{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:09:55Z","timestamp":1784221795230,"version":"3.55.0"},"reference-count":20,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005595","name":"University California","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100005595","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100019065","name":"Masimo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,1,22]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Percutaneous auricular nerve stimulation (neuromodulation) involves implanting electrodes around the ear and administering an electric current. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial; and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following two ambulatory surgical procedures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Within the recovery room following cholecystectomy or hernia repair, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied. Participants were randomized to 5\u2009days of either electrical stimulation or sham in a double-blinded fashion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the first 5\u2009days, the median (IQR) pain level for active stimulation (n=15) was 0.6 (0.3\u20132.4) vs 2.6 (1.1\u20133.7) for the sham group (n=15) (p=0.041). Concurrently, the median oxycodone use for the active stimulation group was 0\u2009mg (0\u20131), compared with 0\u2009mg (0\u20133) for the sham group (p=0.524). Regarding the highest pain level experienced over the entire 8-day study period, only one participant (7%) who received active stimulation experienced severe pain, versus seven (47%) in those given sham (p=0.031).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Percutaneous auricular neuromodulation reduced pain scores but not opioid requirements during the initial week after cholecystectomy and hernia repair. Given the ease of application as well as a lack of systemic side effects and reported complications, a definitive clinical trial appears warranted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05521516\">NCT05521516<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2024-105283","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T01:18:10Z","timestamp":1708564690000},"page":"628-634","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Percutaneous auricular neuromodulation (nerve stimulation) for the treatment of pain following cholecystectomy and hernia repair: a randomized, double-masked, sham-controlled pilot study"],"prefix":"10.1136","volume":"49","clinical-trial-number":[{"clinical-trial-number":"nct05521516","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6144-3273","authenticated-orcid":false,"given":"Brian M","family":"Ilfeld","sequence":"first","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"},{"name":"Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy B","family":"Abramson","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3657-0673","authenticated-orcid":false,"given":"Brenton","family":"Alexander","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacklynn F","family":"Sztain","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7897-1670","authenticated-orcid":false,"given":"Engy T","family":"Said","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C","family":"Broderick","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J","family":"Sandler","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay J","family":"Doucet","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura M","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baharin","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brannon J","family":"Cha","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0955-155X","authenticated-orcid":false,"suffix":"IV","given":"John J","family":"Finneran","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of California San Diego, La Jolla, California, USA"},{"name":"Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"2025090415054612000_49.9.628.1","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1097\/ALN.0000000000004000","article-title":"Postoperative Pain and Age: A Retrospective Cohort Association Study","volume":"135","author":"van Dijk","year":"2021","journal-title":"Anesthesiology"},{"key":"2025090415054612000_49.9.628.2","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.bja.2021.08.037","article-title":"The potential for autonomic neuromodulation to reduce perioperative complications and pain: a systematic review and meta-analysis","volume":"128","author":"Patel","year":"2022","journal-title":"Br J Anaesth"},{"key":"2025090415054612000_49.9.628.3","doi-asserted-by":"crossref","DOI":"10.3389\/fnins.2019.00854","article-title":"Current Directions in the Auricular Vagus Nerve Stimulation I - A Physiological Perspective","volume":"13","author":"Kaniusas","year":"2019","journal-title":"Front Neurosci"},{"key":"2025090415054612000_49.9.628.4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.neuroscience.2017.05.012","article-title":"Percutaneous electrical nerve field stimulation modulates central pain pathways and attenuates post-inflammatory visceral and somatic hyperalgesia in rats","volume":"356","author":"Babygirija","year":"2017","journal-title":"Neuroscience"},{"key":"2025090415054612000_49.9.628.5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1080\/00952990.2017.1295459","article-title":"Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: A multisite, retrospective assessment","volume":"44","author":"Miranda","year":"2018","journal-title":"Am J Drug Alcohol Abuse"},{"key":"2025090415054612000_49.9.628.6","doi-asserted-by":"crossref","unstructured":"Ilfeld BM , Finneran JJ , Alexander B , et al . Percutaneous auricular neuromodulation (nerve stimulation) for the treatment of pain following total knee arthroplasty: a randomized, double-masked, sham-controlled pilot study. Reg Anesth Pain Med 2024. doi:10.1136\/rapm-2023-105028. 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