title: Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children.
abstract: BACKGROUND
  Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking.
  
  
  OBJECTIVE
  Our aim was to study outcome and adverse events of anterior rectus sheath blocks in childhood anterior cutaneous nerve entrapment syndrome.
  
  
  METHODS
  Patients <18 years of age receiving anterior rectus sheath blocks were prospectively followed. Injections were administered using a free-hand technique in the outpatient department.
  
  
  RESULTS
  A total of 85 children were included (median age 15 years, range 8-17, 76% female). Eighty-three children reported immediate pain relief following a single lidocaine block and 13 achieved long-term success. Another 19 children was successfully treated with additional blocks combined with steroids. A total 38% success ratio was attained after a median 17-month follow-up (range, 4-39). Pain intensity and diagnostic delay were not associated with a beneficial outcome. However, young age predicted success. An infrequently occurring adverse event was temporarily increased pain some 6 h post injection.
  
  
  CONCLUSIONS
  Anterior rectus sheath blocks using local anesthetics and steroids are safe and long-term successful in more than one-third of children suffering from abdominal pain due to anterior cutaneous nerve entrapment syndrome.
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Murid
authors.initials: M
authors.lastname: Siawash
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Frederique
authors.initials: F
authors.lastname: Mol
authors.affiliation: Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Walther
authors.initials: W
authors.lastname: Tjon-A-Ten
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Christel
authors.initials: C
authors.lastname: Perquin
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Percy
authors.initials: P
authors.lastname: van Eerten
authors.affiliation: Department of Pediatric Surgery, Emma Children's Hospital AMC & VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ernst
authors.initials: E
authors.lastname: van Heurn
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Rudi
authors.initials: R
authors.lastname: Roumen
authors.affiliation: Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Scheltinga
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy*; D034861:Abdominal Wall; D000293:Adolescent; D000367:Age Factors; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D009408:Nerve Compression Syndromes / Q000150:complications*; D059408:Pain Management; D011446:Prospective Studies; D012867:Skin / Q000294:innervation; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D013256:Steroids; D008012:Lidocaine
keywords: anterior cutaneous nerve entrapment syndrome; children; pain; rectus sheath block; transversus abdominus plane (TAP) blocks