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. 2018 Oct;71(5):407-410.
doi: 10.4097/kja.d.17.00023. Epub 2018 Jul 24.

Lead fracture of peripheral nerve stimulator for brachial plexopathy -a case report

Shu Chung Choi  1 , Ji Seon Chae  2 , Youn Jin Kim  2 , Jin Young Chon  1 , Ho Sik Moon  1
Affiliations

Lead fracture of peripheral nerve stimulator for brachial plexopathy -a case report

Shu Chung Choi et al. Korean J Anesthesiol. 2018 Oct.

Abstract

Peripheral nerve stimulation (PNS) is a useful treatment for chronic pain, but it can cause damage depending on its application site. Here, we describe the case of a 54-year-old man who underwent PNS for brachial plexopathy in 2015. One lead was implanted on the left medial cord to stimulate the medial antebrachial cutaneous nerve, and the other was implanted on the radial nerve to stimulate the posterior antebrachial cutaneous nerve. Both leads were inserted near the shoulder joint but did not cross it. Before PNS, the patient did not move his shoulder and elbow because of severe pain, but the treatment greatly alleviated this pain. Twenty months after the operation, both leads were fractured, and the severe pain returned. Repetitive motion near the joint was closely related to the lead fractures. In conclusion, large joints as the insertion sites of PNS leads should be avoided to prevent lead fractures.

Keywords: Complications; Fracture; Lead; Peripheral nerve; Stimulation..

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Figures

Fig. 1.
Fig. 1.
PNS lead positions prior to lead fractures. One lead was inserted on the radial nerve for pain in the posterior antebrachial cutaneous territory (a), and another was fixed on the medial cord for pain in the medial antebrachial cutaneous dermatome (b). PNS: peripheral nerve stimulation.
Fig. 2.
Fig. 2.
Lead positions after the PNS revision procedure. A new lead was inserted on the medial cord. The lead was inserted into the trunk side to prevent damage due to joint movement. PNS: peripheral nerve stimulation.
Fig. 3.
Fig. 3.
Ultrasound-guided PNS system implantation. The Tuohy needle (arrow-head) was inserted with a conventional infraclavicular approach, and the needle tip was placed between the axillary artery and the medial cord. After a 10-ml normal saline injection, the lead (arrow) was inserted until resistance was felt. The lead’s proper position was settled with repeated electrical stimulation during lead withdrawal. PM: pectoralis major muscle, Pm: pectoralis minor muscle, MC: medial cord, LC: lateral cord, A: axillary artery, V: axillary vein, PC: posterior cord, PNS: peripheral nerve stimulation.
See this image and copyright information in PMC

References

    1. Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Leong M, et al. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee. Neuromodulation. 2014;17:515–50. - PubMed
    1. Park CH, Huh BK. Permanent peripheral nerve stimulation for chronic occipital neuralgia: case reports. Korean J Pain. 2008;21:155–8.
    1. Chung W, Kim Y, Lee J, Lee S, Kim Y, Shin Y, et al. Ultrasound-guided placement of a permanent peripheral nerve stimulator in a patient with complex regional pain syndrome: A case report. Anesth Pain Med. 2016;11:295–8.
    1. Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature. Pain Med. 2016;17:325–36. - PubMed
    1. Sharan A, Huh B, Narouze S, Trentman T, Mogilner A, Vaisman J, et al. Analysis of adverse events in the management of chronic migraine by peripheral nerve stimulation. Neuromodulation. 2015;18:305–12. - PubMed

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