Percutaneous Auricular Nerve Stimulation (Neuromodulation) for Analgesia and Opioid-Sparing Following Knee and Hip Arthroplasty: A Proof-of-Concept Case Series

Figure 1.. A percutaneous auricular nerve stimulation system (NSS-2 Bridge, Masimo). Each of the 3 electrodes has a 2-millimeter-long integrated needle/lead (inset), and the ground electrode has four 2-millimeter-long integrated needles—also termed “leads” (inset). Used with permission from Brian M. Ilfeld, MD, MS.

Figure 2.. A percutaneous auricular nerve stimulation system (NSS-2 Bridge, Masimo). The pulse generator is adhered directly to the patient behind the ear over the mastoid process. Leads are placed: (1) at the most cephalad portion of the antihelix, (2) immediately cephaloanterior to the incisura and posterior to the superficial temporal arterial pulse, and (3) on the posterior ear opposite the antihelix at the level of the incisura. The ground electrode is inserted on the anterior side of the lobule (ear lobe). Used with permission from Baharin Abdullah, MD.

Figure 3.. Pain and opioid consumption following total knee and hip arthroplasty with percutaneous auricular nerve stimulation for the first 5 postoperative days. Each circle represents 1 patient, and the median for each time point is denoted with a horizontal line.