Name of the Procedure:

Percutaneous Implantation of Neurostimulator Electrode Array; Peripheral Nerve (Excludes Sacral Nerve)

• Common name(s): Peripheral nerve stimulation (PNS), Neurostimulator implant
• Medical terms: Percutaneous neurostimulation, Electrode implantation

Summary

Peripheral nerve stimulation involves placing a small device, called a neurostimulator, near a peripheral nerve to deliver electrical impulses. This can help manage chronic pain by interrupting pain signals traveling to the brain.

Purpose

• Medical condition: Chronic pain conditions affecting peripheral nerves (e.g., neuropathic pain, post-surgical pain, complex regional pain syndrome)
• Goals: To reduce pain, improve functional ability, and enhance the quality of life for patients suffering from chronic pain.

Indications

• Symptoms: Persistent and severe localized pain that is not well managed by conservative treatments such as medication or physical therapy
• Patient criteria: Adults who have tried and not found relief from other pain management therapies, with a thorough evaluation confirming eligibility for the implant

Preparation

• Instructions: Patients may need to fast for several hours before the procedure and may need to adjust or halt certain medications under the doctor's guidance
• Diagnostic tests: Pre-procedure assessments may include imaging studies (e.g., MRI, CT scan) and nerve conduction tests to locate the precise site of pain

Procedure Description

1. The patient is positioned, and the target nerve area is sterilized.
2. Local anesthesia is administered to numb the procedure site.
3. Using imaging guidance (e.g., fluoroscopy), the surgeon inserts a thin needle through the skin to the identified nerve.
4. An electrode array is threaded through the needle to the correct position near the nerve.
5. The lead is connected to an external neurostimulator for initial testing to confirm effectiveness.
6. Once proper placement and satisfactory pain relief are confirmed, the needle is removed, and the electrode array is secured.
7. The external neurostimulator may be replaced with an implanted device in a follow-up procedure.

• Tools: Imaging equipment, needle, electrode array, external neurostimulator device
• Anesthesia: Local anesthesia; for the follow-up procedure, light sedation or general anesthesia may be utilized

Duration

The initial implantation typically takes about 1-2 hours.

Setting

The procedure is usually performed in an outpatient setting, such as a surgical center or specialized clinic.

Personnel

• Surgeon or interventional pain specialist
• Nurse or surgical technologist
• Radiology technician (if imaging guidance is used)
• Anesthesiologist or nurse anesthetist (if sedation is required)

Risks and Complications

• Common risks: Mild discomfort at the insertion site, transient increase in pain, minor bleeding or bruising
• Rare risks: Infection, nerve damage, allergic reactions to materials used, electrode displacement

Benefits

• Expected benefits: Significant reduction in pain, decreased reliance on pain medications, improved daily functioning
• Timing: Pain relief may be observed immediately during the test phase. Long-term benefits can be assessed within a few weeks after the permanent device is implanted.

Recovery

• Post-procedure care: Keep the insertion site clean and dry, follow specific wound care instructions, limit strenuous activities
• Recovery time: Most patients resume normal activities within a few days to a week. Follow-up visits are crucial to adjust device settings and monitor progress.

Alternatives

• Other treatment options: Medication management, physical therapy, nerve blocks, surgical interventions
• Pros and cons: Medications may lack long-term effectiveness and can have side effects. Physical therapy may not be sufficient for severe pain. Surgical interventions carry significant risks but can provide permanent relief.

Patient Experience

• During the procedure: Patients will be conscious but should not feel pain due to local anesthesia; they might feel pressure or a minimal amount of discomfort.
• After the procedure: Slight soreness at the insertion site may occur, manageable with over-the-counter pain relief. Patients often feel increased comfort and a gradual reduction in pain symptoms as the neurostimulator begins to work effectively.