Periferal sinir stim�lasyonu (PNS): Anterior kutan�z sinir s�k��ma sendromu (ACNES) olgusu i�in ge�erli ve kesin bir tedavi se�ene�i

ISSN : 1300-0012 E-ISSN 2458-9446

Anasayfa | �leti�im | ENG

Cilt: 36 Say�: 2 Y�l: 2024

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Periferal sinir stim�lasyonu (PNS): Anterior kutan�z sinir s�k��ma sendromu (ACNES) olgusu i�in ge�erli ve kesin bir tedavi se�ene�i [A�r�]

A�r�. 2024; 36(2): 126-128 | DOI: 10.14744/agri.2023.07673

Periferal sinir stim�lasyonu (PNS): Anterior kutan�z sinir s�k��ma sendromu (ACNES) olgusu i�in ge�erli ve kesin bir tedavi se�ene�i

Ezio Amorizzo¹, Francesca De Sanctis², Gianni Colini Baldeschi³, Fernando Ricci⁴, Giustino Varrassi⁵
¹San Paolo Hastanesi, Anesteziyoloji B�l�m�, Civitavecchia, Roma, �talya
²Anesteziyoloji, Kritik Bak�m ve A�r� T�bb� B�l�m�, Azienda Ospedaliera S. Maria Terni, Terni, �talya
³Roma A�r� Klini�i, A�r� B�l�m�, Roma, �talya
⁴Anesteziyoloji ve Kritik Bak�m, San Paolo Hastanesi, Roma, �talya
⁵A�r� T�bb�, Paolo Procacci Vakf�, Roma, �talya

Anterior kutan�z sinir s�k��ma sendromu (ACNES), �zg�l bir anterior kar�n duvar� b�lgesinde, orta ila �iddetli kronik a�r�, hiperestezi/hipoestezi ve �s�/so�uk alg�s�nda de�i�ikli�e sebep olan, bir veya daha fazla interkostal sinirin �n dallar�n�n innerve etti�i b�lgeye atfedilebilen bir durumdur. �u anda mevcut olan tedavi se�eneklerinden hi�biri uzun vadede veya kesin olarak etkili olmam��t�r. Son y�llarda, bu gibi saf duyusal n�ropatileri, kablosuz periferal sinir stim�lat�rleri (PNS) implantasyonu ile tedavi etmeye ba�lad�k, mod�ler ve ki�iselle�tirilmi� analjezi g�venli�ine ula�t�k. �ki y�ld�r 8. interkostal sinirin ACNES�inden muzdarip 41 ya��nda bir erkek hastan�n vakas�n� rapor ediyoruz. �lk olarak, 8. interkostal sa� sinirin anterior kutan�z dal�n�n iki ard��k ultrason k�lavuzlu�unda tan�sal bloklar�n� ger�ekle�tirdik ve ard�ndan hastay� ultrason k�lavuzlu�unda sinir dekompresyonunu takiben n�romod�lasyon ve darbeli-radyofrekans (PRF) uygulamas� i�in se�tik. Tam istihdam, gen� ya� ve tedavinin birka� kez tekrarlanmas� gereklili�ini g�z �n�nde bulundurarak, onu ultrason k�lavuzlu�unda Periferal Sinir Stim�lasyonu (PNS) implantasyonu i�in de�erlendirdik ve kablosuz elektrodu sa� 8. interkostal sinirin anterior dal�na yerle�tirdik ve tonik stim�lasyonu 100 Hz PW 200 ms olarak programlad�k. Hasta, hemen a�r�da rahatlama bildirdi ve bu sorun i�in bir daha asla ila� almad�, iki y�ll�k takipte. PNS, �zellikle ACNES gibi sadece duyarl� n�ropatilerde kronik n�ropatik a�r�n�n y�netiminde giderek artan bir rol oynam��t�r. Bu tema �zerine gelecek ara�t�rmalar� destekliyoruz.

Anahtar Kelimeler: ACNES, kronik a�r�, mod�ler analjezi, periferal sinir stim�lasyonu, radyofrekans.

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, Italy
²Department of Anesthesiology, Critical Care and Pain Medicine, Azienda Ospedaliera S. Maria Terni, Terni, Italy
³Department of Pain, Pain Clinic Rome, Rome, Italy
⁴Anesthesiology and Critical Care, San Paolo Hospital, Roma, Italy
⁵Pain Medicine, Paolo Procacci Foundation, Rome, Italy

Anterior cutaneous nerve entrapment syndrome (ACNES) is a cause of moderate to 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 therapeutic options currently available has 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 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 for 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 Stimulation (PNS) implantation under ultrasound guidance, and we implanted the wireless lead at the anterior branch of the right 8th intercostal nerve, and programmed tonic stimulation 100 Hz PW 200 ms. The patient reported 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: ACNES, chronic pain, modular analgesia, peripheral nerve stimulation, radiofrequency.

Ezio Amorizzo, Francesca De Sanctis, Gianni Colini Baldeschi, Fernando Ricci, Giustino Varrassi. Peripheral nerve stimulation (PNS): A valid and definitive therapeutical option for a case of anterior cutaneous nerve entrapment syndrome (ACNES). A�r�. 2024; 36(2): 126-128

Sorumlu Yazar: Francesca De Sanctis, Italy

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