Sciatic, Femoral, and Lateral Femoral Cutaneous Nerve Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation

Abstract

Objective With advances in peripheral nerve stimulation technology, there has been an emergence of new minimally invasive techniques to provide neurostimulation therapies for chronic pain. This technical note describes the utilization of ultrasonography for percutaneous placement of peripheral nerve stimulation leads at the sciatic, femoral, and lateral femoral cutaneous nerves. Methods Ultrasound can be utilized to localize a specific nerve, view neighboring soft tissue anatomy, and plan a needle trajectory. Various ultrasound techniques and transducer orientations allow for multiple options for lead placement relative to the targeted nerve. Conclusions The option of ultrasound-guided percutaneous technique for neurostimulation lead placement allows this treatment modality to be made available to more patients with chronic pain in specific nerve distributions.

Peripheral Nerve Stimulator for Pain After Surgery for Ulnar Neuropathy at the Elbow

“…PNS is currently used in adults for various indications, including complex regional pain syndrome (CRPS), post-herpetic neuralgia, lumbar and thoracic spinal neuropathy, and peripheral neuropathic pain from the sciatic, femoral, or saphenous nerve [11][12][13][14][15]. PNS acts both on the peripheral and central nervous systems and modulates inflammatory pathways and the autonomic nervous system [16,17].…”

The effect of electrotherapy on traumatic lesions of the sciatic nerve: A review of evidenced-based physiotherapy practice

“…PENS was significantly more effective than TENS in improving physical activity, pain, sleep quality and post-operative functioning [9] . New methods (such as the placement of PNS electrodes, using ultrasound to locate the sciatic nerve and design the needle trajectory) need to be better evaluated in the coming years, but they look very promising [10] . A study evaluating this new method reports a higher proportion of people with PNS reporting at least 50% reduction in pain after eight weeks of treatment compared with people treated with placebo [15] .…”

“…PENS was significantly more effective than TENS and placebo PENS in improving physical activity, sleep quality and post-operative functioning. A recently published technique by Singh [10] describes percutaneous placement of Peripheral Nerve Stimulation (PNS) electrodes, using ultrasound to locate the sciatic nerve and design the needle trajectory. The technique allows parallel or vertical orientation of an electrode to the target nerve.…”

A Case Report of Three Patients Who Underwent Temporary Peripheral Nerve Stimulation for Treatment of Knee Pain Secondary to Osteoarthritis

“…A 12.5 cm, 20 g SPR Therapeutic Inc. introducer (SPRINT, SPR Therapeutics, Inc., Cleveland, OH, USA) needle preloaded with stimulating lead was inserted under ultrasound guidance with a linear array probe. Using an in-plane approach, the needle was directed towards the femoral nerve from the lateral to the medial side [ 9 ]. Once the tip of the needle was confirmed to be around 0.5-2cm from the femoral nerve, the lead was then attached to an external pulse generator.…”