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

Abstract

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.

Unexplained abdominal pain in pregnancy and the use of the term ‘Round Ligament Pain’: a single-centre New Zealand pilot cohort study

“…Accurately placed local anaesthetic injections give immediate, substantial pain relief to over 75% of patients with AWP, often for prolonged periods of time(8). The topic is frequently discussed in publications related to gastroenterology, paediatrics, pain, emergency medicine and general surgery(8, 13, [17][18][19][20][21][22][23][24]. This study suggests that AWP is relevant for obstetric patients too.…”

“…The value of identifying AWP lies not in the semantics of naming the correctly affected nerves, but rather in its therapeutic potential. In the non-pregnant community, AWP is routinely treated with TAP blocks, trigger point injections with steroid, chemical neurolysis and surgical neurectomies (24,25). The opportunities for these therapies to apply to pregnant patients abound.…”

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

“…Para el tratamiento del ACNES en la edad pediátrica se barajan dos estrategias: -La utilización de inyecciones en el punto gatillo con un agente anestésico local. 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 .…”

“…Al tratarse de un niño con poca grasa abdominal consideramos que la técnica guiada por ecografía podría facilitar la visualización de la aguja y aumentar la precisión durante el procedimiento. -La neurectomía anterior 8 . Como primera estrategia de tratamiento, su éxito oscila entre el 78 y el 100% con una duración de seguimiento de cuatro semanas a 36 meses, según las series 3,5,[10][11][12] .…”

Conservative treatment for an anterior cutaneous nerve entrapment syndrome case

“…4 In most case series, block treatment was completed after one to four times and was changed to surgery. 2 We performed six block injections; however, the analgesic effect was enhanced with each block treatment. Anterior cutaneous nerve entrapment syndrome develops in approximately 74-92% of female pediatric patients, 2 and the recurrence rate after neurectomy is as high as 42%.…”