title: Subcutaneous peripheral neurostimulation for the treatment of severe chronic poststernotomy neuralgia.
abstract: OBJECTIVE
  Poststernotomy pain frequently develops after sternotomy in thoracic and cardiovascular surgery, and may affect patients' quality of life. In some cases of severe poststernotomy neuralgia, pharmacologic therapy does not provide adequate relief.
  
  
  METHODS
  We report on a 42- year-old woman who underwent sternotomy for aortic and mitral valve replacement. She developed severe chronic poststernotomy neuralgia that was refractory to medical treatment. After local anesthesia markedly but only transiently alleviated pain, we considered the option of subcutaneous peripheral neurostimulation (SPNS). Plate electrodes were implanted bilaterally in the parasternal region at the site of maximal pain. After a period of test stimulation, the electrodes were connected to a dual-channel implantable pulse generator. SPNS induced paresthesias in the painful area. Revision surgery was necessary twice because of electrode migration. Chronic SPNS markedly alleviated pain (visual-analog scale, VAS, 9/10 preoperatively, 2/10 postoperatively) and allodynia (VAS 9/10 preoperatively, 2/10 postoperatively) at the last available follow-up, 15 months postoperatively.
  
  
  CONCLUSIONS
  SPNS may be a viable treatment option in patients with severe chronic poststernotomy neuralgia.
authors.affiliation: Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
authors.forename: Morad
authors.initials: M
authors.lastname: Peyravi
authors.forename: Hans-Holger
authors.initials: HH
authors.lastname: Capelle
authors.forename: Stefan
authors.initials: S
authors.lastname: Fischer
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Joachim K
authors.initials: JK
authors.lastname: Krauss
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D009437:Neuralgia / Q000209:etiology / Q000628:therapy*; D010147:Pain Measurement; D056346:Sternotomy / Q000009:adverse effects*; D016896:Treatment Outcome