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Brief technical report
Peripheral nerve stimulation for saphenous neuralgia
  1. Meghan McCullough1,
  2. Deborah Kenney2,
  3. Catherine Curtin3 and
  4. Einar Ottestad4
  1. 1Surgery, Plastic and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2Orthopedic Surgery, Stanford University, Palo Alto, California, USA
  3. 3Surgery, Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, USA
  4. 4Anesthesiology and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
  1. Correspondence to Dr Meghan McCullough, Plastic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Meghan.McCullough{at}cshs.org

Abstract

Background Injury to saphenous nerve branches is frequent during knee surgery and can result in chronic pain. This saphenous neuralgia remains challenging to treat. Peripheral nerve stimulation (PNS) is a new potential non-pharmacologic treatment option. We present our outcomes experience using this technology in 12 patients.

Methods We retrospectively reviewed PNS placement for saphenous neuralgia between 2000 and 2022 at a single institution. Demographic information was collected as well as response to the device. Four-question short-form Patient-Reported Outcome Measurement Information System (PROMIS) Scores were collected before and 2 weeks, 6 weeks, and 6 months postprocedure. Specific scores included pain interference and behavior, functional mobility, depression, anxiety, and sleep impairment. Change in pain interference measured by the short-form PROMIS tool at 6 months was chosen as the primary outcome.

Results Twelve patients met inclusion criteria, with 10 patients having the full 6-month follow-up. In these 10 patients, the mean change from baseline in the short-form adjusted pain interference score (greater difference means improved pain) at 6 months was 5.8 (SD 6.5). Among all patients, average follow-up was 11.5 months (range 3–35 months). Most patients’ symptoms developed after knee surgery (84%). Prior to PNS, patients underwent other treatments including cryoablation (8%), radiofrequency ablation (16%), saphenous neurectomy (16%), or surgical release of adjacent nerves (25%). Ten patients (83%) reported any improvement in symptoms while two reported no benefit. Complications occurred in four patients (33%). Two patients had the device removed and a third discontinued use. PROMIS Scores for pain, functional mobility, mood, and sleep impairment all improved.

Discussion Limited effective treatments exist for saphenous neuralgia. Our case series demonstrates the potential of PNS as a treatment for saphenous neuralgia. Comparative effectiveness studies are warranted to assess whether our effect size is clinically relevant.

  • peripheral nerve injuries
  • neuralgia
  • lower extremity
  • pain
  • postoperative complications
  • postoperative

https://doi.org/10.1136/rapm-2023-104538

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    Footnotes

    • Presented at This work was presented at the American Society for Peripheral Nerve Society Annual Meeting, January 2023, Fort Lauderdale, Florida, USA.

    • Contributors MM was involved in study design, data collection, data analysis, and manuscript preparation; DK was involved in study design and data collection; EO and CC were involved in study design, concept, and manuscript revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests EO is the principal investigator for a grant from Bioness for a peripheral nerve stimulation registry. He also receives consulting fees from Bioness.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.