Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: Neuromodulation of the Femoral Nerve for Postoperative Analgesia Following Ambulatory Anterior Cruciate Ligament Reconstruction: A Proof of Concept Study

Neuromodulation. 2019 Jul;22(5):621-629. doi: 10.1111/ner.12851. Epub 2018 Aug 30.


Objectives: The purpose of this prospective proof of concept study was to investigate the feasibility of using percutaneous peripheral nerve stimulation of the femoral nerve to treat pain in the immediate postoperative period following ambulatory anterior cruciate ligament reconstruction with a patellar autograft.

Materials and methods: Preoperatively, an electrical lead (SPRINT, SPR Therapeutics, Inc., Cleveland, OH, USA) was percutaneously implanted with ultrasound guidance anterior to the femoral nerve caudad to the inguinal crease. Within the recovery room, subjects received 5 min of either stimulation or sham in a randomized, double-masked fashion followed by a 5-min crossover period, and then continuous active stimulation until lead removal postoperative Day 14-28. Statistics were not applied to the data due to the small sample size of this feasibility study.

Results: During the initial 5-min treatment period, subjects randomized to stimulation (n = 5) experienced a slight downward trajectory (decrease of 7%) in their pain over the 5 min of treatment, while those receiving sham (n = 5) reported a slight upward trajectory (increase of 4%) until their subsequent 5-min stimulation crossover, during which time they also experienced a slight downward trajectory (decrease of 11% from baseline). A majority of subjects (80%) used a continuous adductor canal nerve block for rescue analgesia (in addition to stimulation) during postoperative Days 1-3, after which the median resting and dynamic pain scores remained equal or less than 1.5 on the numeric rating scale, respectively, and the median daily opioid consumption was less than 1.0 tablet.

Conclusions: This proof of concept study demonstrates that percutaneous femoral nerve stimulation is feasible for ambulatory knee surgery; and suggests that this modality may be effective in providing analgesia and decreasing opioid requirements following anterior cruciate ligament reconstruction. clinicaltrials.gov: NCT02898103.

Keywords: Ambulatory surgery; neuromodulation; outpatient surgery; percutaneous peripheral nerve stimulation; postoperative analgesia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures / adverse effects*
  • Ambulatory Surgical Procedures / trends
  • Analgesia / methods
  • Analgesia / trends
  • Anterior Cruciate Ligament Reconstruction / adverse effects*
  • Anterior Cruciate Ligament Reconstruction / trends
  • Cross-Over Studies
  • Double-Blind Method
  • Electrodes, Implanted / trends
  • Female
  • Femoral Nerve / diagnostic imaging
  • Femoral Nerve / physiology
  • Humans
  • Male
  • Pain Measurement / methods
  • Pain Measurement / trends
  • Pain, Postoperative / diagnostic imaging
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Proof of Concept Study*
  • Prospective Studies
  • Transcutaneous Electric Nerve Stimulation / methods*
  • Transcutaneous Electric Nerve Stimulation / trends
  • Ultrasonography, Interventional / methods*
  • Ultrasonography, Interventional / trends

Associated data

  • ClinicalTrials.gov/NCT02898103