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Volume: 36  Issue: 1   Year: 2023
  Peripheral nerve stimulation (pns): a valid and definitive therapeutical option for a case of anterior cutaneous nerve entrapment syndrome (acnes) [Ağrı]
Ağrı. Ahead of Print: AGRI-07673 | DOI: 10.14744/agri.2023.07673  

Peripheral nerve stimulation (pns): a valid and definitive therapeutical option for a case of anterior cutaneous nerve entrapment syndrome (acnes)

Ezio Amorizzo1, Francesca De Sanctis2, Gianni Colini Baldeschi3, Fernando Ricci4, Giustino Varrassi5
1Department Of Anesthesiology, San Paolo Hospital, Civitavecchia, Roma, Ita
2Department Of Anesthesiology, Critical Care And Pain Medicine, Azienda Ospedaliera S. Maria Terni, Terni, Ita
3Pain Department, Pain Clinic Rome, Rome, Ita
4Anesthesiology And Critical Care, San Paolo Hospital, Roma, Ita
5Pain Medicine, Paolo Procacci Foundation, Rome, Ita

Anterior cutaneous nerve entrapment syndrome (ACNES) is a cause of moderate-severe
chronic pain, hyperesthesia/hypoesthesia and altered perception of heat/cold, in a specific region of the anterior abdominal wall, referable to the territory of innervation of one or more anterior branches of the intercostal nerves. None of the therapeutical option currently available proved to be effective in the long term or decisive. In recent years we have begun to treat purely
sensory neuropathies, such as this, with the implantation of wireless peripheral nerve stimulators (PNS) achieving the safety of a modular and personalized analgesia.
We report the case of a 41 year old man suffering from ACNES of the 8th intercostal nerve for two years. We
first performed two consecutive ultrasound-guided diagnostic blocks of the anterior cutaneous branch of
the 8th intercostal right nerve and then elected the patient to execute ultrasound-guided nerve
decompression followed by neuromodulation and pulsed-radiofrequency (PRF). Taking into account full employment, young age, and the likelihood of having to repeat the
treatment several times, we considered him for Peripheral Nerve Simulation (PNS)
implantation under ultrasound guidance and we implanted the wireless lead at the
branch of the right intercostal 8 th nerve, and programmed tonic stimulation 100 Hz PW 200 ms. The patient
referred immediate pain relief, and never took medication for this problem again, at two years follow-up.
PNS has had an increasing role in the management of chronic neuropathic pain, especially in merely
sensitive neuropathies like ACNES, we support future research on this theme.

Keywords: chronic pain, peripheral nerve stimulation, ACNES, radiofrequency, modular analgesia

Corresponding Author: Francesca De Sanctis, Italy

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