Use of Targeted Transversus Abdominus Plane Blocks in Pediatric Patients with Anterior Cutaneous Nerve Entrapment Syndrome

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlookedsource of chronic abdominal wall pain. A diagnosis of ACNES should be consideredin cases of severe, localized abdominal pain that is accentuated by physical activity.Providers should consider diagnosing ACNES once a patient has both a positive resultfrom a Carnett’s test and precise localization of pain. We describe the use of transversusabdominus plane (TAP) blocks to treat ACNES in the pediatric patient population. TAPblocks are a treatment modality which have been described less frequently in themanagement of this syndrome, with rectus sheath blocks being used more commonly.TAP blocks can be used effectively for ACNES by targeting the site of maximaltenderness, which was identified using ultrasound guidance. Moreover, TAP blocks arean attractive procedure option for ACNES as they are less invasive than other commonlyused techniques. We present 3 case series reports of pediatric patients evaluated at ourinstitution for severe abdominal pain to describe the clinical manifestations, sequelae,and outcome of ACNES. Though the exact incidence of ACNES in the pediatricpopulation is unknown, this condition has significant implications from chronic pain.Chronic pain can lead to significant emotional and social impacts on these pediatricpatients, as well as their on their families. Further, the extensive utilization of healthcare resources is impacted when children with undiagnosed ACNES undergo invasivetreatments when ACNES is not in the early differential. The purpose of this case seriesreport is to prompt better recognition of the condition ACNES, and to highlight theefficacy of TAP blocks as a management strategy.Key words: TAP block, pediatric patients, abdominal pain, ACNES