Successful Ultrasound Guided Nerve Block for Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES)
Background:
A 65-year-old female presented with chronic left-sided lower abdominal pain, which had persisted for more than two years following a Spigelian hernia repair with mesh. Her pain was constant, worsened when lying down, and she experienced a pulling sensation in her left groin. The pain was also aggravated by standing and walking, severely affecting her function and mood.
Clinical History:
The patient underwent several investigations to identify the cause of her pain. An MRI scan of the abdomen with contrast revealed no ongoing pathology, and an MRI scan of the lumbar spine showed scoliosis with left L1 nerve root compression, although this did not explain the abdominal pain. Additionally, an abdominal ultrasound showed no evidence of hernia recurrence.
She had previously seen a pain clinician who performed a rectus sheath block, but this provided minimal relief. Her past medical history included gallstones and COPD. Despite being prescribed amitriptyline, an anti-neuropathic medication, she did not experience any pain relief and continued to struggle with her symptoms.
Diagnosis:
The patient was referred to Dr. Krishna at Pain Spa in Bristol, where he reviewed her case in detail. Dr. Krishna suspected that her pain was likely originating from the abdominal wall, rather than internal viscera, and made a provisional diagnosis of abdominal cutaneous nerve entrapment syndrome (ACNES), a condition caused by entrapment of the abdominal wall nerves.
Treatment:
Dr. Krishna discussed the treatment options with the patient, and they decided to proceed with an ultrasound-guided injection targeting the abdominal cutaneous nerve on the left side, at the level of her pain. The procedure was performed with precision, and the patient reported excellent pain relief immediately following the injection, confirming the diagnosis of ACNES.
Outcome:
At her 6-month follow-up, the patient remained completely pain-free and had regained normal function. She was able to stop all her medications and reported significant improvements in her quality of life. Dr. Krishna also discussed the option of pulsed radiofrequency ablation of the nerve, should the pain return in the future.
Discussion:
This case highlights the importance of correctly diagnosing and treating abdominal cutaneous nerve entrapment syndrome (ACNES), which can mimic other causes of abdominal pain but is often underdiagnosed. Ultrasound-guided nerve blocks, particularly for the abdominal cutaneous nerve, are technically challenging and should only be performed by physicians with formal training in ultrasound-guided procedures. Dr. Krishna’s expertise in ultrasound-guided interventions was instrumental in achieving a successful outcome for this patient.
Conclusion:
Following Dr. Krishna’s precise intervention, the patient experienced long-lasting pain relief and was able to discontinue her medications, regaining her functional ability. This case underscores the value of ultrasound-guided nerve blocks in managing abdominal wall pain when conventional treatments have failed.
For more information or to discuss treatment options, please contact Pain Spa at clinic@painspa.co.uk.
https://www.painspa.co.uk/procedure/abdominal-cutaneous-nerve-block/