Journal de la douleur et du soulagement

Abstrait

Acupuncture Needle-Assisted Nerve Fenestration: Reducing Iatrogenic Neuropathic Outcomes

Murinson BB, Mezei L, Senders ZJ and Ordman J

Introduction: Partial nerve injuries frequently result in neuropathic pain that is treatment refractory and the mechanisms of which are poorly understood. Although several nerve injury models have been investigated in detail, one clinically relevant model that has received little attention is nerve fenestration, or perineurial windowing. Utilized in end-to-side nerve repair techniques and a potentially important component of penetrating and iatrogenic nerve injury, nerve fenestration is usually associated with appreciable nerve injury. The objective of this study was to develop a less injurious method of Sciatic nerve fenestration (SNF).

Methods: Male rats were studied using an approved protocol including videography, paraffin-sectioning and plastic-thin sectioning techniques. Acupuncture and standard cutting needles were used to incise perineurium longitudinally; incisions ranged from 1.5 to 9 mm in length and were carried out using microsurgical instrumentation.

Results: Breaching the epineurium with long incisions (8-9 mm), microsurgical stabilization, and using acupuncture needles to pierce and underskirt the perineurium resulted in full-thickness incisions. Histological analysis confirmed markedly reduced axonal injury.

Discussion: Revised SNF technique using acupuncture needles reduces direct nerve damage; a finding with implications for clinical practice and pre-clinical research. We predict that minimization of axonal injury during fenestration will reduce post-operative pain.