Gregory Nicholas S, Terkawi Abdullah S, Prabhakar Nitin K, Tran Johnathan V, Salmasi Vafi, Hah Jennifer M
Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.
Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
Pain Med. 2020 Aug 1;21(Suppl 1):S51-S55. doi: 10.1093/pm/pnaa171.
Pudendal neuropathy is a chronic, disabling form of perineal pain that involves the pudendal nerve, a mixed somatic and autonomic nerve that originates from sacral nerve roots. Peripheral nerve stimulation of the pudendal nerve can be useful to decrease symptom burden in patients who have failed initial conservative treatment modalities.
In this manuscript, we describe an approach to the placement of a peripheral nerve stimulator for the treatment of pudendal neuralgia. We present a case of complex pelvic neuropathy and review the factors that lead to successful placement. Technical aspects of stimulator placement and ultrasound landmarks are reviewed.
A lateral to medial approach with ultrasound guidance at the level of the ischial spine is likely to facilitate proper lead placement along the course of the pudendal nerve. Aftercare and adherence to postimplant activity restrictions-particularly avoiding use of the extremes of hip flexion and extension for four weeks-lead to the absence of lead migration.
Pudendal nerve stimulation is an emerging technique for neuromodulation of refractory pudendal neuralgia. Ultrasound-guided pudendal nerve stimulation is a viable technique for neuromodulation of pudendal neuralgia. Optimization of patient selection, ultrasound guidance, and proper adherence to postimplant activity restrictions may be helpful for long-term therapeutic success.
阴部神经病变是一种慢性、致残性会阴部疼痛形式，涉及阴部神经，这是一条起源于骶神经根的混合性躯体神经和自主神经。对于初始保守治疗方式失败的患者，阴部神经的周围神经刺激可能有助于减轻症状负担。
在本手稿中，我们描述了一种用于治疗阴部神经痛的周围神经刺激器放置方法。我们呈现了一例复杂盆腔神经病变病例，并回顾了导致成功放置的因素。回顾了刺激器放置的技术方面和超声标志。
在坐骨棘水平采用超声引导从外侧向内侧的方法可能有助于沿阴部神经走行正确放置电极导线。术后护理以及遵守植入后活动限制——特别是四周内避免极度屈曲和伸展髋关节——可防止电极导线移位。
阴部神经刺激是一种用于难治性阴部神经痛神经调节的新兴技术。超声引导下阴部神经刺激是一种用于阴部神经痛神经调节的可行技术。优化患者选择、超声引导以及正确遵守植入后活动限制可能有助于获得长期治疗成功。
