Improvement in the symptoms of anterior cutaneous strangulation syndrome after ultrasound-guided m-TAPA block and trigger point block

Abstract

Anterior cutaneous nerve entrapment syndrome (ACNES) is a known cause of chronic abdominal pain. We experienced a case of ACNES improved by an ultrasound-guided block. The patient was a 41-year-old man. He had persistent pain in the upper left abdomen was diagnosed with ACNES and visited our department. Ultrasound image revealed an high-intensity region in the rectus abdominis muscle. Immediately after performing the modified thoraco abdominal nerves through perichondrial approach block (m-TAPA block), the pain improved with NRS 4 to 0/10. In addition, mepivacaine and dexamethasone was injected around the high-intensity region. No recurrence of symptoms was observed even after one and a half months. The high-intensity region in image was the strangulation part of the anterior cutaneous branch of the intercostal nerve that caused ACNES. Both ultrasound guided trigger point block and m-TAPA block were contributed to the improvement of abdominal wall pain.