title: Ultrasound-guided, percutaneous peripheral nerve stimulation: technical note.
abstract: BACKGROUND
  Peripheral nerve stimulation is a form of neuromodulation that applies electric current to peripheral nerves to induce stimulation paresthesias within the painful areas.
  
  
  OBJECTIVE
  To report a method of ultrasound-guided, percutaneous peripheral nerve stimulation. This technique utilizes real-time imaging to avoid injury to adjacent vascular structures during minimally invasive placement of peripheral nerve stimulator electrodes.
  
  
  METHODS
  We describe a patient that presented with chronic, bilateral foot pain following multiple foot surgeries, for whom a comprehensive, pain management treatment strategy had failed. We utilized ultrasound-guided, percutaneous tibial nerve stimulation at a thigh level to provide durable pain relief on the right side, and open peripheral nerve stimulation on the left.
  
  
  RESULTS
  The patient experienced appropriate stimulation paresthesias and excellent pain relief on the plantar aspect of the right foot with the percutaneous electrode. On the left side, we were unable to direct the stimulation paresthesias to the sole of the foot, despite multiple electrode repositionings. A subsequent, open placement of a left tibial nerve stimulator was performed. This revealed that the correct electrode position against the tibial nerve was immediately adjacent to the popliteal artery, and was thus not appropriate for percutaneous placement.
  
  
  CONCLUSIONS
  We describe a method of ultrasound-guided peripheral nerve stimulation that avoids the invasiveness of electrode placement via an open procedure while providing excellent pain relief. We further describe limitations of the percutaneous approach when navigating close to large blood vessels, a situation more appropriately managed with open peripheral nerve stimulator placement. Ultrasound-guided placement may be considered for patients receiving peripheral nerve stimulators placed within the deep tissues, and not easily placed in a blind fashion.
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Chan
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Brown
authors.forename: Kenneth
authors.initials: K
authors.lastname: Park
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Winfree
mesh_terms: D000328:Adult; D005260:Female; D005528:Foot / Q000503:physiopathology; D006801:Humans; D010146:Pain / Q000000981:diagnostic imaging; D059408:Pain Management; D013979:Tibial Nerve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*