| Autor: |
Mol FMU; Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Veldhoven, The Netherlands., Jansen CH; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Veldhoven, The Netherlands.; Department of Surgery, Máxima Medical Center, P. O. Box 7777, 5500 MB Veldhoven, The Netherlands, Phone: +31 40 8886230., Boelens OB; Department of Surgery, Pantein Hospital Boxmeer, Beugen, The Netherlands., Stronks DL; Center of Pain Medicine, Erasmus Medical Center, Rotterdam, The Netherlands., Eerten PV; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Veldhoven, The Netherlands.; Department of Surgery, Máxima Medical Center, P. O. Box 7777, 5500 MB Veldhoven, The Netherlands, Phone: +31 40 8886230., Huygen FJPM; Center of Pain Medicine, Erasmus Medical Center, Rotterdam, The Netherlands., Scheltinga MR; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Veldhoven, The Netherlands.; Department of Surgery, Máxima Medical Center, P. O. Box 7777, 5500 MB Veldhoven, The Netherlands, Phone: +31 40 8886230., Roumen RM; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Veldhoven, The Netherlands.; Department of Surgery, Máxima Medical Center, P. O. Box 7777, 5500 MB Veldhoven, The Netherlands, Phone: +31 40 8886230. |
| Abstrakt: |
Background and aims Anterior cutaneous nerve entrapment syndrome (ACNES) may result in chronic abdominal pain. Therapeutic options include local injection therapy. Data on the efficacy of adding corticosteroids to these injections is lacking. Methods Patients ≥18 years with ACNES were randomized to receive an injection of lidocaine with (LC-group) or without (LA-group) the addition of methylprednisolone into the point of maximal abdominal wall pain. Pain was recorded using a numeric rating scale (NRS: 0-10) and a verbal rating scale (VRS: 0=no pain, 5=unbearable pain) at baseline and 6 weeks after the start of a bi-weekly injection regimen consisting of a total of three injections. A minimal 50% reduction on NRS and/or two points on VRS were considered successful responses. Results Between February 2014 and August 2016, 136 patients (median age 46 year, range 18-79, 75% females) were randomized (68 vs. 68). The proportion of patients demonstrating a successful response after 6 weeks did not significantly differ between groups (LA 38%, LC 31%, p=0.61). At 12 weeks, the number of patients still experiencing a minimal 50% pain relief had decreased but no group difference was observed (LA 20%, LC 18%, p=0.80). Minor side effects included temporary increase of pain, tenderness at injection sites or transient malaise (LA23/68, LC 29/68, p=0.46). Conclusions Adding corticosteroids to a lidocaine does not increase the proportion of ACNES patients with a successful response to injection therapy. Lidocaine alone can provide long term pain relief after one or multiple injections, in approximately 1 of 5 patients. |
