Peripheral nerve injury remains a significant clinical challenge, particularly in cases of long-gap defects. While autologous nerve grafting serves as the current gold standard treatment, its limitations include donor site morbidity and limited donor nerve availability. As a promising alternative, nerve guidance conduits (NGCs) have emerged within the field of tissue engineering. Incorporating electrical stimulation into NGCs has been shown to facilitate peripheral nerve repair by promoting Schwann cell migration and neurite extension. A significant advancement in this area is the application of piezoelectric biomaterials, which generate endogenous electrical signals from physiological mechanical stimuli. This self-powered mechanism eliminates the need for external power sources or additional surgical interventions. This review systematically examines the material design, fabrication strategies, and electromechanical properties of piezoelectric NGCs, along with their recent applications for enhancing Schwann cell function, guiding axonal growth, and promoting functional nerve recovery. Furthermore, it discusses current challenges and future directions, aiming to provide novel insights for the development of next-generation intelligent neural repair materials.