Peripheral Nerve Stimulation: From Nerve Blocks to Wireless Neuromodulation

Abstract

Peripheral nerve stimulation (PNS) was one of the earliest neuromodulation modalities to be applied clinically soon after the Gateway theory. Prior to PNS, anesthetic nerve blocks were used for pain relief and surgical procedures. From nerve blocks to stimulation, PNS has evolved rapidly in techniques and technology leading to the minimally invasive wireless neuromodulation. Peripheral nerve blocks were applied clinically to predict PNS outcomes. Not only these studies revealed the prognostication of neuromodulation but led to observations to modify PNS also. Accordingly, nerve stimulation along the major nerve or along its branch or the nerve field yielded similar outcomes in experimental as well as clinical settings. This also facilitated approaches with minimalistic surgical procedure, single step implantations without trial stimulation. Wireless PNS enhances the outcomes due to its inherent advantages like minimal tissue trauma,absence of implantable pulse generator (IPG) or the accessories required for traditional PNS. Preliminary case illustrations demonstrated the safety of this wireless technology and further long-term outcome studies in larger patient populations are in progress.