Ultrasound-guided, percutaneous peripheral nerve stimulation: technical note.

Area of Science:

• Neuromodulation
• Pain Management
• Minimally Invasive Procedures

Background:

• Peripheral nerve stimulation (PNS) uses electric currents to alleviate pain by inducing paresthesias in affected areas.
• Chronic pain, particularly post-surgical foot pain, presents a significant challenge in pain management.
• Traditional neuromodulation techniques may involve invasive procedures with potential risks.

Observation:

• A novel method employing ultrasound-guided, percutaneous peripheral nerve stimulation was utilized.
• Real-time imaging guided electrode placement, aiming to prevent injury to adjacent vascular structures.
• A patient with chronic bilateral foot pain refractory to conventional treatments was treated.

Findings:

• Percutaneous ultrasound-guided tibial nerve stimulation in the thigh provided effective pain relief for the right foot.
• Open peripheral nerve stimulation was required for the left side due to the tibial nerve's proximity to the popliteal artery, precluding safe percutaneous placement.
• The percutaneous approach demonstrated limitations when navigating near large blood vessels.

Implications:

• Ultrasound guidance enhances safety and precision in minimally invasive peripheral nerve stimulator electrode placement.
• Open surgical placement remains crucial for cases where percutaneous access is anatomically challenging or risky due to vascular structures.
• This technique is valuable for deep nerve targets not amenable to blind placement, optimizing patient outcomes in neuromodulation therapy.