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Case Series
Treatment of anterior cutaneous nerve entrapment syndrome using an ultrasound-guided transverse abdominis plane block
1 Northern Health, 185 Cooper Street, Epping, Victoria 3076, Australia
2 Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
3 Central Gippsland Health, 155 Guthridge Parade, Sale, Victoria 3850, Australia
Address correspondence to:
Amar Lakhani
Austin Health, 145 Studley Road, Heidelberg, Victoria 3084,
Australia
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Article ID: 100118Z12AL2023
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Lakhani A, Strauss P, Wasserman H. Treatment of anterior cutaneous nerve entrapment syndrome using an ultrasound-guided transverse abdominis plane block. J Case Rep Images Surg 2023;9(1):13–16.ABSTRACT
Introduction: Anterior cutaneous nerve entrapment syndrome (ACNES) is increasingly being considered to be a common cause of abdominal pain. Unfortunately, ACNES is a condition that is frequently overlooked and misdiagnosed resulting in chronic abdominal wall pain, unnecessary investigations, procedures, and repeat admissions. Patients diagnosed with ACNES present with well-localized abdominal pain, a positive Carnett’s sign, somatosensory disturbance of the surrounding skin and symptomatic relief secondary to a trigger point injection. Current treatment strategies include modification of physical activity, simple analgesia, trigger point injections, chemical neurolysis, pulsed radiofrequency, and anterior neurectomy. Despite the plethora of treatment modalities, it is evident that a majority of patients will only experience temporary pain relief.
Case Series: We describe two cases in which ultrasound-guided transverse abdominal plane blocks have successfully provided long-term symptomatic relief in patients diagnosed with ACNES. The first being a 45-year-old female and the second is a 52-year-old male who both presented with ACNES which were successfully treated with an ultrasound-guided transverse abdominal plane (TAP) block with 20 mL of 0.25% Marcaine and 4 mg of Dexamethasone.
Conclusion: We provide evidence supporting the use of an ultrasound-guided TAP block for long-term symptomatic relief in patients with ACNES. However, further research is required to assess its efficacy.
Keywords: Anterior cutaneous nerve entrapment syndrome, Chronic abdominal pain, Ultrasound-guided transverse abdominal plane block
SUPPORTING INFORMATION
Author Contributions
Amar Lakhani - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paul Strauss - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Henry Wasserman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Amar Lakhani et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
