Transverse Abdominal Plane Neurostimulation for Chronic Abdominal Pain: A Novel Technique

Management of chronic abdominal pain can be challenging. Sometimes patients fail to getadequate response from multiple medications and nerve blocks. We present a patient casereport of chronic abdominal pain with a history of multiple surgeries managed successfully byneuromodulation of the transverse abdominis plane (TAP).The TAP block is a procedure in which local anesthetic is injected into the abdominal fascialplane that carries sensory nerves to the abdominal wall in order to block pain sensation. It hasbeen shown to reduce postoperative pain and analgesic dependence after abdominal andgynecological surgeries.A 60-year-old woman presented to us for chronic abdominal pain for which medicationsprovided little relief. She had an extensive history of abdominal surgeries and was also treatedfor lower back pain with surgery and less invasive procedures in the past. Under our care, sheunderwent 2 TAP blocks with almost complete resolution of her abdominal pain. Her pain,however, came back within a few of weeks of the procedures.Since our patient found pain relief from the TAP blocks, we proceeded with neurostimulationof the TAP for long-term pain relief. We placed a dorsal column stimulator 16 contact lead forlower back and leg pain and 8 contact leads placed in the TAP under ultrasound guidance.She has had multiple follow-ups since her TAP lead placement procedure with continued andnear complete resolution of her abdominal pain. The TAP lead stimulation was helping herabdominal pain and the dorsal column lead stimulation was helping her back and leg pain.Key words: Chronic abdominal pain, neuromodulation, transverse abdominis plane,ultrasound, transverse abdominis plane block, multiple abdominal surgeries