Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children

Siawash, Murid; Mol, Frédérique M U; Tjon-A-Ten, Walther; Perquin, Christel W.; Eerten, Percy van; Heurn, Ernst van; Roumen, R. M. H.; Scheltinga, Marc R.

doi:10.1111/pan.13084

Cited by 18 publications

(18 citation statements)

References 19 publications

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“…Interestingly, two‐thirds of our patients reported more than 50% pain reduction for more than 4 weeks after diagnostic blocks. Siawash et al reported this phenomenon in patients with anterior cutaneous nerve entrapment and treated with anterior rectus sheath blocks. A possible explanation could be the interruption of the vicious circle of pain with a reset of the pain processing system .…”

Section: Discussionmentioning

confidence: 96%

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

Vega

Rivera

Echevarría

et al. 2018

Pediatric Anesthesia

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Summary Background Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non‐cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. Aims The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non‐cancer pain in the setting of a multidisciplinary pain treatment program. Methods We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short‐term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4 weeks. Long‐term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6 months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6 months after the last procedure. Results Seventy‐six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4 weeks after the procedure. One hundred and sixty‐six of 202 therapeutics blocks (82%) were associated with a short‐term benefit. Seventy‐two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6 months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. Conclusion The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.

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Section: Discussionmentioning

confidence: 96%

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

Vega

Rivera

Echevarría

et al. 2018

Pediatric Anesthesia

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“…Another explanation might be the use of ultrasound-guided injections instead of free-hand technique. An ultrasound-guided technique allows for a more accurate injection of the anesthetic agent, although short-term and long-term pain relief in adults did not differ between both techniques in lowquality studies [19,25,[34][35][36]. However, the ultrasound-guided technique might be useful to use in the pediatric population.…”

Section: Discussionmentioning

confidence: 98%

“…Initially, the preferred nonsurgical treatment is one or multiple injections with a local anesthetic agent (e.g. lidocaine or bupivacaine) into the trigger point, with or without corticosteroids and with or without ultrasound guidance [11,12,16,17,[24][25][26][27]. Surgical treatment, consisting of a neurectomy, should be considered if multiple injections with a local anesthetic agent are only successful for a short period of time [11,17,[19][20][21][22][23]28,29].…”

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confidence: 99%

Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review

Markus

Sibbing

Ket

et al. 2021

Journal of Pediatric Surgery

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Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence. Method: A literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (b18 years old) with ACNES with a follow-up duration of at least four weeks were included. Results: Six studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months. Conclusion: A step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain. Level of evidence: II.

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“…Se han utilizado las inyecciones subfasciales guiadas por ecografía con 40 mg de lidocaína al 1% y 4 mg de dexametasona, y las inyecciones con 50 mg de lidocaína al 1% utilizando la técnica de manos libres y agregando 40 mg de metilprednisolona si se necesita tratamiento adicional [3][4][5][6][7][8][9] . El éxito de este tratamiento (con un número de inyecciones por paciente entre uno y siete) oscila entre el 38 y el 87% con una duración de seguimiento de cuatro semanas a 39 meses, según las series 3,5,9 . En nuestro caso optamos como primera estrategia de tratamiento por la inyección subfascial guiada por ecografía con 40 mg de lidocaína al 1% y 4 mg de dexametasona.…”

Section: Discussionunclassified

Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children

2021

An Sist Sanit Navar

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Resumen El síndrome de atrapamiento del nervio cutáneo anterior (ACNES) con frecuencia no se tiene presente en el diagnóstico diferencial del dolor abdominal crónico (DAC). Presentamos el caso de un varón de 11 años con DAC estudiado previamente en servicios de urgencia y digestivo sin detectar patología orgánica, sugiriéndose un origen psicosomático. En la exploración mostró dolor en la pared abdominal localizado en el área de la rama terminal del nervio intercostal T11, con signo de Carnett positivo y respuesta favorable a la inyección con anestésico local en el punto gatillo. Los potenciales evocados somatosensoriales revelaron neuropatía del nervio del músculo recto anterior derecho. Se diagnosticó de ACNES. Como tratamiento se administró en el punto gatillo una inyección subfascial ecoguiada de lidocaína y dexametasona. Tras cuatro meses, permanece asintomático. Para el tratamiento de ACNES en población pediátrica, recomendamos una estrategia terapéutica escalonada comenzando con inyecciones en el punto gatillo y reservar la neurectomía anterior para cuando estas fracasan.

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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: 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.

Cited by 18 publications

References 19 publications

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review

Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children

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