A comprehensive literature search was conducted by an experienced reference librarian in order to generate a list of study/trial abstracts for screening. The reporting of this systematic review followed the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Participants in the international, interdisciplinary DRG work group were nominated by the West Virginia Society of Interventional Pain Physicians/American Society for Pain & Neuroscience based on experience with DRG stimulation, participation in research and publications, practice specialty, diversity, and practice setting. In this systematic review, the evidence for DRG stimulation in treating pain is graded and discussed. The clinical practice of neuromodulation is also evolving as new insights into neural targets, such as the DRG, and advances in technology and programming emerge.

The peer-reviewed literature includes consensus statements and best practices for neurostimulation however, no comprehensive systematic literature review of the evidence exists. Neurostimulation is a well-established treatment option for people who suffer from chronic, refractory painful disorders. This invited systematic literature review synthesizes the current evidence for dorsal root ganglion (DRG) stimulation in treating pain. More research is necessary to articulate specific management guidelines before surgery, during surgery and after surgery for DCSs, DRG stimulation, peripheral nerve stimulator and intrathecal pump implantation.Dorsal Root Ganglion Stimulation, Chronic Pain, Systematic Review, Pain Management Introduction There is little information in the literature on appropriate anesthetic management during these forms of neuromodulation. For peripheral nerve stimulation and intrathecal pump implementation, monitored anesthesia care is preferred. For dorsal column and DRG stimulation, monitored anesthesia care, where patients are awake but very relaxed, or general anesthesia with neuromonitoring during the operation (so that surgeons can check the function of the nerves in real time) is recommended. Generally, starting antibiotics before the surgery and then stopping the antibiotics within 24 h after the surgery is recommended. We searched various online databases to find papers that discussed anesthetic management around these surgeries. We review management for different forms of neuromodulation including dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators and intrathecal pumps. This paper reviews current literature and provides guidelines based on our single center experience to discuss anesthetic management of patients before surgery, during surgery and after the surgery.

The implantation of neuromodulation devices requires surgery. Neuromodulation is a procedure wherein the nerves that are responsible for pain are stimulated, for example with electrical pulses, to reduce the pain signals originating from that nerve. More research is necessary to articulate specific pre-operative, intra-operative and postoperative management guidelines and recommendations for dorsal column stimulator, DRG stimulation, PNS and intrathecal pump implantation.Īnesthetic management dorsal column stimulation dorsal root ganglion stimulation intrathecal drug delivery neuromodulation peripheral nerve stimulation. There is little information on appropriate anesthetic management during these forms of neuromodulation. For dorsal column and DRG stimulation, monitored anesthesia care or general anesthesia with intra-operative neuromonitoring is recommended for peripheral nerve stimulation and intrathecal pump implementation, monitored anesthesia care is preferred. Generally, pre-operative antibiotics are recommended with discontinuation within 24 h postoperatively. This paper performs a review of current literature as well as uses our single-center experience to discuss pre-operative, intra-operative and, briefly, postoperative management for dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators (PNSs) and intrathecal pumps.

Dorsal column stimulator technique