Peripheral Nerve Stimulation Reduces Opioid Use and Facilitates Early Ambulation Following Fibular Flap Harvest: A Retrospective Study
In brief
Nerve stimulation lowered postoperative pain, but opioid reduction was not statistically clear
In this retrospective study of 26 patients having fibular flap reconstruction, those receiving peroneal nerve stimulation reported less pain on postoperative days 2 to 5. Their median opioid use was 11.25 mg versus 105 mg, but the difference was not statistically significant, nor was the shorter time to walking independently. Larger prospective studies are needed to confirm whether stimulation speeds recovery.
- Journal
- Plastic and reconstructive surgery. Global open (Q2)
- Published
- 20 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Kyu J Choi, Alexander Ivan B Posis, Alane Costanzo, Anthony Scherschel, Jesse R Qualliotine, Yan T Ortiz-Pomales, et al.
- PMID
- 42903310
- DOI
- 10.1097/GOX.0000000000008167
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 25 October 2026): Donor-site pain and recovery after fibular free-flap harvest
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.