title: Facilitation of percutaneous trial lead placement with ultrasound guidance for peripheral nerve stimulation trial of ilioinguinal neuralgia: a technical note.
abstract: Introduction. Peripheral nerve stimulation (PNS) has been used for many years to treat neuropathic pain syndromes. Technical advances in neurostimulation hardware have led to a renewed interest in the use of PNS for control of intractable pain caused by peripheral mononeuropathies. One such application includes intractable groin pain. This study identified two patients with chronic groin pain, secondary to trauma, referred for interventional pain management. For each patient, PNS trial was attempted using ultrasound guided localization of the inguinal nerve. Direct sonographic visualization of the inguinal nerve has been used in other studies to facilitate regional anesthesia, but to our knowledge, no studies have used this technique for localization of nerves for percutaneous lead placement for PNS. Methods. Each patient was chosen to undergo trial stimulation using percutaneously placed peripheral nerve stimulator leads. In these two cases, both patients presented with similar complaints of chronic groin pain consistent with ilioinguinal neuralgia. Both underwent multiple previous nerve blocks, all of which gave good but transient relief using traditional block techniques. Both patients were trialed on multiple medications, which either gave incomplete relief of pain or were limited by side-effects. Results. Both patients had relatively easy localization of ilioinguinal nerves affected using ultrasound and were provided with stimulating paresthesias which covered their normal pain. Discussion. The successful use of ultrasound as described in these two cases suggests an important role for ultrasound in localization of targeted nerves in percutaneous trial stimulation of injured peripheral nerve. The use of ultrasound may also play a role in permanent lead placement as well. Conclusion. More studies are needed to further qualify the role of ultrasound in isolating peripheral nerves, but the success of trial stimulation in these two cases holds promise for continued advancements in the field of neuromodulation.
authors.affiliation: Lahey Clinic, Spine Center, Department of Neurosurgery, Burlington, MA, USA and              Dartmouth Hitchcock Medical Center, Anesthesia, Pain Clinic; and              Dartmouth Hitchcock Medical Center, Anesthesia, Hanover, NH, USA.
authors.forename: Alexios
authors.initials: A
authors.lastname: Carayannopoulos
authors.forename: Ralph
authors.initials: R
authors.lastname: Beasley
authors.forename: Brian
authors.initials: B
authors.lastname: Sites