Peripheral Nerve Stimulation on the Brachial Plexus With Ultrasound-guided Percutaneous Technique: A Case Series.

INTRODUCTION: The aim of this case series was to assess the safety and effectiveness of peripheral nerve stimulation (PNS) of the brachial plexus performed using a low invasive percutaneous approach with ultrasound guide. MATERIALS AND METHODS: Patients affected by neuropathic pain with a documented brachial plexus partial avulsion were included in this observational study. A totally implantable PNS system specifically designed for peripheral placement (Neurimpulse, Padua, Italy) was implanted and followed for 18 months, recording the level of pain (Numeric Rating Scale [NRS]), therapy satisfaction (Patient Global Impression of Improvement), quality of life (Short Form Health Survey questionnaire), and change in drug consumption and work status. Descriptive statistic (mean and SD) was used to compare pre- and postimplantation differences. RESULTS: A total of 18 patients were included in the observational study; 16 of them proceeded with the permanent implantation. System infection (N = 1) and lead migrations (N = 2) were recorded during a follow-up mean of 14.8 ± 5.4 months. The average NRS reduction at 18 months was 41%. Average quality-of-life physical and mental indexes increased by 14% and 32%, respectively. Drug intake was stopped in 22% and reduced in 56% of the patients. CONCLUSIONS: PNS systems of the brachial plexus implanted with percutaneous approach appear to be safe and effective in a follow-up period of 18 months. Longer and larger studies are needed to confirm and extend these outcomes.

Occipital Nerve Stimulation.

Although the first publications on clinical use of peripheral nerve stimulation for the treatment of chronic pain came out in the mid-1960s, it took 10 years before this approach was used to stimulate the occipital nerves. The future for occipital nerve stimulation is likely to bring new indications, devices, stimulation paradigms, and a decrease in invasiveness. As experience increases, one may expect that occipital nerve stimulation will eventually gain regulatory approval for more indications, most likely for occipital neuralgia, migraines and cluster headaches. This process may require additional studies, at least for approval from the US Food and Drug Administration.