The nationwide surgical backlog caused by COVID-19 continues to have a severe impact on the NHS, with data showing over 4.46 million patients were awaiting treatment in November 2020*. The same data suggests an estimated 2.3 million people are on the waiting list for surgical care. 

Patients and clinicians alike are seeking viable, effective solutions to provide better pre-surgical interventions and ‘enhanced recovery after surgery’ (ERAS) protocols. A number of health professionals are even choosing to invest in up-and-coming technologies, such as bioelectronics. Orthopaedic surgeon and NuroKor investor, Raj Bhattacharya explains the clinician perspective further:

"As part of my daily job, I work with patients undergoing major surgery. Whether it is routine joint replacements, or complex procedures following major trauma, the need for effective aftercare is just as important as the surgery itself, and pain management is one of the biggest challenges we as clinicians need to address.” ‍

The role of Electrical Stimulation

Electrical stimulation (ES) is a treatment method gaining interest amongst health care professionals due to its convenient, non-invasive and drug-free nature. It is a highly accessible technology that can offer patients greater autonomy over their own treatment both pre and post surgery. 

For example, if an Orthopaedic surgeon was to use Electrical Stimulation to manage a patient’s hip surgery, a number of benefits could be attributed in both pre and post surgery stages:

‍Benefits before surgical intervention

BioElectronic technology or ES, such as NuroKor, can help to maintain muscle strength and increase circulation. This can assist a patient who has been advised to limit physical activities and use crutches - for example, a patient with Avascular Femur Necrosis. The implementation of the technology allows for the patient’s muscles to exercise without placing excessive weight on the affected joint.

On the other hand, patients who are awaiting a hip replacement, such as Osteoarthiritis (OA) and Rheumatoid Arthritis (RA) patients, often require a high dosage of painkillers to manage pain levels. These patients need extra care for their kidneys and gastrointestinal system (GIS). With the help of ES, vulnerable patients could require lower dosages of painkillers before surgery. Preadjuvant usage of NuroKor technology can assist with relaxation and can offer an analgesic effect so the patients will be more comfortable before the surgery.

Wound healing and scar management

Studies have shown ES therapy to be a successful treatment modality for wound healing, with limited to no side effects. The bioelectronic modalities utilised in NuroKor technology can be applied to local infections and scar tissue. This means diabetic patients who are at higher risk of infection and those with decubitus ulcerations and lymphedema may benefit (1,2). ES also, has the potential to be combined with wound dressings for wound management after arthroplasty(3).

Optimising recovery post-surgery

Post-surgical pain relief is paramount to optimising the patient’s experience. ES, such as NuroKor technology, can play a key role in the rehabilitation and early mobilisation stages. The technology can help post-operative pain management by maintaining muscle strength and functional capacity, increasing patients’ walking ability and balance. It is a non-invasive technique which can be utilised at home easily without assistance.

In the case of a total hip arthroplasty for hip osteoarthritis in elderly patients - low-frequency, ES is recognised as a safe, well-tolerated therapy, which also can increase knee extensor strength (4). Studies have also shown that the effects of NeuroMuscular Stimulation (NMS) on quadriceps femoris strength are significant and can provide maintenance or increased muscle mass, strength and volume in critically ill patients (5). 

Immobilisation and intensive surgeries can be risk factors for thromboembolism. Neuromuscular ES provides impulses to lower extremities to encourage involuntary mechanical contractions of the muscles and has been used for the prevention of venous thromboembolism. It increases venous blood flow and is well tolerated (7-10).

Other benefits post-surgery include an increase in microvascular circulation, NuroKor’s anti-inflammatory effects may assist with decreasing peripheral edema after the surgery - which in turn, can help the circulation process(1). Furthermore, in a postoperative state patients can feel post-op numbness, weakness and pain. These rare but unpleasant effects can be salvaged with bioelectronic intervention(6). In addition, the at-home and self-administered nature of the treatment has the potential to positively impact the patients psychological state - providing comfort and self confidence. 

