Percutaneous Peripheral Nerve Stimulation in Acute Pain Medicine
Purpose of Review: The current opioid epidemic in North America has directed trends in acute pain management towards complementary therapies, including nonopioid analgesics and regional anesthesia techniques. More recently neurostimulation has reappeared as an alternative therapy. Neurostimulation has been used for many years as an analgesic modality in the treatment of a variety of acute and chronic pain conditions. However, available technologies previously limited its widespread use. More recently, percutaneous peripheral nerve stimulation (pPNS) has been suggested as a means to help manage acute postoperative pain following total knee arthroplasty. This review aims to evaluate the current literature regarding the use of pPNS and its role in management of acute pain. Recent Findings: Recently, several studies have demonstrated the successful perineural placement of stimulating electrodes under ultrasound guidance. Along with technological advancements in lead and stimulator manufacture, this has made it easier to utilize neurostimulation for pain management. Several recent case reports have demonstrated use in management of acute postoperative pain following total knee arthroplasty, with patients showing an improvement in pain scores from baseline and faster achievement of postoperative milestones. Summary: Nerve stimulation has been utilized as an effective treatment for a variety of chronic pain states. Although its use for acute pain is much less documented, preliminary data from case reports suggest that the ultrasound-guided placement of electrodes and targeted electrical stimulation of specific peripheral nerves may have a role in the management of acute postoperative pain in total knee arthroplasty.
