A monopolar needle electrode for testing optimal lead placement is also recommended. A small volume of local anesthetic for skin anesthesia is the recommended procedure. A sterile transducer sleeve should be utilized for this procedure as well. Any ultrasound machine with either a curved array transducer or linear array transducer may be used. Necessary equipment for placing a peripheral nerve stimulator include ultrasound for identification of target nerve, equipment to maintain sterility of the procedure, appropriate needles for monopolar lead placement, and a sterile dressing. Relative contraindications include coagulopathy and local infection near the access site. Examples of such conditions are but not limited to-ĩ) Intercostal neuralgia ContraindicationsĪbsolute contraindications to the placement of a peripheral nerve stimulator include allergy to any component of the stimulator or patient refusal. Indications of a peripheral nerve stimulator include all conditions that result in neuropathic pain in a dermatomal distribution of a particular nerve. The ideal placement of a peripheral nerve stimulator lead is parallel to a nerve. However, peripheral nerve stimulation may be used effectively at other sites. Cadaveric studies have shown that tibial nerve, peroneal nerve, sciatic nerve, and lateral sural nerve are all acceptable locations in the lower extremity and radial nerve, median nerve, and ulnar nerve would be feasible locations for peripheral nerve stimulator placement in the upper extremity. Because the anatomy and approach to this technique are similar to that of continuous peripheral nerve block, percutaneous peripheral nerve stimulator placement could theoretically be in any location commonly used for peripheral nerve block. The determination for the appropriate location for the placement of a peripheral nerve stimulator lead depends on the area in which analgesia is necessary. The uses of peripheral nerve stimulators have not yet been fully explored, but several studies suggest that this technique is a feasible adjunct to current pain management practices. In addition, post-operative pain control may be achievable using peripheral nerve stimulation. Previously percutaneous peripheral nerve stimulators have been used for chronic neuropathic pain in patients with contraindications to spinal cord stimulators, and permanent lead placement has been the choice for chronic neuropathic pain. In this changing setting, peripheral nerve stimulators may serve as an important adjunct in both chronic and acute pain management. Managing chronic pain continues to be a challenge secondary to increasing opioid-related deaths and the opioid crisis. Non-opioid analgesia is a growing field and is gaining increased traction among pain physicians. Explain a structured interprofessional team approach to provide effective care to and appropriate surveillance of patients undergoing peripheral nerve stimulator placement.Ĭhronic pain is one of the leading causes of disability in the world.Review the technique involved in placing a peripheral nerve stimulator lead.Describe potential complications of peripheral nerve stimulator placement.Identify the indications for placement of peripheral nerve stimulators.This activity highlights the role of the interprofessional team in the care of patients undergoing this procedure. ![]() This activity reviews the indications, contraindications, and technique involved in placing peripheral nerve stimulators. ![]() Peripheral nerve stimulation is an emerging field in adjunctive analgesic therapies.
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