Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Combining Awake Anesthesia with Minimal Invasive Surgery Optimizes Intraoperative Surgical Spinal Cord Stimulation Lead Placement

Philippe Rigoard
,
Amine Ounajim
ORCID logo ,
Lisa Goudman
ORCID logo ,
Chantal Wood
ORCID logo ,
Manuel Roulaud
,
Philippe Page
,
Bertille Lorgeoux
,
Sandrine Baron
,
Kevin Nivole
,
Mathilde Many
,
Emmanuel Cuny
,
Jimmy Voirin
,
Denys Fontaine
,
Sylvie Raoul
,
Patrick Mertens
,
Philippe Peruzzi
,
François Caire
,
Nadia Buisset
,
Romain David
ORCID logo ,
Maarten Moens
,
Maxime Billot
*
Version 1 : Received: 22 July 2022 / Approved: 25 July 2022 / Online: 25 July 2022 (08:34:26 CEST)

A peer-reviewed article of this Preprint also exists.

Rigoard, P.; Ounajim, A.; Goudman, L.; Wood, C.; Roulaud, M.; Page, P.; Lorgeoux, B.; Baron, S.; Nivole, K.; Many, M.; Cuny, E.; Voirin, J.; Fontaine, D.; Raoul, S.; Mertens, P.; Peruzzi, P.; Caire, F.; Buisset, N.; David, R.; Moens, M.; Billot, M. Combining Awake Anesthesia with Minimal Invasive Surgery Optimizes Intraoperative Surgical Spinal Cord Stimulation Lead Placement. J. Clin. Med. 2022, 11, 5575. Rigoard, P.; Ounajim, A.; Goudman, L.; Wood, C.; Roulaud, M.; Page, P.; Lorgeoux, B.; Baron, S.; Nivole, K.; Many, M.; Cuny, E.; Voirin, J.; Fontaine, D.; Raoul, S.; Mertens, P.; Peruzzi, P.; Caire, F.; Buisset, N.; David, R.; Moens, M.; Billot, M. Combining Awake Anesthesia with Minimal Invasive Surgery Optimizes Intraoperative Surgical Spinal Cord Stimulation Lead Placement. J. Clin. Med. 2022, 11, 5575.

Abstract

Spinal Cord Stimulation (SCS) is an effective and validated treatment to address chronic refractory neuropathic pain in Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients. Surgical SCS lead placement is traditionally performed under general anesthesia due to its invasiveness. In parallel, recent works have suggested that Awake Anesthesia (AA), consisting in Target Controlled Intra-Veinous Anesthesia (TCIVA), could be an interesting tool to optimize lead anatomical placement using patient intra-operative feedback. We hypothesized that combining AA with Minimal Invasive Surgery (MIS) could improve SCS outcomes. The goal of this study was to evaluate SCS lead performance (defined by the area of pain adequately covered by paraesthesia generated via SCS), using an intraoperative objective quantitative mapping tool, and secondarily to assess pain relief, functional improvement and change in quality of life with a composite score. We analyzed data from a prospective multicenter study (ESTIMET) to compare the outcomes of 115 patients implanted with MIS under AA (MISAA group) or General Anesthesia (MISGA group), or by Laminectomy under General Anesthesia (LGA group). All in all, MISAA appears to show significantly better performance in terms of patient pain coverage, as well as improved secondary outcomes. One step further, our results suggest that MISAA combined with intra-operative hypnosis could potentialize patient intraoperative cooperation and could be proposed as a personalized package offered to PSPS-T2 patients eligible for SCS implantation in highly dedicated neuromodulation centers.

Keywords

PSPS; FBSS; SCS; surgical lead; SCS implantation; MAST (for Minimal Access Spine Technologies); TCIVA (for Target Controlled Intra-Veinous Anesthesia); composite score; pain mapping; neuropathic pain; chronic pain; quality of life; anesthesia; hypnosis

Subject

Medicine and Pharmacology, Anesthesiology and Pain Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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