41. Pre-emptive use of lidocaine patches following SCS implant to prevent postoperative pain and hypersensitivity - 6 month prospective data

Abstract

Background: Although considered intrinsically safe, spinal cord stimulation (SCS) surgery related complications have been reported in the literature. Local pain/tenderness/neuropathic sensations at the IPG site (0.9-12%, mean 6.15%) is one of the commonest procedure related complications that may also result in poor patient satisfaction and limited compliance with therapy. Gluteal IPG site pain remains a challenge and can result in failure of therapy despite adequate dermatomal coverage. Due to the inherent issue of slow healing, pain can become persistent with neuropathic characteristics. Persistence of the pain may mandate revision or even explantation in up to 7% of patients. Unsurprisingly, repeated procedures expose patients to further disability and cost. Although IPG site pain can be treated conservatively with lidocaine patches, injections of neuroma or cushioning of hardware sites, pre-emptive mitigating measures have never been studied. This is the first prospective single centre observational study reporting the effects of pre-emptive use of lidocaine patches to evaluate their efficacy and usefulness in the prevention of IPG site pain. Method(s): After local trust committee approval (March 2022), patients implanted with SCS from March 2022 to November 2022 were reviewed at their 14 day wound check follow-up. After ensuring adequate wound closure and confirmation of no signs of infection, they were instructed to apply lidocaine patches for 4 weeks over the IPG site. In case of inadequate wound healing, patch application was delayed by a further 2 weeks. Data were collected at 1, 3 and 6 month clinical reviews through validated pain questionnaires. Extended patch application for a further 8 weeks was offered to patients who presented with IPG site pain at the 1 month follow up. Result(s): A total 47 patients were enrolled and followed up to 6 months. Six patients (13%) reported IPG site pain >=3/10 on NRS Scale over 6 months of which four patients (8.5%) reported at one month follow up. Two of these had complete resolution of pain by three months. One patient reported pain at 3 months (5/10) which got better by 6 months. One patient presented pain at 6 months (4/10), who was managed conservatively beyond 6 months. Two required revision due to other concomitant reasons, who had persistent IPG site pain. Thus total 3 patients continued with IPG site pain till and beyond 6 months (6.3%). In our study, the prevalence of IPG site gluteal pain at 6 months appears to be within lower range of reported limit (6.3%). The pain was less intense and manageable with the pre-emptive application of lignocaine patches. Delayed wound healing was implicated in the late start of application of patches for two patients who had IPG site pain at one month and responded to lidocaine plasters/conservative management. The concomitant factors necessitating revision included- 1.Allergy to lidocaine plasters, hence inability to apply; 2. Lead migration. These two patients continued to have persistent IPG site pain after revision surgery. Conclusion(s): This is the first reported evaluation of pre-emptive application of lidocaine plasters for IPG site pain. This may be an effective therapeutic measure in reducing the IPG site complication rate. Revision surgery can lead to increased chance of IPG site pain unresponsive to lignocaine plasters, which may require meticulous planning of alternative site selection. Copyright © 2025