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Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation
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Peripheral Nerve Stimulation for Pudendal Neuralgia: A Technical Note.

Nicholas S Gregory1, Abdullah S Terkawi1, Nitin K Prabhakar2

  • 1Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.

Pain Medicine (Malden, Mass.)
|August 18, 2020
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Summary

Pudendal nerve stimulation, using ultrasound guidance, offers a viable treatment for chronic pudendal neuralgia when conservative methods fail. Proper lead placement and post-procedure care are crucial for successful pain management.

Keywords:
NeuromodulationPeripheral Nerve StimulationPudendal NeuralgiaUltrasound Guidance

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Area of Science:

  • Neurology
  • Pain Management
  • Medical Devices

Background:

  • Pudendal neuropathy causes chronic, disabling perineal pain.
  • The pudendal nerve is vital for somatic and autonomic functions, originating from sacral nerve roots.
  • Peripheral nerve stimulation (PNS) is a potential treatment for patients unresponsive to conservative therapies.

Observation:

  • This manuscript details an approach for peripheral nerve stimulator placement for pudendal neuralgia.
  • A case of complex pelvic neuropathy is presented, highlighting factors for successful stimulator placement.
  • Technical aspects and ultrasound landmarks for precise stimulator placement are reviewed.

Findings:

  • A lateral to medial approach with ultrasound guidance near the ischial spine facilitates accurate lead placement along the pudendal nerve.
  • Strict adherence to post-implant activity restrictions, avoiding extreme hip movements for four weeks, prevents lead migration.

Implications:

  • Ultrasound-guided pudendal nerve stimulation is an emerging and viable neuromodulation technique for refractory pudendal neuralgia.
  • Optimizing patient selection, utilizing ultrasound guidance, and ensuring adherence to post-implant protocols are key for long-term therapeutic success.