title: 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands. o.boelens@gmail.com
authors: O B
authors: OB
authors: Boelens
authors: M R
authors: MR
authors: Scheltinga
authors: S
authors: S
authors: Houterman
authors: R M
authors: RM
authors: Roumen
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000628:therapy*; D034861:Abdominal Wall / Q000294:innervation*; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000628:therapy*; D009426:Netherlands; D012189:Retrospective Studies; D016896:Treatment Outcome; D061028:Trigger Points; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D008012:Lidocaine