Neurolysis using a carbohydrate polymer gel for the treatment of postoperative neuropathic pain

Abstract

Perineural and intraneural fibrosis is thought to be the main cause of failure of the many surgical treatments of neuropathic pain. We have used Adcon-T/N^® carbohydrate polymer gel for prevention of perineural fibrosis in several parts of the body. In this retrospective study, 54 patients who presented with postoperative neuropathic pain had microsurgical epineural neurolysis and relocation of a terminal neuroma. In 19 of them, the carbohydrate gel was applied at the same time. The mean follow-up was four years and the nerve distribution varied. Postoperative improvement in pain scores (visual analogue scale (VAS) and neuropathic pain scale inventory (NPSI)), sensitivity, overall improvement and satisfaction were equivalent in the two groups, with pain relief in about 80% of the patients. There was no significant beneficial effect in the carbohydrate gel group. Patients treated with this device had a higher infection rate (21 compared with 0, p = 0.01) and delayed wound healing (31.6 compared with 11.8, p = 0.2). We conclude that good long-term pain relief is obtained postoperatively independently of the addition of carbohydrate gel. There was a slight but not significant trend towards profound pain relief with the gel.

Key Words::

• Neuropathic pain
• Adcon-T/N
• neuroma
• neurolysis
• perineural fibrosis

Acknowledgements

We thank Josee Beutler and Patricia Thierrin for manuscript preparation, Christiane Ruffieux and CEPIC Team for the statistical analysis, Dr Isabelle Decosterd and Dr Pierre Schertenleib for scientific support, and Dr Nana Poku for English correction.