Challenges of Peripheral Nerve Stimulator Implantation in a Patient with New Onset Thrombocytopenia

Interventional procedures in the setting of multimodal practice are an often used treatment approach to chronic pain. Advanced technologies such as neuromodulation by way of peripheral nerve stimulation (PNS) is a promising frontier. Patients offered this technique have often failed conservative management, a series of injections and are not favorable candidates for pursuing spinal cord stimulation (SCS). A major goal for chronic pain treatment is the improvement of quality of life, return to work and activity. The spectrum of clinical situations where PNS has been successfully used includes chronic pain in extremities, neck, lower back, chest and abdominal wall, and head and face regions. It is also a widely accepted technique in the management of postsurgical neuropathy. We present a patient with complex regional pain syndrome (CRPS)-like symptoms of the lateral femoral cutaneous nerve after laparoscopic hysterectomy who underwent successful ultrasound-guided PNS trial using SCS leads and unfortunate delayed implantation due to thrombocytopenia. From this case we learned the following: positioning for laparoscopic hysterectomy may not be a readily attributed etiology for injury to the lateral femoral cutaneous nerve amongst some nonsurgical specialties; PNS is a viable option where SCS use is unfavorable; the use of spinal cord stimulator leads are useful in PNS trials, but may be less desirable for long term therapy; institution of basic coagulation screening at the time of trial rather than implantation in low risk candidates remains controversial.


Stephanie Thompson

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