Ultrasound-guided placement of a permanent percutaneous femoral nerve stimulator leads for the treatment of intractable femoral neuropathy.

BACKGROUND: Femoral nerve injury is a rare complication of cardiac catheterization and is usually caused by direct trauma during femoral artery access, compression from a hematoma, or prolonged digital pressure for post-procedural hemostasis. Peripheral nerve stimulation has been used to treat different pain syndromes in the upper and lower extremities with variable success and it typically requires direct vision with open surgical approach. Since the femoral nerve can be readily seen with ultrasonography, an ultrasound-guided lead placement seemed practical. CASE REPORT: A 61-year-old morbidly obese male who sustained femoral nerve injury during cardiac catheterization continued to complain of intractable femoral neuropathy 18 months afterwords. He failed multiple treatment modalities and continued to complain of severe neuropathic pains that markedly interfere with his daily activities. Two percutaneous leads were placed under real-time ultrasonography and the placement was confirmed with fluoroscopy. One lead was placed along the longitudinal axis of the nerve and the patient had good coverage over the anterior thigh but not below the knee. So another lead was placed horizontally across the femoral nerve in order to stimulate all the branches and the patient reported good coverage along the saphenous nerve distribution down to the foot. RESULTS: The patient continues to be pain free 20 months after the implant. CONCLUSION: Here we described a novel non-invasive percutaneous approach for femoral nerve stimulation with ultrasound guidance which allowed precise placement of the stimulating lead very close to the femoral nerve without the need for surgical exploration.

[Neuralgia of the genitofemoral nerve after hernioplasty. Therapy by peripheral nerve stimulation]. / Neuralgie des N. genitofemoralis nach Hernioplastik. Therapie durch periphere Nervenstimulation.

The peripheral nerve stimulation (PNS) is an established therapy in the management of neuropathic pain. Here, we describe a case of successful epifascial stimulation in the proximity of the genitofemoral nerve, which was injured during an endoscopic hernioplasty. During the following months the patient developed an intense neuropathy of this nerve, which we now treated by permanent PNS with an 8-polar electrode. During the 1 year follow-up the patient described a pain reduction of nearly 70%. There were no adverse events until now. In conclusion, PNS is a promising procedure in the treatment of neuralgia after hernioplasty.

Transient femoral neuropathy after harvest of bone from the iliac crest.

A 31-year-old woman had bone harvested from the left anterior iliac crest as a graft for an augmentation genioplasty. For postoperative analgesia, she was given a bupivacaine infusion into the iliac wound. She developed a temporary left femoral mononeuropathy from which she recovered completely.

Femoral nerve injury complicating continuous psoas compartment block.

OBJECTIVES: The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. CASE REPORT: A 60-year-old, American Society of Anesthesiologists II woman underwent right total knee replacement under general anesthesia and continuous PCB for postoperative analgesia. Postoperatively, she showed signs of severe femoral nerve injury. A physical therapy program and muscle electrical stimulation were instituted and continued for 6 months. The patient recovered completely with no residual motor or sensory deficit and had no other complication. CONCLUSIONS: Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.