Use of Targeted Transversus Abdominus Plane Blocks in Pediatric Patients with Anterior Cutaneous Nerve Entrapment Syndrome

Abstract

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers should consider diagnosing ACNES once a patient has both a positive result from a Carnett’s test and precise localization of pain. We describe the use of transversus abdominus plane (TAP) blocks to treat ACNES in the pediatric patient population. TAP blocks are a treatment modality which have been described less frequently in the management of this syndrome, with rectus sheath blocks being used more commonly. TAP blocks can be used effectively for ACNES by targeting the site of maximal tenderness, which was identified using ultrasound guidance. Moreover, TAP blocks are an attractive procedure option for ACNES as they are less invasive than other commonly used techniques. We present 3 case series reports of pediatric patients evaluated at our institution for severe abdominal pain to describe the clinical manifestations, sequelae, and outcome of ACNES. Though the exact incidence of ACNES in the pediatric population is unknown, this condition has significant implications from chronic pain. Chronic pain can lead to significant emotional and social impacts on these pediatric patients, as well as their on their families. Further, the extensive utilization of health care resources is impacted when children with undiagnosed ACNES undergo invasive treatments when ACNES is not in the early differential. The purpose of this case series report is to prompt better recognition of the condition ACNES, and to highlight the efficacy of TAP blocks as a management strategy. Key words: TAP block, pediatric patients, abdominal pain, ACNES

Three Subtypes of Cutaneous Nerve Entrapment Syndrome: A Narrative Review

“…Examinations Numerous patients were accurately diagnosed within a short timeframe, thereby avoiding superfluous tests, when the physicians possessed sufficient expertise in the symptomatic manifestations of ACNES. However, during a prolonged disease course, patients are often subjected to various examinations, including blood tests, abdominal ultrasound, computed tomography (sometimes with contrast), magnetic resonance imaging or angiography, upper and lower endoscopies, gynecological examinations, and, in some cases, even more invasive tests, such as surgical procedures (28,30). ACNES is a disease that does not show any abnormal findings on these examinations; therefore, there have been several cases in which patients were suspected of having a somatic symptom disorder or were referred to a psychiatrist during the long course of their illness (Table 2) (31)(32)(33).…”

How Do We Treat Children with Anterior Cutaneous Nerve Entrapment Syndrome and Is the Biopsychosocial Model Also Being Applied? A Scoping Review

“…Markus et al conducted a review on the efcacy of neurectomy and trigger point injections in children [6]. Other authors have presented various techniques for peripheral nerve blocks, such as transversus abdominal plane (TAP) block [7][8][9][10]. Despite the multitude of patients undergoing treatment for ACNES, there is a notable absence of evidence-based guidelines on how to manage these cases.…”

Novel Implantation Technique for Thoracoabdominal Peripheral Nerve Stimulation via a Transversus Abdominal Plane Approach for Treatment of Chronic Abdominal Pain

“…5 The transversus abdominis plane (TAP) block has been popularized for the management of CAP. [6][7][8][9] Indicated conditions have varied from chronic post-operative abdominal pain, anterior cutaneous entrapment syndrome, and chronic neuropathic abdominal pain. Although effective, there exists a patient population for whom repeated blocks are not desired or the efficacy of TAP blocks is short lived, and a more permanent treatment approach, such as neuromodulation, is desired.…”