Novel Implantation Technique for Thoracoabdominal Peripheral Nerve Stimulation via a Transversus Abdominal Plane Approach for Treatment of Chronic Abdominal Pain

Abstract

Background

Chronic abdominal pain (CAP) is a common and challenging to treat condition with a global prevalence of up to 25%. Despite extensive evaluation, approximately 40% of patients with CAP have an unknown diagnosis. Medications may be ineffective, and surgery is rarely indicated. Interventional treatment including sympathetic blocks, sympathetic neurolysis, and transversus abdominal plane (TAP) blocks may be an option, but their efficacy can wane over time. Neuromodulation has emerged as an option for these patients, as there is evidence of success with dorsal column spinal cord and dorsal root ganglion (DRG) stimulation. Peripheral nerve stimulation (PNS) may be an alternative option, particularly in higher risk patients or in patients for whom neuraxial access may be unsafe or too technically challenging. Thoracoabdominal nerve peripheral nerve stimulation via a TAP approach may be more specifically targeted in comparison to dorsal column or DRG stimulation. In this short report, we detail a technique that the authors have successfully used for thoracoabdominal nerve PNS via a TAP approach for management of CAP.

Methods

This article describes a novel medial to lateral ultrasound guided thoracoabdominal nerve PNS via a TAP approach technique for lead placement and implantation.

Results

A medial to lateral ultrasound guided TAP approach as described to successfully implant percutaneous thoracoabdominal nerve PNS leads for management of CAP.

Conclusion

The thoracoabdominal nerve PNS via a TAP approach lead placement technique noted in this report has been used as a means for management of CAP utilizing peripheral neuromodulation. Here, we present a short report detailing a potential technique for PNS utilization for management of CAP. Further studies are needed to validate the safety and efficacy of this therapy modality, although the authors have found it to be a viable management option for patients with medically refractory neuropathic CAP.

Keywords:

• peripheral nerve stimulator
• neuromodulation
• neuropathic pain
• ultrasound
• thoracic nerves

Acknowledgment

Nalu Medical paid the artist used for our illustration for this study.

Disclosure

Dr Dawood Sayed reports stock options from SPR, Painteq, Surgentec, Neuralace, Vertos; personal fees from Abbott, Saluda, outside the submitted work. Dr Alaa Abd-Elsayed reports consultant for Curonix. Dr Amitabh Gulati reports consulting for Medtronic, AIS HealthCare, Neurovasis, SPR Therapeutics, Tersera Medical, Hinge Health, Nalu Medical, Bausch health, outside the submitted work. Dr Michael E Schatman is a research consultant for Modoscript and advisory committee for Syneos Health, outside the submitted work. Dr Timothy Deer reports personal fees for consultant, Advisory Board, Research from SPR Therapeutics, during the conduct of the study; personal fees for consultant, advisory board, and/or research from Abbott, Vertos, SpineThera, Saluda, Mainstay, Cornerloc, Boston Scientific, PainTeq, Spinal Simplicity, and Biotronik, outside the submitted work. In addition, Dr Timothy Deer has a patent pending to Abbott. Dr Usman Latif reports personal fees from Nalu Medical, SPR Therapeutics, Nevro, Vertos Medical, Omnia Medical, Hydrocision, InFormed Consent, Spinal Simplicity; grants from Mainstay Medical, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

Nalu Medical provided an unrestricted grant for funding for the artist anatomic drawings used within.