Moon DH, Park J, Park YG, et al. Intramuscular stimulation as a new modality to control postthoracotomy pain: A randomized clinical trial. J Thorac Cardiovasc Surg. 2022 Mar 10:S0022-5223(22)00243-4. doi: 10.1016/j.jtcvs.2022.02.047. (Original study)

OBJECTIVE: Postoperative pain after thoracic surgery primarily hinders patients' mobility, decreasing the quality of life. To date, various modalities have been suggested to improve postoperative pain. However, pain alleviation still remains a challenge, resulting in continued reliance on opioids. To tackle this problem, this study introduces a needle electrical twitch obtaining intramuscular stimulation (NETOIMS) as a new effective treatment modality for postoperative pain after thoracoscopic surgery.

METHODS: This randomized clinical trial analyzed patients receiving video-assisted thoracoscopic surgery pulmonary resection between March 2018 and June 2020 at a single institution. A total of 77 patients (NETOIMS, 36; intravenous patient-controlled analgesia, 41) were included. NETOIMS was conducted on the retracted intercostal muscle immediately following the main procedure, just before skin closure. Postoperative pain (numeric rating scale) and oral opioid morphine milligram equivalent were assessed daily until postoperative day 5.

RESULTS: The NETOIMS group had a significantly lower numeric rating scale score on postoperative day (POD) 0 (P < .01), POD2 (P < .001), POD4 (P < .001), and POD5 (P = .01). The predicted time to complete pain resolution was 6.15 days in the NETOIMS group and 20.7 days in the intravenous patient-controlled analgesia group. The oral opioid morphine milligram equivalent was significantly lower in the NETOIMS group on POD0 (P < .001) and POD1 (P < .001).

CONCLUSIONS: NETOIMS appears to be an effective modality in alleviating postoperative pain after thoracoscopic surgery, thereby reducing the reliance on opioid use.

Discipline Area Score
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Comments from MORE raters

Physician rater

This RCT shows statistically and clinically significant outcomes. This modality may be effective in other post-op settings offering opportunity to decrease post-op opiates.

Physician rater

Minimally invasive surgery has minimal potential for long-term pain, but usually the first and second days postoperatively are more painful than we would like them to be. So, this technique seems interesting to alleviate pain on the first and second day of operation and is probably relevant.

Physician rater

This is an interesting study, however, its limitation is the training period of the team and the device acquisition to obtain the intramuscular stimulation. In small medical centers in poor countries with low volume thoracic surgeries, it might be necessary to make an economic evaluation of the NETOIM use in patients receiving video-assisted thoracoscopic surgery.

Physician rater

Methodologically, it is surprising to see reported means and standard errors as opposed to standard deviations. There are no data on the actual cost of the technology, which should also be a factor. The data may not be reproducible as pain patterns vary significant among clinical practitioners.
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