Efficacy of treating abdominal wall pain by local injection.
OBJECTIVE
When a patient's chief complaint is lower abdominal pain, but physical and ultrasonic examinations and laboratory tests show no evidence of any noticeable disease, physicians may make a wrong diagnosis, such as abdominal adhesion, chronic pelvic inflammatory disease, pelvic congestion and even psychosomatic disorders. In actuality, the pain may originate from the abdominal wall instead of the viscera. Local anesthetics coupled with steroid injections not only effectively alleviate the pain but also means that laparoscopy and medication can be avoided and is thereby worthy of wide use. Here, we present the results for the treatment of abdominal wall pain by local injection.


METHODS
Between January 1994 and December 2005, we treated 211 abdominal wall pain patients. Diagnoses were based on the pressure of the abdominal wall tender point, which elicited sharp shooting pain during compression, and presence of positive Carnett's sign. After confirmation of the trigger point, a fine needle was used to inject a mixture of 0.5% bupivacaine 2 mL, 2% lidocaine 3 mL and 4 mg betamethasone 1 mL. The patients were examined on a weekly basis and underwent reinjection if symptoms recurred.


RESULTS
There were 71 patients who were lost to or refused treatment or follow-up; the 140 remaining patients were evaluated. After trigger point injection in these patients, 95 (67.9%) reported no pain at all after treatment. Forty-five (32.1%) patients still had abdominal pain and required a second injection. A total of 133 (95%) patients showed complete pain resolution. After 3 months of follow-up, 115 (86.5%) patients remained free of abdominal pain.


CONCLUSIONS
Local injection for selective abdominal wall pain patients produces significant pain relief. The diagnosis of abdominal wall pain is an important component in avoiding unnecessary operations in patients with abdominal pain.
Kuan
Long-Ching
LC
Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan.
Li
Yiu-Tai
YT
Chen
Fu-Min
FM
Tseng
Chia-Jung
CJ
Wu
Shu-Fang
SF
Kuo
Tsung-Cheng
TC
D015746:Abdominal Pain / Q000188:drug therapy*; D034861:Abdominal Wall; D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011247:Pregnancy; D012189:Retrospective Studies
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine