Clinical Anesthesia & Research

Abstract

A Novel Minimally Invasive Wireless Technology for Neuromodulation via Percutaneous Lateral Femoral Cutaneous Nerve Stimulation for Meralgia Paresthetica: A Case Report with 3-Month Follow-Up

Stefan Stockli, Elissa R. Ettinger, Niek E. Vanquathem BA.

Background: Peripheral nerve stimulation (PNS) of the lateral femoral cutaneous nerve provides control of burning pain and severe allodynia in the anterolateral thigh at the right side.

Objective: To assess analgesic effects of a minimally invasive wireless neuromodulation in the treatment of chronic pain due to Meralgia Paresthetica.

Case Summary: A patient presented with burning pain and severe allodynia in the right anterolateral thigh, and was subsequently diagnosed with Meralgia Paresthetica. The patient’s problems began with arthroscopy of the knee for cruciate ligament repair and several debridements following that. Thereafter, he developed infection, empyema, and life-threatening necrotizing fasciitis. In 2015, he had adhesiolysis of the femoral cutaneous nerve by a hand surgeon resulting in one year relief of pain, and thereafter, recurring pain. Other previous therapies attempted include: cryoablation of the femoral cutaneous nerve; repeated ultrasound-guided femoral cutaneous nerve blocks; physiotherapy; and medications including tramadol, paracetamol, acemetacin, tapentadol, pregabalin, lidocaine patch, and trimipramin. Patient was deemed a suitable candidate for a minimally invasive neuromodulation procedure. One subcutaneous electrode was inserted approximately 20 cm below the groin in the anterior thigh on the right side, and placed on the lateral femoral cutaneous nerve.

Results: The procedure was uneventful, and pain scores (NRS) reduced from a 10 out of 10 before stimulation to a 0 while applying stimulation at 3-months follow-up.

Conclusions: Subcutaneous placement of electrodes with a minimally invasive technique and wireless technology was safe and effective. Significant improvements in pain relief ensued at the three-month follow-up with no adverse events.