Delay and prevention

The benefits of ES do not need to begin with surgical intervention, it can similarly assist in the delay and preventative stages. For example, ES can be a useful modality in early-stage (stage 1-2) avascular necrosis patients who are predominantly younger and active. Microcurrent, one of NuroKor’s three bioelectronic technologies, has the potential to be used after core decompression, stem cell implantations or PRP injections (11,12). 

Conclusion

The health and social care systems of the future will be augmented and enhanced by innovative technology and products. The application of EMS, such as NuroKor technology, has the ability to enhance patient care - benefiting both pre-surgery and post-surgery stages. EMS offers healthcare professionals an effective, non-invasive and drug-free alternative or adjunct therapy for patients. 

To find out more about EMS and NuroKor technology read NuroKor’s BioElectric Medicine Clinician Explainer.

About NuroKor

Founded in 2018, NuroKor is a company committed to the development of bioelectronic technologies. NuroKor develops and formulates programmable bioelectronic software for clinical and therapeutic applications, in a range of easy to use, wearable devices. It provides the highest-quality products, delivering personalised pain relief and recovery support and rehabilitation to patients.

 Footnotes:

*COVIDSurg collaborative, Elective surgery cancellation due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020; https://doi.org/10.1002/bjs.11746

Resource:

1. Choi YD, Lee JH. Edema and pain reduction using transcutaneous electrical nerve stimulation treatment. J Phys Ther Sci. 2016;28(11):3084-3087. doi:10.1589/jpts.28.3084
2. Kloth LC. Electrical Stimulation Technologies for Wound Healing. Adv Wound Care (New Rochelle). 2014;3(2):81-90. doi:10.1089/wound.2013.0459
3. Chow J. Wireless Microcurrent-Generating Antimicrobial Wound Dressing in Primary Total Knee Arthroplasty: A Single-Center Experience. Orthop Rev (Pavia). 2016;8(2):6296. Published 2016 Jun 27. doi:10.4081/or.2016.6296
4. P Gremeaux V, Renault J, Pardon L, Deley G, Lepers R, Casillas JM. Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2265-2273. doi:10.1016/j.apmr.2008.05.024
5. Wageck B, Nunes GS, Silva FL, et al. : Application and effects of neuromuscular electrical stimulation in critically ill patients: systematic review. Med Intensiva, 2014, 38: 444–454
6. Dabby R, Sadeh M, Goldberg I, Finkelshtein V. Electrical stimulation of the posterior tibial nerve reduces neuropathic pain in patients with polyneuropathy. J Pain Res. 2017;10:2717-2723. Published 2017 Nov 29. doi:10.2147/JPR.S137420
7. Miller C, McGuiness W, Wilson S, et al. Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial. J Wound Care. 2017;26(3):88-98. doi:10.12968/jowc.2017.26.3.88 
8. Nicolaides AN, Kakkar VV, Field ES, Fish P. Optimal electrical stimulus for prevention of deep vein thrombosis. Br Med J. 1972;3(5829):756-758. doi:10.1136/bmj.3.5829.756 
9. Hajibandeh S, Hajibandeh S, Antoniou GA, Scurr JR, Torella F. Neuromuscular electrical stimulation for thromboprophylaxis: A systematic review. Phlebology. 2015;30(9):589-602. doi:10.1177/0268355514567731 
10. Ravikumar R, Williams KJ, Babber A, et al. Neuromuscular electrical stimulation for the prevention of venous thromboembolism. Phlebology. 2018;33(6):367-378. doi:10.1177/0268355517710130
11. Griffin M, Bayat A. Electrical stimulation in bone healing: critical analysis by evaluating levels of evidence. Eplasty. 2011;11:e34
12. Steinberg ME, Brighton CT, Corces A, et al. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation. Clin Orthop Relat Res. 1989;(249):199-208

‍