Percutaneous peripheral nerve stimulation for post-amputation pain

A majority of patients have been reported to experience post amputation neuropathic limb pain, with twin components of residual limb pain, and phantom limb pain. Its refractory nature has spurred a variety of physical, psychological, opioid and non-opioid therapies.

With the arrival of improved percutaneous ultrasound-guided fine-wire coiled peripheral nerve stimulation (PNS) leads in proximity to the sciatic and femoral nerves, this randomized study reported significant pain relief and improved disability in patients with chronic neuropathic postamputation pain.

The reversible procedure involved 8 weeks stimulation, but longer term improvements persisted. Further follow-up and study is ongoing for this promising intervention in an often intractable condition.

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High Flow Nasal Oxygen vs. Facemask Preoxygenation

Two studies compare high flow nasal oxygen (HFNO) with facemask preoxygenation, one in obstetrics. Both reach the same conclusion in that HFNO is inferior to standard facemask preoxygenation.

HFNO, or simply a maximally cranked nasal cannula placed under the facemask have both been shown to increase apnea time and desaturation during difficult intubations but as a stand-alone measure are inadequate to optimize oxygenation prior to anesthesia induction.