Chronic Abdominal Wall Pain and Ultrasound-Guided Abdominal Cutaneous Nerve Infiltration: A Case Series

Kanakarajan, Saravanakumar; High, Kristina; Nagaraja, R.

doi:10.1111/j.1526-4637.2011.01056.x

Cited by 54 publications

(42 citation statements)

References 6 publications

(4 reference statements)

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“…These results were confirmed in a volunteer study where a nerve stimulator was used [3]. In a series of 20 patients with meralgia paresthetica, all had resolution of their symptoms within 2 weeks of injection; however, four patients required repeat injections at 1 week [73] • • Other US-guidance has also been described for injections of the ganglion of impar [75], pudendal nerves [76] and abdominal cutaneous nerves [77]. These studies demonstrated feasibility of the methods rather than superiority of the technique.…”

Section: • Lateral Femoral Cutaneous Nervesupporting

confidence: 57%

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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Section: • Lateral Femoral Cutaneous Nervesupporting

confidence: 57%

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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“…The main advantages of the ultrasound-guided blocks are the accuracy of injections and the reduction of risk since the injection is performed in real time. Kanakarajan et al5 published a case series of nine patients suffering from ACNES who were diagnosed by clinical symptoms combined with a positive Carnett’s sign. All patients were treated with an ultrasound-guided infiltration of the abdominal cutaneous nerves at the site of maximum tenderness and the lateral border of the rectus abdominis muscle.…”

Section: Ultrasound-guided Blocksmentioning

confidence: 99%

“…Anatomically, the lower intercostal nerves (T8–T12) run between the internal oblique and transversus abdominis muscles, up to the point where they reach the rectus abdominis; here, they make a turn in their course to enter the rectus channels (commonly five at each abdominal side) 5,6. Some authors have suggested that the entrapment is usually caused by this sudden turn in their course into the rectus abdominis channel, leading to ACNES 1,7.…”

Section: Introductionmentioning

confidence: 99%

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Anterior cutaneous nerve entrapment syndrome: management challenges

Chrona¹,

Kostopanagiotou²,

Damigos³

et al. 2017

JPR

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Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly underdiagnosed and undertreated chronic state of pain. This syndrome is characterized by the entrapment of the cutaneous branches of the lower thoracoabdominal intercostal nerves at the lateral border of the rectus abdominis muscle, which causes severe, often refractory, chronic pain. This narrative review aims to identify the possible therapeutic strategies for the management of the syndrome. Seventeen studies about ACNES therapy were reviewed; of them, 15 were case–control studies, case series, or case reports, and two were randomized controlled trials. The presently available management strategies for ACNES include trigger point injections (diagnostic and therapeutic), ultrasound-guided blocks, chemical neurolysis, and surgical neurectomy, in combination with systemic medication, as well as some emerging techniques, such as radiofrequency ablation and neuromodulation. An increased awareness of the syndrome and the use of specific diagnostic criteria for its recognition are required to facilitate an early and successful management. This review compiles the proposed management strategies for ACNES.

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“…C hronic abdominal and flank pain can be multifactorial 1 and difficult to treat. Loin pain hematuria syndrome (LPHS) is a rare clinical cause of chronic abdominal and flank pain and is a diagnosis of exclusion.…”

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confidence: 99%

A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves

Moeschler

Hoelzer

Eldrige

2013

The Clinical Journal of Pain

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LPHS is a difficult clinical scenario to diagnose and treat. Conservative options are often unsuccessful, but the more extreme interventions such as renal autotransplantation and nephrectomies are invasive and not always effective. In this case report, we describe the novel use of PRF to the splanchnic nerves as an alternative treatment modality for patients with LPHS.Although the exact mechanism of action of PRF on nerve tissue is unclear, its indication in pain management requires further research and discussion. Our patient experienced substantial and sustained relief of his flank pain. PRF may be a viable option for patients with LPHS.

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Chronic Abdominal Wall Pain and Ultrasound-Guided Abdominal Cutaneous Nerve Infiltration: A Case Series

Abstract: Ultrasound can reliably be used for infiltration of the abdominal cutaneous nerves. This will improve the safety as well as diagnostic utility of the procedure.

Cited by 54 publications

References 6 publications

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Anterior cutaneous nerve entrapment syndrome: management challenges

A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves

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