PNS Antibiotics

[BloodySurgeon]

I’m using a sprint PNS as a 60 day trial for permanent implant. The representative states that no antibiotics needed. Any thoughts?

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[MitchLevi]

None are recommended.

 

[lobelsteve]

None are recommended.

Abx or No Sprint recommended?

 

[fathead88]

You don't need prophylactic antibiotics for them

 

[MitchLevi]

Abx or No Sprint recommended?

No ABx.

SPRINT recs are...TBD.

For multifidus stim it is not recommended. Peripheral nerve we shall see. Post stroke shoulder it simply has to work.

It would be great if this worked for occipital neuralgia. Woodbury at the Decatur VA did bilateral placement at the TON and it seemed to work.

Makes me nervous considering leads fracture not infrequently.

 

[BloodySurgeon]

I want to use it for a median and ulnar neuropathy following injury. Anyone have experience placing them at axillary or infraclavicular area? If so, in-plane or out-of-plane approach. Any suggestions to avoid migration for trial?

 

[fathead88]

I have placed these for severe median neuropathy refractory to carpal tunnel release. Placed in plane proximal to the carpal tunnel. The issue with placing these more proximal (ie brachial plexus for hand pain) is that the stimulation seems to strongest more proximal. You would think you would get uniform stim within the distribution of the target nerve (essentially the whole arm for infraclavic placement), but that has not been my experience. The patients get a strong paresthesia proximally but nothing distally unless the strength is cranked up to the point it is supratherapeutic proximally. n=10-15

 

[painfree23]

is this Medicare or commercial patients??

 

[Orin]

Antibiotics per SCIP guidelines for durable implants such as Nalu/Stimwave/Stimrouter, but not SPR routinely.

The new lead should be a bit more fracture resistant, but fracture with SPR isn't a major problem even if it does occur.

Quite a few PNS approaches in use for occipital neuralgia and hopefully some on-label guidance coming from Stimwave, SPR, etc.