Biowave as an adjuvant for pain relief in acute radicolopathy secondary to spinal anesthesia. case report: Coincidence or…?

Background. BioWave is a non-invasive electrical neuromodulation therapy indicated for neuropathic pain management(1); it utilizes high-frequency electrical impulses deliverd by transcutaneous electrodes to inhibit action potential conduction along nociceptive nerve fibers and to block pain signaling before it reaches the brain. The incidence of back pain post dural puncture during spinal anesthesia is not a rare event; it is usually mild, localized in the low back, rarely radiates to the lower extremities and it may manifest during and immediately following the puncture, with associated symptoms such as paresthesia, sensory disturbances, motor deficit in one or both limbs and reduced reflexes. The diagnosis is clinical and imaging. We report the case of a patient who experienced post-spinal anesthesia pain following inguinal hernioplasty.Case Report. The patient reported pain (NRS=8) with sever motor disability in the right lower limb. The temporal correlation with the procedure was clear in the absence of other previous causes. Examinations within normal limits, procedure performed using a 27 G Whitacre needle. Upon puncture, immediate pain response occurred, with withdrawal of the right lower limb. Three days after surgery the patient reported acute pain to the right lower limb and severe ambulation impairment. The MRI was negative for spinal hematoma, the EMG was negative after three weeks from the event. Immediate treatment: tapentadol 25 mg twice daily, pregabalin in incremental dosages, duloxetina 30 mg twice daily, soldesam 10 mg once daily. The patient started BioWave treatment a week later with a weekly 35 minutes session, for ten weeks. After seven weeks the patient has regained mobility without the use of braces, he reported pain NRS=2 and rare episodes of paresthesia in the right knee. Nowadays the patient continues the therapy with pregabiln 75 mg twice daily and physiotherapy; he reportes pain NRS=1-2 and mild paresthesia in the right knee. The patient is currently under follow-up.Conclusions. The risk of developing back pain during spinal anesthesia is rare but it is due to several factors (e.g. unexpected structural abnormalities of the spine). The first solution is the imeddiate care of the patient, once severe injuries have been ruled out through instrumental tests, reassure the patient by manintaining continous contact, initiate immediate symptomatic therapy, refer the patient for pain management clinic follow-up and evaluate adjuvant therapeutic solutions. In our case we used BioWave as an adjuvant: it proved to be a highly effective tool as an adjuvant in a very serious clinical condition, facilitating an early patient mobilization and reducing the need for multiple and prolonged pharmacological therapy with consequent discomfort for the patient. However we can’t be able to find many studies on the subject and we believe that the positivity outcome justifies the investigation of novel applications, to differentiate between coincidental efficacy and true therapeutic opportunity.