Name of the Procedure:

Incision for implantation of neurostimulator electrode array; peripheral nerve (Common names: Peripheral nerve stimulator implantation, PNS electrode array implantation)

Summary

This procedure involves making a surgical incision to implant a neurostimulator electrode array near a peripheral nerve. The array helps manage pain or improve nerve function by delivering electrical impulses to the targeted nerve areas, excluding sacral nerves.

Purpose

The procedure addresses chronic pain conditions or nerve dysfunctions that do not respond to typical treatments. The goal is to reduce pain, improve quality of life, and enhance nerve function by modulating the electrical signals of peripheral nerves.

Indications

• Chronic pain that is localized to specific peripheral nerve areas
• Peripheral neuropathy
• Failed back surgery syndrome
• Complex regional pain syndrome (CRPS)
• Other peripheral nerve injuries or conditions

Preparation

• Fasting for 8-12 hours prior to the procedure if general anesthesia is used.
• Adjustments to medications, as advised by the healthcare provider.
• Pre-procedure diagnostic tests, such as MRI or nerve conduction studies, to identify the affected nerves and to plan the placement of the electrodes.

Procedure Description

1. The patient is positioned and prepped in the surgical area.
2. Anesthesia is administered (local, regional, or general anesthesia based on the case).
3. A small incision is made near the targeted peripheral nerve.
4. The surgeon carefully places the electrode array over the nerve.
5. The electrode leads are connected to a small pulse generator, which is implanted under the skin.
6. The incision is closed with sutures or surgical staples.
7. The neurostimulator is tested and programmed to ensure proper function.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Surgeon (specialized in neurology or pain management)
• Anesthesiologist (if general or regional anesthesia is used)
• Nurses and surgical technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage
• Device malfunction or displacement
• Allergic reactions to anesthesia
• Unintended stimulation of adjacent nerves

Benefits

• Reduction in chronic pain
• Improved physical function and mobility
• Enhanced quality of life
• Potential reduction in the need for pain medications

Recovery

• Rest and limited physical activity for a few days following the procedure.
• Follow-up appointments to monitor the device and ensure proper healing.
• Gradual return to normal activities is typically expected within a few weeks.

Alternatives

• Conservative pain management: Medication adjustments, physical therapy
• Other interventional procedures: Nerve blocks, radiofrequency ablation
• Surgical options: Peripheral nerve decompression or repair

Patient Experience

During the procedure, the patient may be under anesthesia and will not feel pain. Post-procedure, there may be some discomfort or soreness at the incision site, which is typically managed with prescribed pain medication. Adjustments to the neurostimulator settings may be needed to achieve the best results. The patient can often expect gradual improvement in their symptoms within weeks after the procedure.