Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.
Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131 Naples, Italy.
Int J Environ Res Public Health. 2023 Mar 3;20(5):4488. doi: 10.3390/ijerph20054488.
Peripheral neuro-stimulation (PNS) has been proved to be effective for the treatment of neuropathic pain as well as other painful conditions. We discuss two approaches to PNS placement in the upper extremity. The first case describes a neuropathic syndrome after the traumatic amputation of the distal phalanx of the fifth digit secondary to a work accident with lack of responsiveness to a triple conservative therapy. An upper arm region approach for the PNS was chosen. The procedure had a favorable outcome; in fact, after one month the pain symptoms were absent (VAS 0) and the pharmacological therapy was suspended. The second case presented a patient affected by progressive CRPS type II in the sensory regions of the ulnar and median nerve in the hand, unresponsive to drug therapy. For this procedure, the PNS device was implanted in the forearm. Unfortunately, in this second case the migration of the catheter affected the effectiveness of the treatment. After examining the two cases in this paper, we changed our practice and suggest the implantation of PNS for radial, median and/or ulnar nerve stimulation in the upper arm region, which has significant advantages over the forearm region.
周围神经刺激（PNS）已被证明对治疗神经性疼痛以及其他疼痛状况有效。我们讨论了两种在上肢放置 PNS 的方法。第一个病例描述了因工作事故导致第五指末节外伤性截肢后出现的神经综合征，该患者对三联保守治疗无反应。选择在上臂区域进行 PNS 治疗。该手术结果良好；事实上，一个月后疼痛症状消失（VAS 评分为 0），并停止了药物治疗。第二个病例为手部尺神经和正中神经感觉区域的进展性复杂性区域疼痛综合征 II 型患者，对药物治疗无反应。为此，在患者前臂中植入了 PNS 设备。不幸的是，在第二种情况下，导管的迁移影响了治疗效果。在对本文中的两个案例进行检查后，我们改变了我们的实践，并建议在上臂区域植入 PNS 以刺激桡神经、正中神经和/或尺神经，这比在前臂区域有显著优势。
