Acupuncture Needle-Assisted Nerve Fenestration: Reducing Iatrogenic Neuropathic Outcomes
|Murinson BB1-3*, Mezei L1, Senders ZJ1 and Ordman J4|
|1Department of Neurology, Johns Hopkins School of Medicine, Baltimore, USA|
|2Department of Neurology, Pain Program, Washington DC VAMC, USA|
|3Clinical Research Institute at Rambam and Technion Faculty of Medicine, Haifa Israel|
|4Acupuncture Services, Wounded Warrior Pain Initiative Program, Walter Reed National Military Medical Center, USA|
|Corresponding Author :||Beth B. Murinson M.D., Ph.D.
Department of Neurology
Johns Hopkins School of Medicine
600 North Wolfe Street, Meyer 5-119
Baltimore, MD, 21287 USA
|Received April 09, 2014; Accepted May 02, 2014; Published May 04, 2014|
|Citation: Murinson BB, Mezei L, Senders ZJ, Ordman J (2014) Acupuncture Needle-Assisted Nerve Fenestration: Reducing Iatrogenic Neuropathic Outcomes. J Pain Relief S3:005. doi: 10.4172/2167-0846.S3-005|
|Copyright: © 2014 Murinson BB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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.