Peripheral Nerve Stimulation Reduces Opioid Use and Facilitates Early Ambulation Following Fibular Flap Harvest: A Retrospective Study.
7 affiliations
- 1From the Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, CA.
- 2Warfighter Performance Department, Naval Health Research Center San Diego, San Diego, CA.
- 3Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA.
- 4Department of Anesthesiology and Pain Medicine, Naval Medical Center San Diego, San Diego, CA.
- 5Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA.
- 6Department of Plastic and Reconstructive Surgery, Naval Medical Center San Diego, San Diego, CA.
- 7Department of Plastic and Reconstructive Surgery, Missouri University Hospital, Columbia, MO.
Abstract
Background
Fibular free flap (FFF) reconstruction is the gold standard for mandibular and maxillary defects, but donor-site pain remains challenging. Multimodal analgesia (MMA) relies on opioids, which risk dependence, systemic side effects, and delayed recovery. Regional nerve blocks reduce pain but have inconsistent efficacy owing to variable drug metabolism, potential effects on flap perfusion, and motor blockade. Temporary percutaneous peripheral nerve stimulation (TPNS) is a promising alternative that selectively modulates sensory pathways while preserving motor function.Methods
This retrospective, single-center study evaluated 26 patients who underwent FFF reconstruction between July 2021 and November 2025, divided into 2 cohorts: MMA alone and MMA with peroneal nerve TPNS. The primary outcome was opioid consumption, expressed as oral morphine equivalents. Secondary outcomes were postoperative pain scores, time to independent ambulation, and length of stay.Results
The TPNS group had significantly lower pain scores on postoperative days 2-5 (P < 0.05). Cumulative opioid use was clinically but not statistically lower (median oral morphine equivalents 11.25 versus 105 mg; P = 0.1), as was median time to independent ambulation (3.71 versus 4.76 d; P = 0.24).Conclusions
TPNS may be a safe, opioid-sparing adjunct that promotes earlier mobilization after FFF harvest. Further study is needed to justify prospective, multicenter trials validating efficacy, cost-effectiveness, and broader applicability in head and neck reconstructive surgery.
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BibTeX
@article{choi2026peripheral,
title = {{Peripheral Nerve Stimulation Reduces Opioid Use and Facilitates Early Ambulation Following Fibular Flap Harvest: A Retrospective Study.}},
author = {Kyu J Choi and Alexander Ivan B Posis and Alane Costanzo and Anthony Scherschel and Jesse R Qualliotine and Yan T Ortiz-Pomales and Eamon O'Reilly and Daniel A Hammer},
journal = {Plastic and reconstructive surgery. Global open},
year = {2026},
month = oct,
doi = {10.1097/gox.0000000000008167},
url = {https://europepmc.org/article/MED/42903310},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Peripheral Nerve Stimulation Reduces Opioid Use and Facilitates Early Ambulation Following Fibular Flap Harvest: A Retrospective Study.
AU - Kyu J Choi
AU - Alexander Ivan B Posis
AU - Alane Costanzo
AU - Anthony Scherschel
AU - Jesse R Qualliotine
AU - Yan T Ortiz-Pomales
AU - Eamon O'Reilly
AU - Daniel A Hammer
PY - 2026
DA - 2026/10/20
JO - Plastic and reconstructive surgery. Global open
DO - 10.1097/gox.0000000000008167
UR - https://europepmc.org/article/MED/42903310
AB - Background Fibular free flap (FFF) reconstruction is the gold standard for mandibular and maxillary defects, but donor-site pain remains challenging. Multimodal analgesia (MMA) relies on opioids, which risk dependence, systemic side effects, and delayed recovery. Regional nerve blocks reduce pain but have inconsistent efficacy owing to variable drug metabolism, potential effects on flap perfusion, and motor blockade. Temporary percutaneous peripheral nerve stimulation (TPNS) is a promising alternative that selectively modulates sensory pathways while preserving motor function.Methods This retrospective, single-center study evaluated 26 patients who underwent FFF reconstruction between July 2021 and November 2025, divided into 2 cohorts: MMA alone and MMA with peroneal nerve TPNS. The primary outcome was opioid consumption, expressed as oral morphine equivalents. Secondary outcomes were postoperative pain scores, time to independent ambulation, and length of stay.Results The TPNS group had significantly lower pain scores on postoperative days 2-5 (P < 0.05). Cumulative opioid use was clinically but not statistically lower (median oral morphine equivalents 11.25 versus 105 mg; P = 0.1), as was median time to independent ambulation (3.71 versus 4.76 d; P = 0.24).Conclusions TPNS may be a safe, opioid-sparing adjunct that promotes earlier mobilization after FFF harvest. Further study is needed to justify prospective, multicenter trials validating efficacy, cost-effectiveness, and broader applicability in head and neck reconstructive surgery.
SN - 2169-7574
ER -