Ultrasound-Guided Peripheral Nerve Stimulation

Peripheral nerve stimulation (PNS) is currently a topic of increased interest after decades of apparent decline. Some of this increased popularity can be attributed to the advent of new imaging techniques, including ultrasound. Two recent feasibility studies in fresh cadavers suggested that ultrasound (US) could be used to place electrodes without apparent nerve injury next to peripheral nerves, similar to nerve catheter placement. These reports were followed by a small case series of patients receiving permanent implants, with ­generally good outcomes. US-guided placement allowed a percutaneous trial, preventing incision in ­nonresponders, and in many cases produced durable analgesia beyond 1 year. Percutaneous leads designed for spinal cord stimulation placed via US allowed the intraoperative testing of multiple different stimulation parameters. US visualization also allowed electrode ­placement superior or inferior to the nerve, or even two parallel leads placed abreast of the nerve.