Yukiko Saito, Joho Tokumine, Ryuji Sawada, Kunitaro Watanabe, Tomoko Yorozu, Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
Hirohisa Takeuchi, Department of Surgery, Kyorin University School of Medicine, Tokyo 181-8611, Japan
Author contributions: Saito Y, Takeuchi H, and Tokumine J helped in writing the original draft; Takeuchi H and Tokumine J helped in the conceptualization of the case report; Sawada R and Watanabe K helped in the literature acquisition; Yorozu T helped with literature acquisition and data validation; all authors have read and agreed to the published version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Joho Tokumine, MD, PhD, Professor, Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Tokyo 181-8611, Japan. ii36469@wa2.so-net.ne.jp
Received: March 27, 2024 Revised: July 17, 2024 Accepted: July 23, 2024 Published online: August 27, 2024 Processing time: 142 Days and 8 Hours
Abstract
BACKGROUND
Anterior cutaneous nerve entrapment syndrome (ACNES) is a condition manifesting with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves. This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.
CASE SUMMARY
A 66-year-old woman manifested ACNES after a robot-assisted distal gastrectomy. An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar. However, the sudden severe pain, which radiated laterally from the previous site, remained. A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.
CONCLUSION
In this case, the trocar port was inserted between the rectus and transverse abdominis muscles. The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles. Hence, rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief. To the best of our knowledge, this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.
Core Tip: Anterior cutaneous nerve entrapment syndrome (ACNES) is defined as chronic abdominal wall pain caused by entrapment of cutaneous branches of lower thoracoabdominal intercostal nerves. In the present report, ACNES after a robot-assisted distal gastrectomy was successfully treated with a combination of ultrasound-guided rectus sheath and transverse abdominis plane blocks. Peripheral nerve block should be selected based on the extent and degree of adhesions causing ACNES.
