Huntoon Marc A, Hoelzer Bryan C, Burgher Abram H, Hurdle Mark Friedrich B, Huntoon Elizabeth A
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
Reg Anesth Pain Med. 2008 Nov-Dec;33(6):558-65. doi: 10.1016/j.rapm.2008.04.006.
Peripheral nerve stimulation (PNS) may provide analgesia for neuropathic pain syndromes in that nerve distribution. PNS electrode placement using ultrasound (US) guidance for upper extremity pain syndromes has not been reported. Existing anchoring technology may allow permanent implantation without significant migration.
Three cadaver midhumeral fresh frozen upper extremity specimens were studied. US scanning was performed, targeting electrode placement at the radial, ulnar, and median nerves. Leads were anchored in the superficial fascia. The targeted nerves were exposed by careful dissection. Visual inspection for gross nerve damage, and electrode proximity to the nerve was performed. After confirmation of adequate lead placement, 2 extremities were sutured and placed in a continuous passive motion (CPM) machine for 21 hours to simulate activity. Each electrode was assessed for migration.
Acceptable locations for US-guided electrode placement were: radial nerve approximately 10-14 cm superior to the lateral epicondyle; median nerve approximately 6 cm below the antecubital fossa; and ulnar nerve approximately 9 to 13 cm above the medial epicondyle. One electrode was placed at each site without difficulty. After careful exposure, visual inspection showed no gross nerve damage. Each electrode had at least 2 electrical contacts within 2 mm of the nerve sheath. At CPM termination, only the median nerve electrode on 1 cadaver extremity had migrated significantly.
This new minimally invasive approach to lead placement requires further study to determine implantation criteria, optimal locations, anchoring techniques, and electrode design to define best clinical practice.
周围神经刺激（PNS）可为该神经分布区域的神经性疼痛综合征提供镇痛效果。尚未有关于使用超声（US）引导进行上肢疼痛综合征的PNS电极置入的报道。现有的锚定技术可能允许永久性植入且无明显移位。
研究了3个新鲜冷冻的尸体肱骨中段上肢标本。进行超声扫描，目标是将电极置于桡神经、尺神经和正中神经处。导线锚定在浅筋膜中。通过仔细解剖暴露目标神经。进行肉眼神经损伤的视觉检查以及电极与神经的接近程度检查。确认导线放置合适后，对2个肢体进行缝合，并置于连续被动运动（CPM）机器中21小时以模拟活动。评估每个电极的移位情况。
超声引导电极置入的可接受位置为：桡神经在外侧髁上方约10 - 14厘米处；正中神经在前臂肘窝下方约6厘米处；尺神经在内侧髁上方约9至13厘米处。每个部位均顺利放置一个电极。仔细暴露后，视觉检查未发现明显神经损伤。每个电极在神经鞘2毫米范围内至少有2个电接触点。在CPM结束时，只有1个尸体肢体上的正中神经电极有明显移位。
这种新的微创导线置入方法需要进一步研究，以确定植入标准、最佳位置、锚定技术和电极设计，从而确定最佳临床实践。
