Percutaneously Inserted Continuous Peripheral Nerve Block Catheter as a Novel Minimal Invasive Treatment of Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Pilot Study to Assess Efficacy of This Novel Treatment

Percutaneously Inserted Continuous Peripheral Nerve Block Catheter as a Novel Minimal Invasive Treatment of Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Pilot Study to Assess Efficacy of This Novel Treatment

Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is an often overlooked and under diagnosed medical condition characterized by abdominal wall pain. The cause is supposedly an entrapment of one of the cutaneous branches of the intercostal nerves in the abdominal fascia. Treatment options are restricted to pain killers, infiltration with local anaesthetics and operative neurectomy. The use of a percutaneously inserted peripheral block catheter could be a useful minimal invasive treatment strategy for patients suffering from ACNES if medication and infiltration are unsuccessful. Methods: We report our first series of ten patients suffering from ACNES, who were treated with an ultrasound guided, percutaneously inserted peripheral block in the retro-rectus space at the level where the corresponding intercostal nerve was anticipated The procedure was performed in an outpatient setting. Results: Following the insertion of a percutaneous retrorectus catheter and three days of local anaesthetic infiltration, a significant proportion of these patients reported a reduction in pain. Six out of ten patients derived sufficient benefit from this treatment 14 days and six months after catheter placement, thus eliminating the need for operative treatment. Conclusions: Percutaneous inserted, ultrasound guided catheter placement seems to result in adequate short-term and long-term pain reduction in a significant proportion of patients suffering from ACNES. Up until now, surgery seemed the only viable treatment for patients suffering from ACNES who did not respond to conservative treatment. Using this minimal invasive percutaneous technique, over 50% of patients might be offered a definitive treatment, thus preventing surgical treatment.

Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is an often overlooked and under diagnosed medical condition characterized by abdominal wall pain. The cause is supposedly an entrapment of one of the cutaneous branches of the intercostal nerves in the abdominal fascia. Treatment options are restricted to pain killers, infiltration with local anaesthetics and operative neurectomy. The use of a percutaneously inserted peripheral block catheter could be a useful minimal invasive treatment strategy for patients suffering from ACNES if medication and infiltration are unsuccessful. Methods: We report our first series of ten patients suffering from ACNES, who were treated with an ultrasound guided, percutaneously inserted peripheral block in the retro-rectus space at the level where the corresponding intercostal nerve was anticipated The procedure was performed in an outpatient setting. Results: Following the insertion of a percutaneous retrorectus catheter and three days of local anaesthetic infiltration, a significant proportion of these patients reported a reduction in pain. Six out of ten patients derived sufficient benefit from this treatment 14 days and six months after catheter placement, thus eliminating the need for operative treatment. Conclusions: Percutaneous inserted, ultrasound guided catheter placement seems to result in adequate short-term and long-term pain reduction in a significant proportion of patients suffering from ACNES. Up until now, surgery seemed the only viable treatment for patients suffering from ACNES who did not respond to conservative treatment. Using this minimal invasive percutaneous technique, over 50% of patients might be offered a definitive treatment, thus preventing surgical treatment.