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Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review

  • Acute Pain Medicine (R Urman, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Recent research has shown the effectiveness of peripheral nerve stimulators (PNS) in managing chronic pain conditions. Ongoing studies aim to explore its potential application in treating acute postoperative pain states. The purpose of this systematic review is to assess the role of PNS in providing relief for postoperative pain.

Recent Findings

Clinical studies investigating the use of peripheral nerve stimulators (PNS) for analgesia following various surgeries, such as total knee arthroplasty, anterior cruciate ligament repair, ankle arthroplasty, rotator cuff repair, hallux valgus correction, and extremity amputation, have shown promising results. Lead placement locations include the brachial plexus, sciatic, femoral, tibial, genicular, perineal, sural, radial, median, and ulnar nerves. These studies consistently report clinically significant reductions in pain scores, and some even indicate a decrease in opioid consumption following PNS for postoperative pain.

Summary

PNS involves the subcutaneous placement of electrode leads to target peripheral nerve(s) followed by delivery of an electric current via an external pulse generator. While the precise mechanism is not fully understood, the theory posits that PNS modulates electrical stimulation, hindering the signaling of nociceptive pain. PNS presents itself as an alternative to opioid therapy, holding promise to address the opioid epidemic by offering a nonpharmacologic approach for both acute and chronic pain states.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Funding

No funding or sponsorship was received for this study or publication of this article.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA

    Alan D. Kaye, Azem A. Chami & Sahar Shekoohi

  2. Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA

    Alan D. Kaye

  3. School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA

    Taylor R. Plaisance, Summer A. Smith, Michael J. Alfred & Catherine G. Nguyen

  4. School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Amanda R. Ragland & Kylie Dufrene

  5. Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA

    Saurabh Kataria

  6. Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Christopher L. Robinson

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  1. Alan D. Kaye
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Contributions

Conceptualization, ADK, TRP, SAS, ARR, MJA, CGN, AAC, SK, KD, SS, CLR. Writing—original draft preparation, ADK, TRP, SAS, ARR, MJA, CGN, AAC, SK, KD, SS, CLR. Writing—review and editing, ADK, TRP, SAS, ARR, MJA, CGN, AAC, SK, KD, SS, CLR. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Sahar Shekoohi.

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The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any authors.

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Key Summary Points

• PNS involves the subcutaneous placement of an electrode near a target nerve using ultrasound guidance. Electric current is delivered via an external pulse generator, or stimulator, to the area surrounding the peripheral nerve. The current provides therapeutic pain relief by interrupting nociceptive pain signals to the brain.

• Most recognized indications for PNS involve treatment of pain conditions not related to surgery. However, the FDA has confirmed the postoperative use of PNS, and current research shows favorable results for PNS in the treatment of acute pain states.

• Standard postoperative analgesic treatments such as opioids, peripheral nerve blocks, epidural injections, radiofrequency ablation, and spinal cord stimulation are known to have potential adverse effects and high patient burden. PNS appears to be an effective alternative approach to postoperative analgesia with efficacy and minimal side effects.

• Though further research is needed, PNS is a promising analgesic technique that has shown positive results in recent clinical studies for chronic pain states as well as managing acute postoperative pain.

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Kaye, A.D., Plaisance, T.R., Smith, S.A. et al. Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01257-z

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