Abdominal Cutaneous Nerve Entrapment (ACNES) Injection

Various authors have described a technique for performing an ACNE block

Equipment

Syringe	Needle	Steroid	Local Anaesthetic	Total Volume
10mL	25G 38mm	optional 10mg triamcinolone	Clinician choice	10mL

Technique

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• First locate the point of maximal tenderness using the Carnett Sign
• Position: Supine
• Ultrasound Anatomy
  • Transverse plane in the midline at first to identify the rectus abdominis muscle and linea alba (the medial border of the rectus abdominis).
  • Move the transducer laterally to view the lateral border of the rectus abdominis and the linea semilunaris
  • The target abdominal cutaneous nerve normally exits between the rectus abdominis and linea semilunaris.
• Advance the needle lateral to medial in plane
• Aspirate to ensure needle not penetrated a blood vessel.
• Inject local anaesthetic +/- steroid around the nerve

Indications

Anterior Cutaneous Nerve Entrapment Syndrome

Risks

Infection, subcutaneous injection, allergic reaction, intravascular injection ADR from steroids

Aftercare

Advised to keep active within pain limits, and is reassessed about 10 days later. Steroid remains in situ for about 2 weeks. Up to 3-4 injections may be performed before declaring the therapy a failure.