Management of Anterior Cutaneous Nerve Entrapment Syndrome in a Cohort of 139 Patients

Abstract

Objective: 

Anterior cutaneous nerve entrapment syndrome (ACNES) is generally neglected as a source of chronic abdominal pain. The aim of this study was to evaluate the efficacy of a diagnostic workup protocol and treatment regimen in patients with suspected ACNES.

Methods: 

A cohort of all consecutive patients presenting with chronic abdominal pain suggestive of ACNES between 2003 and 2008 was evaluated retrospectively. Patients were offered a single diagnostic injection of 1% lidocaine into the trigger point followed by subsequent therapeutic injections including corticosteroids. If pain was refractory, an anterior neurectomy was performed. Pain scores were done using a visual analog scale for evaluation of the injection regimen and Verbal Rating Scale (1–5) for long-term efficacy.

Results: 

A total of 139 patients with suspected ACNES (77% women, mean age 47 ± 17 years) were evaluated. Eighty-one percent (n = 94) demonstrated a visual analog scale reduction of at least 50% after the first injection. Some 33% (n = 44) remained permanently pain-free after injection therapy only. Sixty-nine patients underwent a neurectomy, which was successful in 49 (71%). Long-term efficacy revealed in 71% (very) satisfying visual rating scale (1–2) results, whereas an additional 9% reported attenuated levels of pain (visual rating scale 3).

Conclusion: 

A regimen of consecutive local trigger point injections is effective in one-thirds of patients with ACNES. Surgical neurectomy is effective in about two-thirds of the injection regimen refractory patients. Eighty percent of the entire ACNES population reports total or substantial pain relief on the long term.

In Brief

Anterior cutaneous nerve entrapment syndrome is a frequent cause of abdominal wall pain but often misdiagnosed. This study describes the results of a diagnostic and treatment protocol of both conservative and surgical measures.