Percutaneous brachial plexus peripheral nerve stimulation for cancer-related upper extremity pain: a novel technical
Lee Nguyen1, Naileshni Singh1, Chinar Sanghvi1
1Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA.
Background:
Peripheral nerve stimulation (PNS) is a well-established therapy for neuropathic pain syndromes. Emerging literature suggests that PNS is effective for treating oncologic pain.
Objective:
This case report presents a novel ultrasound-guided, dual-lead PNS neuromodulation of the brachial plexus for upper-extremity cancer pain, with a focus on technical considerations.
Methods:
Temporary, percutaneous, brachial plexus PNS was implanted in a patient with metastatic lung adenocarcinoma who was hospitalized for refractory pain from a pathologic humeral fracture. A novel approach is presented via the DAVIS (Dual-Lead Approach with Vectoring in the Subclavicular Plane) technique. This technique uses a parallel, subclavicular trajectory to optimize parallel lead positioning and minimize migration. Nerve localization, procedural technique, and patient-specific considerations are discussed.
Results:
Following PNS implantation, the patient achieved complete cessation of opioid use with substantial and sustained pain relief, highlighting the clinical potential of the DAVIS technique.
Conclusion:
Brachial plexus PNS presents a promising strategy for extremity oncologic pain. Novel approaches focusing on dual-lead placement with a parallel trajectory may expand the efficacy of PNS in anatomically complex or opioid-refractory cases.
