Percutaneous Nerve Evaluation for Sacral Nerve Stimulation

Sacral nerve stimulation is a treatment that involves using an implanted device that sends mild electrical impulses to the sacral nerves. The sacral nerves control several functions in the lower part of the body, including bladder and bowel functions. Sacral nerve stimulation can be used to treat various disorders that cause problems with urinary or bowel control.

Before having a sacral nerve stimulator implanted, a person must go through a trial known as a percutaneous nerve evaluation. This involves using a temporary nerve stimulator that will remain outside of your body. This trial helps determine if sacral nerve stimulation will help your condition. For the trial, a procedure must first be done to insert temporary wires into your body. Electric pulses will travel through these wires (electrodes) to an area close to your sacral nerves. The electrodes are connected to the temporary nerve stimulator. The nerve stimulator will send electric pulses during the trial period, which is usually 1–2 weeks.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Malfunction of the stimulator.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:

• Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins. Fluids and medicine will flow into your body through this tube.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• Long needles will be inserted into your lower back. Your health care provider will use a type of X-ray (fluoroscopy) to guide the needles to the right spot. The needles will be guided to the left or right of the third hole in the back (S3 foramen) of the bone at the base of your spine (sacrum).
• The position of the needles will be tested. If they are in the right spot, your toes or feet may move. You may feel a tingling in your legs.
• Electrodes will be inserted through the needles and into your body.
• The electrodes will be anchored in place close to your sacral nerves.
• The ends of the electrodes outside your body will be connected to a nerve stimulator device. A bandage (dressing) will be applied to cover the electrodes.
• Your health care provider will program the rate at which the nerve stimulator will deliver the electronic pulses.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will need to wear the sacral nerve stimulator throughout the trial period.
• Do not drive for 24 hours if you received a sedative.

Percutaneous Nerve Evaluation for Sacral Nerve Stimulation, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After your procedure, it is common to have soreness or pain in the area where the needles were inserted.

Follow these instructions at home:

Activity

• Follow instructions from your health care provider about any restrictions on activities or movements during the test period. You may need to avoid:
  • Bending, twisting, or stretching.
  • Having sex.
• Do not lift anything that is heavier than 10 lb (4.5 kg).

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep the bandage (dressing) dry until your health care provider says it can be removed. Also keep the electrodes and the nerve stimulator device dry.

Puncture Site Care

• Follow instructions from your health care provider about how to take care of your puncture site. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
• Check your puncture area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Use a journal to keep track of your symptoms during the test period. Write down your bladder or bowel activity and symptoms as told by your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative).
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Keep all follow-up visits as told by your health care provider. This is important.

Use Instructions for the Sacral Nerve Stimulator Device

• Follow instructions from your health care provider about how to use the nerve stimulator device.
• If you see any other health care providers during the test period, tell them that you have this device.

Contact a health care provider if:

• The electrodes get damaged.
• The length of the electrodes seems to change significantly. This could mean that the electrodes have moved out of place.
• The nerve stimulator device gets damaged.
• The electrodes or the nerve stimulator device gets wet.
• You have more redness, swelling, or pain around your puncture area.
• You have more fluid or blood coming from your puncture area.
• Your puncture area feels warm to the touch.
• You have pus or a bad smell coming from your puncture area.
• You have a fever.