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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• Position: Supine
• Ultrasound: Transverse plane, identify linea alba - the medial border of the rectus abdominis. Move laterally to find the linea semilunaris.
• Advance needle lateral to medial, entering approximately 0.5–1 cm medial to the hyperechoic semilunaris, reaching the abdominal cutaneous nerve exist.
• Aspirate to ensure needle not penetrated a blood vessel.
• Inject local anaesthetic +/- steroid.

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.