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Peripheral Nerve Stimulation Reduces Opioid Use and Facilitates Early Ambulation Following Fibular Flap Harvest: A
Kyu J Choi1, Alexander Ivan B Posis2,3, Alane Costanzo4
1From the Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, CA.
Background:
Fibular free flap (FFF) reconstruction is the gold standard for mandibular and maxillary defects, but donor-site pain remains challenging. Multimodal analgesia (MMA) relies on opioids, which risk dependence, systemic side effects, and delayed recovery. Regional nerve blocks reduce pain but have inconsistent efficacy owing to variable drug metabolism, potential effects on flap perfusion, and motor blockade. Temporary percutaneous peripheral nerve stimulation (TPNS) is a promising alternative that selectively modulates sensory pathways while preserving motor function.
Methods:
This retrospective, single-center study evaluated 26 patients who underwent FFF reconstruction between July 2021 and November 2025, divided into 2 cohorts: MMA alone and MMA with peroneal nerve TPNS. The primary outcome was opioid consumption, expressed as oral morphine equivalents. Secondary outcomes were postoperative pain scores, time to independent ambulation, and length of stay.
Results:
The TPNS group had significantly lower pain scores on postoperative days 2-5 (P < 0.05). Cumulative opioid use was clinically but not statistically lower (median oral morphine equivalents 11.25 versus 105 mg; P = 0.1), as was median time to independent ambulation (3.71 versus 4.76 d; P = 0.24).
Conclusions:
TPNS may be a safe, opioid-sparing adjunct that promotes earlier mobilization after FFF harvest. Further study is needed to justify prospective, multicenter trials validating efficacy, cost-effectiveness, and broader applicability in head and neck reconstructive surgery.