title: Perforator-Guided Drug Injection in the Treatment of Abdominal Wall Pain.
abstract: Pain from the abdominal wall can be caused by nerve entrapment, a condition called abdominal cutaneous nerve entrapment syndrome (ACNES). As an alternative to surgery, ACNES may be treated with injection of local anesthetics, corticosteroids, or botulinum toxin at the point of maximal pain.
  
  
  
  The point of maximal pain was marked on the abdominal skin. Using color Doppler ultrasound, the corresponding exit point of perforating blood vessels through the anterior fascia of the rectus abdominis muscle was identified. Ultrasound-guided injection of botulinum toxin in close proximity to the perforator's exit point was performed below and above the muscle fascia.
  
  
  
  The technique was used from 2008 to 2014 on 15 patients in 46 sessions with a total of 128 injections without complications. The injection technique provided safe and accurate administration of the drug in proximity to the affected cutaneous nerves. The effect of botulinum toxin on ACNES is beyond the scope of this article.
  
  
  
  Perforator-guided injection enables precise drug administration at the location of nerve entrapment in ACNES in contrast to blind injections.
authors.affiliation: *Medical Imaging Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Radiology; sven.weum@unn.no.
authors.forename: Sven
authors.initials: S
authors.lastname: Weum
authors.affiliation: *Medical Imaging Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Plastic Surgery and Hand Surgery at University Hospital of North Norway, Tromsø, Norway.
authors.forename: Louis
authors.initials: L
authors.lastname: de Weerd
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology; D034861:Abdominal Wall; D001905:Botulinum Toxins / Q000008:administration & dosage*; D006801:Humans; D009408:Nerve Compression Syndromes / Q000150:complications / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins
keywords: Abdominal Cutaneous Nerve Entrapment Syndrome; Abdominal Wall Pain; Perforator Anatomy; Ultrasound-Guided Injection