Percutaneous peripheral nerve stimulation as an ancillary treatment following nerve repair surgery.

Abstract

Background: Neuropathic pain after peripheral nerve injury severely degrades quality of life. Peripheral nerve stimulation (PN-Stim) is cleared by the U.S, Food and Drug Administration for the treatment of acute and chronic pain. This broad indication supports its potential use at the time of peripheral nerve repair in patients reporting neuropathic pain preoperatively.

Objective: To explore the safety and therapeutic effects of PN-Stim on neuropathic pain in patients with severe peripheral nerve injuries undergoing surgical nerve repair.

Methods: We analyzed 16 consecutive patients 18 years and older who received PN-Stim implantation at the time of nerve repair surgery. Patients younger than 18 years of age, pregnant, and those without preoperative pain associated with nerve injury were excluded from our study. The primary outcome was pain score reduction, which was evaluated by Visual Analog Scale. The secondary outcomes included motor functional recovery and opioid usage, which were evaluated by manual muscle testing (MMT) and Morphine Milligram Equivalents quantification, respectively. Statistical analyses used paired two-tailed t-tests and Wilcoxon sign tests, contingent on data normalcy.

Results: Pain scores decreased significantly post-PN-Stim implantation (mean preplacement: 7.35, postplacement: 2.56; p < .05). MMT scores showed improvement in 13 patients, with 2 achieving the maximum MMT score (p < .05). Chronic opioid usage was observed to decrease in six of seven patients who were using them (p < .05). No significant adverse effects were seen after implantation.

Conclusion: In this case series of 16 patients with various peripheral nerve injuries who each underwent peripheral nerve repair surgery and concomitant placement of a temporary peripheral nerve stimulator, there were no adverse effects attributable to the peripheral nerve stimulator.