A Systematic Review of Temporary Peripheral Nerve Stimulation for Postoperative Pain Management in Orthopedic Surgery

BACKGROUND/OBJECTIVES: Over 18 million orthopedic procedures were performed in the United States in 2022 with pharmacological management being the primary mode of analgesia. Percutaneous neuromodulation in the form of temporary peripheral nerve stimulation (tPNS) may provide a new method of postsurgical analgesia devoid of systemic side effects and the potential for substance addiction. tPNS can also be used for chronic pain long after surgery.

METHODS: The initial literature search of PubMed/MEDLINE, Web of Science, and Cochrane was conducted on September 21, 2023, and repeated on May 23, 2025. Included studies had patients over 18 years of age with implanted tPNS in the first 2 years following orthopedic surgery of the knee, shoulder, hip, foot, or ankle.

RESULTS: Eleven articles of nine distinct studies were found: eight articles from six randomized trials and three articles from three case series. Seven publications assessed implanted tPNS in the acute perioperative phase, and four publications assessed implanted tPNS for chronic postoperative pain. This systematic review's aim was to compile current literature on the safety and efficacy of percutaneous tPNS both immediately after orthopedic surgery and for longer-term postsurgical persistent pain. This collection of evidence suggests using percutaneous tPNS is safe and may reduce pain and postoperative opioid consumption.

CONCLUSIONS: This emerging treatment may reduce postoperative pain and opioid consumption, is safe, and warrants further robust trials. Future studies with robust, multimodal treatment designs are needed to specifically delineate the role of tPNS within the context of current pain management.