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Management strategies for anterior cutaneous nerve entrapment syndrome: a scoping review
Annabelle De Troyer1, Frederik Berrevoet2, Mathias Allaeys2
1Department of General Surgery, ZAS Augustinus and ZAS Vincentius, Antwerp, 2610, Belgium. Annabelle.detroyer@gmail.com.
Purpose:
Chronic Abdominal Wall Pain (CAWP) covers a broad spectrum of abdominal wall-related disorders, with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) being the most prevalent. Treatment strategies in published literature are limited and often not clearly outlined. This scoping review aims to outline current available literature about the management of ACNES, focusing on trigger point injections (TPI), pulsed radiofrequency (PRF) and surgical neurectomy.
Methods:
A systematic search in PubMed and EMBASE was performed until December 2024, in compliance with PRISMA guidelines. Articles concerning treatment for ACNES in adult patients were eligible. Data was collected on patient-reported outcomes using Numeric Rating Scale (NRS), Verbal Rating Scale (VRS) and EQ-5D-5 L scale. Success rate was determined as ≥ 50% NRS reduction and/or ≥ 2-point VRS reduction.
Results:
A comprehensive search identified 18 records containing 3007 patients eligible for inclusion, including 7 randomized controlled trials (RCTs), 9 retrospective cohort studies and 2 retrospective case series. TPI has been considered as first step in the management of ACNES, offering both a diagnostic tool and a long-term success rate of 30%. PRF, as minimally invasive technique, tends to have a successful outcome in 20% with only a median temporary effect of 4 months. Surgical neurectomy provides long-term pain relief in 61%. Secondary surgery with anterior re-exploration or posterior neurectomy is long-term beneficial in 66% of refractory ACNES patients. The success rate for recurrent pain is significantly higher compared to residual pain after primary neurectomy.
Conclusion:
TPI, PRF and neurectomy are the cornerstones of ACNES treatment, often used in a three-step treatment algorithm. With an accurate diagnosis of ACNES, surgical neurectomy provides the best long-term effect on pain reduction. Future studies should standardize outcome measures, directing for a standardized step-up treatment algorithm in collaboration with pain specialists.
