the initial 5 min of stimulation when tested every minute and a similar increase in pain scores over the 5-minute sham stimulation period. A mean pain score decrease of 84% was seen in both groups after 5 min of the secondary 30-minute stimulation period. Median pain score with movement was <2/10 by POD 4, and median pain score at rest across all patients was <4/10 on POD 1 and <2/10 by POD 3 | – | No motor or sensory deficits reported in any patient |
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