Skip Navigation


Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on April 24, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(3):78-81; doi:10.1093/bjaceaccp/mkp009
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME/CE:
Take the course for this article:
 CEACCP, Volume 9 – Issue 3, June...
Right arrow All Versions of this Article:
9/3/78    most recent
mkp009v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Raphael, J. H.
Right arrow Articles by Kapur, S.
PubMed
Right arrow Articles by Raphael, J. H.
Right arrow Articles by Kapur, S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Spinal cord stimulation and its anaesthetic implications

Jon H. Raphael, MB ChB MSc MD FRCA
Professor of Pain Medicine
Birmingham City University
Birmingham
UK
Consultant in Pain Management
Dudley Hospitals NHS Trust
Dudley DY1 2HQ UK
Tel: +44 1384 244809
Fax: +44 1384 244025

Hirachand S. Mutagi, MBBS MD FRCA
Consultant in Pain Management and Anaesthesia
Dudley Hospitals NHS Trust
Dudley DY1 2HQ UK

Sandeep Kapur, MBBS MD FRCA
Consultant in Pain Management
Dudley Hospitals NHS Trust
Dudley DY1 2HQ UK
E-mail: jon.raphael@bcu.ac.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Neuromodulatory techniques such as spinal cord stimulation (SCS) are playing an increasing role in chronic pain management.
The National Institute for Clinical Excellence has shown it to be cost-effective in the management of neuropathic pain and complex regional pain syndrome. It also has a role in the management of angina pectoris and ischaemic peripheral vascular disease.
The neuromodulatory effects of SCS are only partly attributable to the gate control theory. Gamma-amino butyric acid, adenosine, substance P, serotonin, calcitonin gene-related peptide, and nitric oxide also play a role in its analgesic and anti-ischaemic effects.
The SCS leads are placed in the dorsal epidural space, either surgically or percutaneously, and are connected to a subcutaneously implanted programmable pulse generator.
Precautions are necessary in patients with implanted SCS system requiring a pacemaker, MRI scanning, or centro-neuraxial anaesthesia.

 

Following the landmark gate control theory of Melzack and Wall in 1965 and Shealy's . . . [Full Text of this Article]


   Physiology
 
Analgesic mechanisms

Anti-ischaemic mechanisms


   Implantation and technology
 

   Therapeutic trial
 

   Complications
 

   Anaesthetic considerations during implantation
 

   Anaesthetic considerations for unrelated surgery
 

   MRI imaging
 

   Pacemakers
 

   Outcomes
 

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?